self-reported features of borderline and schizotypal personality disorders in patients with mood
TRANSCRIPT
SELF-REPORTED FEATURES OF BORDERLINE AND SCHIZOTYPAL PERSONALITY DISORDERS IN PATIENTS WITH MOOD DISORDERS
Ilya Baryshnikov
ACADEMIC DISSERTATION To be presented, with the permission of the Faculty of Medicine, University of Helsinki, for public
examination at the HUCH Psychiatry Centre, on 7th April
Helsinki 2017
Supervisors Professor Erkki Isometsä, MD, PhD University of Helsinki, Department of Psychiatry Helsinki, Finland and Docent Grigori Joffe, MD, PhD Hospital District of Helsinki and Uusimaa, Department of Psychiatry Helsinki, Finland Reviewers Associate Professor Olli Kampman, MD, PhD University of Tampere Faculty of Medicine and Life Sciences Seinäjoki Hospital District, Department of Psychiatry and Professor Juha Veijola, MD, PhD University of Oulu, Department of Psychiatry Oulu, Finland Opponent Professor Jyrki Korkeila, MD, PhD University of Turku, department of Psychiatry Helsinki, Finland
To my family and my friends
CONTENTS
7.5
7.11
11 Abstract
Objective
Materials and Methods
Results:
r
P
Conclusions:
22 Sammandrag
Målsättningen
Material och metoder
Resultat:
Slutsatser:
.
33 Tiivistelmä
Tavoitteet:
Aineisto ja menetelmät
Tulokset:
Johtopäätökset:
44 List of original publications
55 Abbreviations
66 Introduction
77 A review of the literature
7.1 A categorical and dimensional approach to psychiatric diagnosis
77.2 Definitions of mood disorders
7.2.1 Depressive disorders
77.2.2 Bipolar disorder
77.3 Definitions of personality disorders
7.3.1 General criteria
77.3.2 Schizotypal personality disorder
7.3.3 Borderline personality disorder
77.4 The epidemiology and course of mood disorders
7.4.1 The epidemiology of bipolar disorder
77.4.2 The course of bipolar disorder
7.4.3 The epidemiology of major depressive disorders
77.4.4 The course of major depressive disorder
The epidemiology of personality disorders
77.5.1 The epidemiology of borderline personality disorder
77.5.2 The epidemiology of schizotypal personality disorder
77.6 The comorbidity of mood disorders
7.6.1 The comorbidity of bipolar disorder
Comorbidity with anxiety disorder
Comorbidity with substance-use disorder
Comorbidity with personality disorders
77.6.2 Relationships between borderline personality disorders and bipolar disorder
77.6.3 The comorbidity of major depressive disorder
Comorbidity with anxiety disorders
Comorbidity with Substance Use Disorder
Comorbidity with personality disorders
77.7 The assessment of personality disorders
7.7.1 General aspects
77.7.2 The assessment of personality disorders in patients with mood disorders
77.8 Psychotic-like experiences in patients with mood disorders
77.9 Relationships between mood disorders, and borderline and schizotypal personality
disorder
77.10 The etiology and pathogenesis of mood disorders
7.10.1 The etiology and pathogenesis of bipolar disorder
The genetics of BD
Pathophysiological mechanisms
Brain-imagining studies
Neurocognitive distortions
Psychosocial factors
77.10.2 The etiology and pathogenesis of major depressive disorder
Genetics
Pathophysiological mechanisms
Brain-imaging studies
Psychosocial factors
Cognitive bias
MDD and personality
The etiology and pathogenesis of borderline personality disorder and schizotypal
personality disorder
77.11.1 Borderline personality disorders
Genetics
Neuroimaging
Neurocognitive distortions
Childhood traumatic experiences
Attachment theory
The diathesis-stre s model of BPD
Personality models and BPD
77.11.2 Schizotypal personality disorder
77.12 The treatment of mood disorders
7.12.1 The treatment of bipolar disorder
Pharmacotherapy
Psychological treatment
7.12.2 The treatment of major depressive disorder
Psychological treatment
Pharmacotherapy
Neuromodulation and light therapies
7.13 The treatment of personality disorders
7.13.1 Borderline personality disorder
Psychological therapies
Pharmacotherapy
7.13.2 TThe treatment of Schizotypal personality disorder
Psychological treatment
Pharma otherapy
8 TThe aims of the study
99 Materials and Methods.
9.1 The Helsinki University Psychiatric Consortium
9.2 Setting
9.3 Sampling process
99.4 The patients.
BD UD Others
Number
Age
(mean+SD)
BPD
Sex (male)
Marital
state
Work
status
99.5 Clinical diagnoses
9.6 Self-report scales
9.6.1 The Mood Disorder Questionnaire (MDQ)
9.6.2 The McLean Screening Instrument (MSI)
99.6.3 The Schizotypal Personality Questionnaire-Brief form (SPQ-B)
9.6.4 Community Assessment of Psychic Experiences (CAPE-42)
9.6.5 The trauma and Distress Scale (TADS)
99.6.6 Experiences in Close Relationships – Revised (ECR-R)
9.6.7 The Short 5 (S5)
9.6.8 Beck’s Depression Inventory (BDI)
9.6.9 The Overall Anxiety Severity and Impairment Scale (OASIS)
99.7 Statistical analysis
9.7.1 Study I
9.7.2 Study II
99.7.3 Study III
9.7.4 Study IV
110 Results.
10.1 Study I: Differences and overlap in self-reported features of bipolar disorder and
borderline personality disorder
10.1.1 Scores on the self-report bipolar and borderline personality disorder scales among patients with
mood disorders
BD-I BD-II UD Others P
MDQ mean
MSI mean
MDQ positive
MDQ negative
MSI positive
MSI negative
110.1.2 Correlations between the total scores and the separate items of the self-report scales for
bipolar and borderline personality disorder
110.1.3 Exploratory factor analyses of self-report scales for bipolar and borderline personality disorders
Figure 2 Exploratory factor analysis of MDQ and MSI-scales.
110.2 Study II Differences between and overlap in the self-reported features of schizotypal and
borderline personality disorder
10.2.1 Total scores of the self-report scales
10.2.2 Dimension-by-dimension correlations between the self-report scales
110.2.3 Item-by-dimension correlations between the self-report scales
110.2.4 Item-by-item correlations between the self-report scales
r
110.2.5 Hierarchical Multivariate Regression (HMR) analysis with MSI and SPQ-B
10.3 Study III. Self-reported psychotic-like experiences in patients with mood disorders
10.3.1 The prevalence and distributions of psychotic-like symptoms among patients with mood
disorders
.
CAPE
-42
posi
tive
dim
ensi
on’s
item
s
BD-1
n (%
)
n=36
BD-2
n (%
)
n=63
UD
n (%
)
n=18
3
Mea
ns (S
D)
hint
s ab
out y
ou o
r th
ings
wit
h
doub
le m
eani
ng
thin
gs i
n m
agaz
ines
wri
tten
espe
cial
ly fo
r yo
u
som
e pe
ople
ar
e no
t w
hat
they
see
m to
be
you
are
bein
g pe
rsec
uted
in
som
e w
ay
ther
e is
a c
onsp
irac
y ag
ains
t
you
you
are
dest
ined
to
be
som
eone
ver
y im
port
ant
you
are
a ve
ry
spec
ial
or
unus
ual p
erso
n
peop
le
can
com
mun
icat
e
tele
path
ical
ly
elec
tric
dev
ices
can
influ
ence
the
way
you
thin
k
you
belie
ve i
n th
e po
wer
of
wit
chcr
aft,
vood
oo
or
the
occu
lt
peop
le
look
at
yo
u od
dly
beca
use
of y
our
appe
aran
ce
thou
ghts
in
yo
ur
head
ar
e
bein
g ta
ken
away
thou
ghts
in y
our
head
are
not
your
ow
n
so
vivi
d th
ough
ts
that
yo
u
wer
e w
orri
ed o
ther
peo
ple
wou
ld h
ear
them
your
ow
n th
ough
ts h
ave
been
echo
ed b
ack
to y
ou
you
are
unde
r th
e co
ntro
l of
som
e fo
rce
or p
ower
you
hear
voi
ces
whe
n yo
u ar
e
alon
e
you
hear
vo
ices
ta
lkin
g to
each
oth
er
A do
uble
had
tak
en t
he p
lace
of a
fam
ily m
embe
r, fr
iend
or
acqu
aint
ance
you
see
obje
cts
, pe
ople
or
anim
als
that
ot
her
peop
le
cann
ot s
ee
110.3.2 Item-by-item correlations between the self-report scales for PEs and mood disorders
-
-
-
-
-
10.3.3 Hierarchical multiple regression predicting the frequency of psychotic-like symptoms in
patients with mood disorders
110.4 Study IV. Relationships among self-reported childhood traumatic experiences (TEs),
attachment styles, neuroticism and BPD features in patients with mood disorders
10.4.1 Total scores on the self-report scales (TADS; ECR-R and S5) among patients with mood disorders
TAD
S it
em
Nev
er n
(%)
Rare
ly n
(%)
Som
etim
es
n(%
)
Oft
en n
(%)
Alw
ays
n(%
) M
ean
(SD
1 )2
I fel
t saf
e an
d pr
otec
ted
I was
oft
en h
ungr
y
I was
bul
lied
at s
choo
l
I oft
en h
ad to
wea
r ra
gged
or
dirt
y cl
othe
s
I fel
t val
ued
or im
port
ant
My
pare
nts
wer
e of
ten
drun
k, s
tone
d or
was
ted
I hav
e be
en b
ullie
d at
wor
k
My
fam
ily w
as e
mot
iona
lly w
arm
and
lovi
ng
I was
hit
so
hard
that
it le
ft m
arks
, cut
s or
bru
ises
I fel
t rej
ecte
d by
my
pare
nts
Ther
e w
as a
n ad
ult I
cou
ld c
onfid
e in
I was
hum
iliat
ed b
y pe
ople
in m
y fa
mily
Mem
bers
in m
y fa
mily
look
ed a
fter
eac
h ot
her
I bel
ieve
that
I am
a b
ad p
erso
n
I bel
ieve
that
som
ebod
y di
es b
ecau
se o
f me
I hav
e ex
peri
ence
d se
riou
s ph
ysic
al a
ssau
lt
Adul
ts n
otic
ed c
uts,
bru
ises
or
mar
ks fr
om w
hen
I was
bea
ten
My
child
hood
was
per
fect
I am
bot
here
d by
a v
ery
sham
eful
sec
ret
I was
phy
sica
lly a
buse
d w
hen
I was
you
ng
I res
pect
mys
elf
Som
eone
touc
hed
me
or tr
ied
to m
ake
me
touc
h th
em in
a s
exua
l way
I hav
e ha
d ex
peri
ence
s th
at I
feel
ver
y gu
ilty
abou
t
I hav
e be
en in
volv
ed in
life
-thr
eate
ning
sit
uati
ons
I was
forc
ed to
kee
p se
cret
s ab
out s
omeo
ne s
exua
lly in
terf
erin
g w
ith
me
whe
n
I was
you
ng
I fel
t hat
ed b
y a
mem
ber
or m
embe
rs o
f my
fam
ily
My
fam
ily w
as th
e gr
eate
st e
ver
Oth
er p
eopl
e ha
ve a
cted
bad
ly b
ecau
se o
f me
I fel
t lik
e th
e od
d on
e ou
t in
my
fam
ily
I hav
e ex
peri
ence
d se
xual
ass
ault
Som
eone
wou
ld a
lway
s ta
ke m
e to
see
a d
octo
r or
nur
se
I was
put
dow
n, c
riti
cize
d an
d m
ade
to fe
el in
feri
or w
hen
I was
you
ng
Som
eone
sex
ually
mol
este
d m
e
I fee
l res
pons
ible
for
harm
or
inju
ry to
ano
ther
per
son
I had
frie
nds
I cou
ld ta
lk to
abo
ut p
erso
nal p
robl
ems
I hav
e ex
peri
ence
d ha
rass
men
t/pe
rsec
utio
n fr
om o
ther
eth
nic
grou
ps
I did
wel
l at s
choo
l
I hav
e ex
peri
ence
d th
e lo
ss o
f som
ebod
y w
ho w
as v
ery
impo
rtan
t to
me
I do
not d
eser
ve to
do
wel
l in
life
My
fam
ily w
as s
uppo
rtiv
e an
d en
cour
agin
g w
hen
I was
you
ng
I was
sex
ually
abu
sed
I fee
l afr
aid
of s
omeo
ne in
my
fam
ily
I cou
ld m
ake
frie
nds
easi
ly
110.4.2 Hierarchical Multiple Regression (HMR) analysis predicting self-reported features of BPD in
patients with mood disorders
.
Model 1 Model 2 Model 3 Model 4
Variable
Constant
Age
Sex
TADS
ECR-R anxious
ECR-R avoidant
S5 neuroticism
R2
R2
F
F
110.4.3 Mediation analysis between childhood TE, Attachment Anxiety and self-reported features of
BPD
111 Discussion
11.1 Main findings
111.2 Strengths
111.3 Limitations.
111.4 Differences and overlap in self-reported symptoms of bipolar disorder and borderline
personality disorder
111.5 Differences and overlap in self-reported features of borderline personality disorder and
schizotypal personality disorder
111.6 Self-reported psychotic-like experiences in patients with mood disorders
111.7 Relationships linking self-reported childhood traumatic experiences, attachment style,
neuroticism and BPD features in patients with mood disorders
12 CConclusions and clinical implications
113 Implications for future research
114 Appendix
F60.3 Emotionally unstable personality disorder
F21 Schizotypal disorder
115 Acknowledgments.
116 References
TADS-EPOS 1.2
117 Original publications