Editorial: Reviews in psychiatry 2023: personality disorders

Résumé fourni par la source

In this editorial, we provide an overview and discussion of key points from the nine papers published in this 2022 Research Topic entitled "Reviews in psychiatry 2023: personality disorders." The overview has been thematically organized by Research Topic.The dimensional view of personality disorders (PDs) represents these conditions as extreme variants of normal personality continua. Hualparuca-Oliveira and colleagues, examined whether there is sufficient correlation between PD)measures of ICD-11 [1] and DSM 5 [2] alternative models of personality disorder (AMPD) in the general population. The quality of the sixteen included studies was moderate. The authors found a strong and significant degree of heterogeneity and moderate association both for the overall model (r=0.62) and for the subgroup of associations (0.57 for the severity model and 0.63 for the association between of ICD-11 and DSM 5 AMPD trait models). When considering the specific trait domains the correlation was high (0.71) for negative affectivity and moderate for Detachment (0.59), Dissociality/Antagonism (0.55), and Dishinibition (0,68). The results indicate satisfactory empirical evidence of the interchangeable usefulness of these measures between the two models. Szucs et al. carried out a meta-analysis of 48 studies on the association between personality and help-seeking (HS). Schizotypal and borderline PDs, and neuroticism traits are likely to engage in mental healthcare despite negative general attitudes towards care seeking, while paranoid, schizoid and obsessive compulsive PD related to both negative HS attitudes and behavior, despite unfavorable long-term prognosis. Limited evidence linked extraversion to social support seeking and conscientiousness to care seeking behaviors. Meta-analyses on the Five Factor confirmed a modest associations between neuroticism and more negative attitudes towards seeking professional psychological help as well as between agreeableness and more positive attitudes towards seeking professional psychological help, but the latter is lost at sensitivity analysis. HS behavior is negatively associated with reality weakness and cynicism, and positively associated with abasement and rigidity.Zhou and colleagues used two sample mendelian randomization (TSMR) [3] to evaluate the causal relationship between BPD and atrial fibrillation (AF), founding that with both fixed effect inverse variance weighted model (p=0.0031) and random effect inverse variance weighted model (p=0.0394) genetically predicted BPD was associated with an increased risk of AF. The authors pointed out a genetic evidence of a causal relationship between BPD and increased risk of AF through TSMR, with no casual relationship of AF on BPD risk, concluding that inflammation might be a mediating factor between BPD and AF. Di Giacomo et al., systematically reviewed the existing literature on the complex interplay between BPD and oxytocin, following the hypothesis that dysregulation in the oxytocin system may contribute to the emotional instability and interpersonal difficulties observed in individuals with BPD [4]. In the 70 studies included in their qualitative analysis, the authors found that Oxytocin might influence attachment styles, parental behaviors, and stress responses, particularly in individuals with a history of childhood trauma. The interaction between oxytocin, genetics, early life experiences, and environmental factors contributed to the complexity of BPD, while genetic variations in the oxytocin receptor gene might influence social and emotional abilities and contribute to the development of psychopathology. Moreover, early adverse experiences, such as childhood maltreatment, could alter oxytocin functioning, impacting social cognition and emotional regulation. They concluded that there is evidence for both potential benefits for specific symptoms like social threat avoidance, and adverse effects on nonverbal behavior and mentalizing.A noteworthy associations of PD with chronic back/neck/spine conditions, arthritis, fibromyalgia, and reduced bone mineral density has been found [5], Quirk and colleagues carried out a systematic review to evaluate the quality and extent of evidence of the associations of PD with chronic back/neck/spine conditions, arthritis, fibromyalgia, and reduced bone mineral density in eleven population based studies. The association was highest in cluster B PDs. In younger groups, any PDs, schizoid and obsessive compulsive were each associated with increased odds of arthritis. Similarly, people with arthritis had increased odds of several specific PDs (paranoid, schizoid, histrionic, antisocial, avoidant and obsessive compulsive). Spinal pain was associated with BP, while muscular pain but not fibromyalgia was associated with PDs and women with cluster A, but not cluster B and C PDs had poorer bone health. Authors concluded the need for new evidence from case control and cohort studies.People with temporal lobe epilepsy (TLE) were frequently described to report specific personality features (hyper-religiosity, hypergraphia, hyposexuality, and irritability) called Geshwind syndrome [6]. Viola and colleagues, with a mini review of 23 studies, tried to collect and synthesize the existing evidence about PDs in people with epilepsy. They found higher prevalence rates (18-42%) of PDs in focal epilepsies (not specifically TLE), candidates for surgery, with cluster C personality as the most common. In juvenile mioclonic epilepsy prevalence rates were 8-23% with no strong correlation with any subtype. In functional seizures (FS), the prevalence ranged between 30% and 60% with higher correlation with cluster B PDs. The comorbidity with PDs complicated the treatment. Authors pointed out that studies usually focused on traits rather than specific PDs and often a substantial gap of knowledge exists about the common etiology, effects of AEDs and epilepsy surgery in PDs.The role of personality in the developing of FS has been studied in the recent literature [7,8]. Sammarra and colleagues systematically reviewed 14 studies on FS population (prevalence of PDs, frequency of cluster A, B and C and comparison with patients with epilepsy). Rate of PDs as comorbidity in FS ranged from 18% to 87%, with a mean of 53.7% (41.7%-84.6% cluster B, 0%-48.3% cluster A and 7.7%-75.9% for cluster C) Individuals with FS have nearly three times the odds to have PDs than people with epilepsy (p<0.00001), a four-time increased OR to have cluster B, (p<0.00001), an OR<1 to have a cluster A (p=0.024), or cluster C (p=0.014) PDs. Authors concluded that future research should assess the advantages of a systematic evaluation of personality disorders in FS, to address the specific treatment planning, evaluating its effectiveness on seizure recurrency, psychological comorbidities and quality of life. personality traits and axis I spectrums More than 25% of patients diagnosed with obsessive-compulsive disorder do not respond adequately to treatment [9] and the complex examination of risk factors can be conducted by using a new approach in the study of OCD, i.e. the empirical and theoretical frame of maladaptive schemas. Csigò and colleagues tried to identify the early maladaptive schemas characteristic of 112 (58 men and 54 women) Hungarian patients diagnosed with OCD, and to examine the presence and severity of comorbid anxiety and depressive symptoms in the light of early maladaptive schemas (Mistrust-Abuse, Inferiority/Shame, Dependence/Incompetence, Insufficient Self-Control/Self-Discipline and Entitlement/Grandiosity (reversed effect)). Not the severity, but the number of the early maladaptive schemas showed a stronger correlation with the OCD symptom variables. Authors concluded that the relationship between OCD symptom severity and personality impairment seems to be not directly proportional. Moreover They highlighted that OCD is only one and not the most serious consequence of personality dam

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