Adverse childhood experiences and clinical severity in bipolar disorder and schizophrenia: A transdiagnostic two-step cluster analysis

Carbone, Elvira Anna; Pugliese, Valentina; Bruni, Antonella; Aloi, Matteo; Calabrò, Giuseppina; Jaén-Moreno, María José; Segura-Garcia, Cristina; Fazio, Pasquale De

doi:10.1016/j.jad.2019.08.049

Cited by 36 publications

(37 citation statements)

References 75 publications

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“…Fair or higher quality is considered acceptable clustering. 47 The importance of each predictor for clustering formation was 1.00 for mental health and 0.55 for physical health. According to the mean scores in each cluster, cluster 1 (n=271, 71.5%) was named 'low perceived mental and physical health' (mental health: M=18.…”

Section: Cluster Analysismentioning

confidence: 99%

Positive psychological profiles based on perceived health clustering in patients with cardiovascular disease: a longitudinal study

et al. 2021

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ObjectivesPsychological well-being and sociodemographic factors have been associated with cardiovascular health. Positive psychological well-being research is limited in the literature; as such, this study aimed to investigate how patients with cardiovascular disease could be classified according to their perceived mental and physical health, and to identify positive psychological profiles based on this classification and test their stability over time.Design and settingLongitudinal study with patients from a public hospital located in Córdoba (Spain).ParticipantsThis study comprised 379 cardiovascular patients (87.3% men) tested at three measurement points.Outcome measuresParticipants reported their sociodemographic variables (age, sex, educational level, employment and socioeconomic status) at phase 1, while their perceived health and variables relating to positive psychological well-being were tested at this and two subsequent time points (average interval time: 9 months).ResultsThe two-step cluster analysis classified participants into three groups according to their mental and physical health levels, p<0.001: high (n=76), moderate (n=113) and low (n=189) perceived health clusters. Low perceived health was the largest cluster, comprising almost half of patients. Clusters significantly differed according to sex, p=0.002, and socioeconomic level, p=0.004. The profile analysis indicated that participants in the high perceived health cluster showed high positive affect, positivity, life satisfaction, and self-efficacy in emotion regulation, and less negative affect and use of passive strategies over the three measurement points (95% CI, all ps<0.01). Moreover, psychological profile stability for each cluster was generally found over an 18-month period, all ps<0.05.ConclusionCardiovascular patients may differ in terms of their perceived health and, accordingly, in terms of other relevant variables. Perceived health clusters generated varying and generally stable psychological profiles based on positive psychological well-being variables. Psychological interventions should be adapted to patients’ requirements.

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Section: Cluster Analysismentioning

confidence: 99%

Positive psychological profiles based on perceived health clustering in patients with cardiovascular disease: a longitudinal study

et al. 2021

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“…Furthermore, our results highlight the correlation of various measures of childhood trauma, adverse experiences, and lack of support with illness severity, positive symptoms, hospitalizations, and the need for more intensive treatment. Several prior studies support such a correlation [30, 68–71].…”

Section: Discussionmentioning

confidence: 63%

“…Transdiagnostic clustering supports the existence of diagnostically mixed subtypes across two [4,[29][30][31] or more disorders [32][33][34][35]. However, previous transdiagnostic clustering studies were limited by small samples and analyzed few disorders or variables [36,37].…”

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confidence: 96%

Identification of transdiagnostic psychiatric disorder subtypes using unsupervised learning

Pelin

Ising

Stein

et al. 2021

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Psychiatric disorders show heterogeneous clinical manifestations and disease trajectories, with current classification systems not accurately reflecting their molecular etiology. This heterogeneity impedes timely and targeted treatment. Our study aimed to identify diagnostically mixed psychiatric patient clusters that share clinical and genetic features and may profit from similar therapeutic interventions. We used unsupervised high-dimensional data clustering on deep clinical data to identify transdiagnostic groups in a discovery sample (N=1250) of healthy controls and patients diagnosed with depression, bipolar disorder, schizophrenia, schizoaffective disorder, and other psychiatric disorders. We observed five diagnostically mixed clusters and ordered them based on severity. The least impaired cluster 0, containing most healthy controls, was characterized by general well-being. Clusters 1-3 differed predominantly regarding levels of maltreatment, depression, daily functioning, and parental bonding. Cluster 4 contained most patients diagnosed with psychotic disorders and exhibited the highest severity in many dimensions, including medication load. MDD patients were present in all clusters, indicating that we captured different disease stages or subtypes. We replicated all but the smallest cluster 1 in an independent sample (N=622). Next, we analyzed genetic differences between clusters using polygenic scores (PGS) and the psychiatric family history. These genetic variables differed mainly between clusters 0 and 4 (prediction AUC=81%; significant PGS: cross-disorder psychiatric risk, schizophrenia, and educational attainment). Our results confirm that psychiatric disorders consist of heterogeneous subtypes sharing molecular factors and symptoms. The identification of transdiagnostic clusters advances our understanding of the heterogeneity of psychiatric disorders and may support the development of personalized treatment regimes.

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“…Moreover, other authors have highlighted the inverse relationship in which dissociation is a defense against the disorganization and acute distress generated by psychosis (Giese et al 1997). Other possible mechanisms might be the early trauma exposure that predisposes to a higher psychopathological load among different psychiatric disorders, including BD (Carbone et al 2019;Wang et al 2021). However, we did not assess the impact of trauma in this study and therefore this explanation remains speculative.…”

Section: Discussionmentioning

confidence: 99%

Dissociative Symptoms and Psychotic Features in Bipolar Disorder: Impact on Clinical Course and Treatment Response

Steardo¹,

Carbone²,

Ventura³

et al. 2021

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Background Dissociative symptoms are widely expressed in patients with bipolar disorder (BD) and may precede the onset of the disorder and be a marker of poor treatment response. In the present study we aimed: 1) to assess the relationship between dissociative symptoms and the onset of psychotic symptoms in patients with BD; 2) to assess clinical and socio-demographic characteristics more frequently associated with dissociative symptoms and the response to treatment with mood stabilizers. Methods One-hundred patients diagnosed with BD were enrolled in this study. They underwent a semi-structured interview to collect socio-demographic and clinical characteristics. Dissociative Experiences Scale-II (DES-II) and ALDA scale were used to assess dissociative psychopathologies and response to treatment with mood stabilizers respectively. Results Forty-four percent of patients reported psychotic symptoms on the DES-II scale; BD I patients had a higher total DES-II score than BD II patients. Dissociative symptoms presented a direct correlation with the total number of episodes (p < .000), antidepressant switch to mania (p < .000), seasonality (p < .000), aggression (p < .000), and mixed states (p < .000). higher DES-II scores were reported by patients with poor response to treatment. Conclusions Dissociative phenomena are closely related to the presence of psychotic symptoms in BD, especially in BD I. In a future perspective, this association could represent a diagnostic indicator of BD I have given the close association with psychotic symptoms. Our study shows that several clinical variables transversely indicate a poor response to treatment with mood stabilizers, a worse course of illness, and the presence of dissociative symptoms.

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Adverse childhood experiences and clinical severity in bipolar disorder and schizophrenia: A transdiagnostic two-step cluster analysis

Cited by 36 publications

References 75 publications

Positive psychological profiles based on perceived health clustering in patients with cardiovascular disease: a longitudinal study

Positive psychological profiles based on perceived health clustering in patients with cardiovascular disease: a longitudinal study

Identification of transdiagnostic psychiatric disorder subtypes using unsupervised learning

Dissociative Symptoms and Psychotic Features in Bipolar Disorder: Impact on Clinical Course and Treatment Response

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