Ernesto Magallón-Neri

The influence of personality disorders on the use of mental health services in adolescents with psychiatric disorders

OBJECTIVE The aims of this study were to explore the influence of personality disorders (PDs) in Spanish adolescents with Axis I psychiatric disorders on their use of mental health services and to analyze the risk of having a comorbid PD in relation to psychiatric service use. METHODS The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and International Classification of Diseases, Tenth Revision (ICD-10) modules of the semistructured interview International Personality Disorders Examination were administered to a sample of 112 adolescent psychiatric patients (mean age = 15.8 years; SD, 0.8; range, 15-17; 79% women) at the point of initiating treatment. On the basis of the interview, subjects were divided into two groups: a PD group (PDG) and a non-PD group (NPDG). After 3 years of treatment, clinical records were retrospectively analyzed. RESULTS The PDG showed a significantly higher number of psychiatric admissions (P < .001), days per psychiatric admission (P < .001), and psychiatric emergencies (P < .010) than the NPDG, although the number of outpatient consultations was not significantly higher. Logistic regression analysis showed that the probability of belonging to the PDG rather than the NPDG increased with each psychiatric admission (odds ratio [OR] = 1.67 for DSM-IV criteria and OR = 1.59 for ICD-10 criteria), after controlling by sex, age, and comorbidity (Axis I disorders). CONCLUSIONS Patients with comorbid PD used more inpatient and emergency psychiatric services than did patients without a PD. Large number of psychiatric hospitalizations suggests the likelihood of a PD being present.

The ability of multi-type maltreatment and poly-victimization approaches to reflect psychopathological impairment of victimization in Spanish community adolescents

This paper examined the ability of two different approaches (the multi-type maltreatment approach, and the polyvictimization approach) to reflect the psychopathological aftermath of victimization. It also analyzed gender-related differences in psychopathological symptoms at varying levels of exposure to violence. The study was conducted in 923 Spanish community adolescents (aged from 14 to 18 years; 62.4% girls; 87.4% born in Spain), recruited for screening purposes from eight secondary schools in Barcelona and its metropolitan area (Spain). The study was based on cross-sectional data. The Juvenile Victimization Questionnaire and the Youth Self Report (DSM scales) were used to analyze victimization and psychopathological impairment respectively. The results showed that the two approaches present a similar ability to reflect psychopathological outcomes. The use of mean T scores to analyze psychopathological impairments conceals the high percentages of adolescents who are at risk in several psychopathological scales. Gender-related differences, analyzed under the multi-type approach, showed that girls presented slightly higher levels of symptomatology in reaction to their first experiences of victimization, whereas boys presented strong emotional reactions after the accumulation of a high number of victimized areas. Adolescents victimized in up to three areas showed evidence of resiliency to interpersonal victimization events and displayed non-clinical psychopathological profiles. Obsessive-compulsive symptoms had to be considered in high victimized groups, conjointly with affective, somatic and post-traumatic stress as psychopathological symptoms related to victimization.

Usefulness of the International Personality Disorder Examination screening questionnaire for borderline and impulsive personality pathology in adolescents

UNLABELLED The aim of this study was to analyze the usefulness of the International Personality Disorder Examination Screening Questionnaire (IPDE-SQ) for identifying DSM-IV and ICD-10 Borderline and Impulsive personality disorders (PD) in Spanish adolescents. METHOD The DSM-IV and ICD-10 IPDE-SQ screeners were used and compared with the diagnoses obtained with the IPDE semistructured interview in a sample of 125 adolescents treated in a psychiatric department. RESULTS For primary screening, the cutoff point with the best combination of sensitivity and specificity for ICD-10 impulsive and borderline PDs was obtained with three positive items, whereas for DSM-IV borderline the best PD cut-off was five positive items. For secondary screening, the best option would be one item above the cut-off points proposed for primary screening. CONCLUSION The 3-item cut-off point in the IPDE-SQ produces a high proportion of false positives on impulsive and borderline PDs in clinical adolescents. We propose several cut-off points, depending on whether the study is designed to perform primary or secondary screening.

Ecological Momentary Assessment with smartphones for measuring mental health problems in adolescents

AIM To analyze the viability of Ecological Momentary Assessment (EMA) for measuring the mental states associated with psychopathological problems in adolescents. METHODS In a sample of 110 adolescents, a sociodemographic data survey and an EMA Smartphone application over a one-week period (five times each day), was developed to explore symptom profiles, everyday problems, coping strategies, and the contexts in which the events take place. RESULTS The positive response was 68.6%. Over 2250 prompts about mental states were recorded. In 53% of situations the smartphone was answered at home, 25.5% of cases they were with their parents or with peers (20.3%). Associations were found with attention, affective and anxiety problems (P < 0.001) in the participants who took longer to respond to the EMA app. Anxious and depressive states were highly interrelated (rho = 0.51, P < 0.001), as well as oppositional defiant problems and conduct problems (rho = 0.56, P < 0.001). Only in 6.2% of the situations the subjects perceived they had problems, mainly associated with inter-relational aspects with family, peers, boyfriends or girlfriends (31.2%). We also found moderate-high reliability on scales of satisfaction level on the context, on positive emotionality, and on the discomfort index associated with mental health problems. CONCLUSION EMA methodology using smartphones is a useful tool for understanding adolescents’ daily dynamics. It achieved moderate-high reliability and accurately identified psychopathological manifestations experienced by community adolescents in their natural context.

Neither too much, nor too little. The dilemma of identifying personality disorders in adolescents patients with self-reports

The study aimed to compare methods of identification of Personality Disorders (PD) in adolescent patients with psychiatric disorders. A sample of 120 Spanish adolescents with clinical disorders was assessed using the International Personality Disorder Examination (IPDE) interview, its Screening Questionnaires (IPDE-SQ) comprising the ICD-10 and DSM-IV modules, and also the Temperament Character Inventory (TCI) to identify risk of PD. The IPDE-SQ identified a risk of PD around 92-97% of the sample; 61.7% when adjusting the stricter cut-off points. The TCI showed a PD risk of 20%, whereas the prevalence of PD identified by the IPDE clinical interview was around 36-38%. The differences between the IPDE, IPDE-SQ and TCI were significant, and a low agreement among instruments was obtained. Large discrepancy between self-report instruments in identifying PD with regard to the clinical interview raises several questions concerning the use of these instruments in clinical settings on adolescents with psychiatric disorders.

Personality psychopathology, drug use and psychological symptoms in adolescents with substance use disorders and community controls

Substance use is a risk behavior that tends to increase during adolescence, a time when part of the personality is still in development. Traditionally, personality psychopathology has been measured in terms of categories, although dimensional models have demonstrated better consistency. This study aimed to analyze differences in personality profiles between adolescents with substance use disorders (SUD n = 74) and matched community controls (MCC n = 74) using the Personality Psychopathology Five (PSY-5) dimensional model. Additionally, we compared age at first drug use, level of drug use and internalizing and externalizing symptoms between the groups. In this study, the PSY-5 model has proved to be useful for differentiating specific personality disturbances in adolescents with SUD and community adolescents. The Disconstraint scale was particularly useful for discriminating adolescents with substance use problems and the Delinquent Attitudes facet offered the best differentiation.

Facing Interpersonal Violence: Identifying the Coping Profile of Poly-Victimized Resilient Adolescents

Coping strategies are factors that mediate the relationship between interpersonal victimizations and psychological maladjustment. The objectives are as follows: (a) to establish the coping profile of adolescents according to the number of reported interpersonal victimizations; (b) to identify the most victimized adolescents (poly-victims), detecting those with psychological symptoms (nonresilient poly-victims) and those without psychological symptoms (resilient poly-victims), and then to examine any differences in coping strategies between the two groups; (c) to determine the accumulative effect of victimizations on mental health; and (d) to test the mediating role of both approach and avoidance coping between lifetime interpersonal victimizations and symptoms. Participants were 918 community Spanish adolescents (62.7% girls) aged between 14 and 18 years. Measures used were Youth Self-Report, Juvenile Victimization Questionnaire, and Adolescent Coping Orientation for Problem Experiences. The following results were reported: (a) The most victimized adolescents used to a greater degree avoidance coping strategies than nonvictimized adolescents. (b) Resilient poly-victimized adolescents were more likely to seek family support and tended to use more positive reappraisal than nonresilient poly-victimized adolescents. (c) A clear cumulative effect of victimizations on mental health was observed: 45% of the most victimized adolescents (poly-victims) reached clinical range on Youth Self-Report in front of 2% of nonvictimized adolescents. (d) Avoidance coping and more specifically Escaping and Venting feelings strategies played a mediating role between interpersonal victimizations and psychological symptoms. Approach coping had no mediating role, except for Positive reappraisal in girls. In conclusion, the possibility of identifying the coping profile of victimized adolescents may have clinical implications in terms of both prevention and intervention.

Ecological momentary assessment of contextual variables, satisfaction, and emotional and behavioral states of adolescents by level of victimization

The harmful effects of victimization on mental health have been demonstrated in several age groups, cultures, and populations, but there is wide variability in the resulting psychopathology. Ecological momentary assessment (EMA) allows the expression of an emotional state to be recorded at any given time and linked to a situation or context. This study aimed to analyze the contextual variables (where, with whom, and what), momentary satisfaction, and perception of momentary emotional and behavioral symptoms in a cohort of adolescents by the level of victimization, using EMA. We explored the everyday symptom profiles and the contexts in which events took place among 100 adolescents over a one-week period. Sociodemographic data were collected and assessment was done using the EMA (as a smartphone application) and the Juvenile Victimization Questionnaire (to assess childhood and adolescent victimization). In this study, regarding contextual variables, the group with the highest level of victimization (top 10%) showed a significant relationship with being away from home and being with friends other than classmates, and not being with parents or relatives. There was also an unexpectedly higher frequency of sporting engagement in this group. A relationship existed between emotional and behavioral problems and higher levels of victimization. In conclusion, the different groups of victimized subjects present a relatively high level of satisfaction in relation to the daily contexts and show low levels of emotional and behavioral symptomatology.

The Daily Experience of Adolescents with Autism Spectrum Disorder of High Performance.

Study of mental disorders phenomenology is a field increasingly developing. The Ecological Momentary Assessment (EMA) is a methodology that allows to capture mental microprocesses fluctuations in the moment they happen. Objective To explain the development of an application based on EMA methodology by using smartphones, for assessing several criteria of autism spectrum disorders in adolescents with Asperger syndrome. Method The application assesses several contexts among them situational, personal contact, interests fields, communicative interaction, satisfaction level, and feelings. Additionally, it is applied a cognitive (WISC-IV) and psychopathological (ADOS-G, CBCL, STAI, CDI) assessment. Results Preliminary results suggest that adolescents diagnosed with Asperger syndrome present a response rate of about 90%. They tend to spend more time with parents and tuthors taking care of them. They present anxiety peaks when they live together with groups of three or more persons. The activity mostly registered in their everyday life is resting. Besides, they regularly have a feeling that they understand the others and that are understood by the others when they communicate orally. Conclusion The Ecological Momentary Assessment can be a methodology very useful for understanding the daily dynamics of persons with Asperger syndrome. It is not intrusive and is very useful for the contents that provides to the clinician or researcher.

Mental Health Problems and Victimization in Adolescents

Poly-victims are described as subjects who experience extremely high levels of victimization. This condition is regularly associated with wide psychopathological distress. Children and adolescents are special risk collective for this type of victimization. Objective To describe and analyze more frequents mental health problems in adolescents with different levels of victimization. Method A community sample of 895 adolescents (M = 15.7; SD=1.3 years old) was subdivided into several groups taking as reference the number of victimizations suffered in the last year, obtained from the Juvenile Victimization Questionnaire . Resulting groups were as follows: those adolescents presenting no type of victimization, the group below average, a group above average and the group of poly-victimized adolescents. Mental health problems were identified with the Youth Self Report , analyzing specifically the DSM syndrome scales. Results The group of poly-victimized adolescents presented more significant ( p Conclusions Poly-victimization in adolescents is associated to larger symptomatology patterns and mental health problems development.