Eva Baillés

Structure of personality pathology in normal and clinical samples: Spanish validation of the DAPP-BQ.

Given that the DSM taxonomy of personality disorders is flawed by severe classificatory problems, the development of alternative classificatory systems, such as the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ), has now become a priority. This study examined the internal consistency, second-order factor structure, and criterion validity of a Spanish translation of the DAPP-BQ in two samples: subjects with personality disorder (n = 155) and subjects from the general population (n = 300). Alpha coefficients ranged satisfactorily from .75 to .93. Four second-order factors of Emotional Dysregulation, Dissocial Behavior, Inhibitedness, and Compulsivity were obtained, which were replicable between samples and identical to those reported in the literature. Finally, disordered subjects scored significantly higher than normal subjects on 17 of the 18 DAPP-BQ traits. Some pending issues in the construction of an alternative taxonomy of personality disorders are discussed.

Personality does not distinguish people with fibromyalgia but identifies subgroups of patients

OBJECTIVES The objectives were to compare the personality of fibromyalgia (FM) patients with other chronic painful and nonpainful disorders considering the confusion due to psychopathology and to assess the clustering of FM patients according to their personality profile. METHODS Differences in the NEO Five-Factor Inventory between FM, non-FM chronic pain and drug-resistant epileptic patients were assessed including the confounding effect of demographics and psychopathological status by multivariate regression analysis. Clustering of FM patients was assessed by two-step cluster analysis. Differences in clinical severity and psychosocial problems between subgroups and their outcome 6 months after multidisciplinary treatment were assessed. RESULTS The final sample comprised 874 patients. Once the effect of confounding variables was considered, clinically nonsignificant differences in personality were observed between groups. FM patients could, however, be grouped into two clusters. Cluster 1 was characterized by higher neuroticism and lower extraversion and showed a worse pretreatment clinical state including more psychosocial problems. In spite of having reached a wider general improvement at 6-month follow-up, Cluster 1 patients remained more anxious and depressed. CONCLUSIONS Identifying personality-based subgroups of FM might allow implementing specific preventive strategies. FM treatment might be optimized by increasing medication compliance, improving therapeutic alliance and testing different therapeutic options and treatment sequencing for each personality subgroup.

Pain locus of control predicts return to work among Spanish fibromyalgia patients after completion of a multidisciplinary pain program.

OBJECTIVE To assess the influence of the pain locus of control on return to work in fibromyalgia patients. METHODS Ninety-eight fibromyalgia patients on sick leave were enrolled in a multidisciplinary treatment program and were followed up for 12 months post-discharge. Treatment was considered successful at discharge in the case of patients who returned to work and unsuccessful in patients who remained sick listed. Treatment was considered successful during follow-up in patients who remained at work for at least the last 6 months of follow-up. Patients who took sick leave again and those lost to follow-up were considered failures. Logistic regression methods were used to define the best predictive models of treatment failure. RESULTS Fifty-eight patients were considered treatment successes at discharge and 50 at 12-month follow-up. The subscale Fate from the Multidimensional Health Locus of Control-Pain Scale and the Health Assessment Questionnaire predicted treatment failure at discharge (-2lnR=57.79; chi-square=74.74; df=2; P<.001). The predictive model of treatment failure at 12-month follow-up was unspecific. CONCLUSION Fibromyalgia patients undergoing a multidisciplinary treatment who were least likely to return to work at discharge were those with a pain locus of control characterized by more negative expectations about pain progression and a high perceived functional disability.

Psychometric Properties of the Spanish PID-5 in a Clinical and a Community Sample:

The Personality Inventory for DSM-5 (PID-5) measures the trait part (Criterion B) of the alternative model for personality disorders proposed in Section III of DSM-5. Although its psychometric properties have proven adequate thus far, evidence is limited in other languages and in clinical samples. The Spanish PID-5 was examined in two samples comprising 446 clinical and 1,036 community subjects. Facet scales showed good internal consistency in both samples (median α = .86 and .79) and were unidimensional under exploratory and confirmatory approaches. They were also able to distinguish between clinical and community subjects with a mean standardized difference of z = 0.81. All facets except for Risk Taking were unipolar, such that the upper poles indicated pathology and the lower poles reflected normality, rather than the opposite pole of abnormality. The entire PID-5 hierarchical structure, from one to five factors, was confirmed in both samples with Tucker’s congruence coefficients over .95.

The Symptom Checklist-Revised (SCL-90-R) is able to discriminate between simulation and fibromyalgia.

This study assessed the ability of the Symptom Checklist-Revised (SCL-90-R) to discriminate between two groups of fibromyalgia patients (those who were about to begin a treatment including the explicit aim of returning to work and those who were initiating a legal procedure to obtain permanent disability compensation) and two groups of healthy volunteers (medical students and psychology graduates), who were asked to produce a symptomatic resemblance to a chronic pain disorder. Logistic regression analyses were applied to the SCL-90-R subscales and individual probabilistic indices of simulation were calculated. Results showed that the SCL-90-R was able to discriminate between healthy subjects and both groups of patients with a high sensitivity and specificity. The individual indices of simulation, which might be more useful in clinical practice than the comparison of the SCL-90-R profiles, also showed an appropriate level of accuracy.

Seven basic dimensions of personality pathology and their clinical consequences: Are all personalities equally harmful?

OBJECTIVES Dimensional pathology models are increasingly being accepted for the assessment of disordered personalities, but their ability to predict negative outcomes is yet to be studied. We examine the relative clinical impact of seven basic dimensions of personality pathology through their associations with a wide range of clinical outcomes. METHODS A sample of 960 outpatients was assessed through a 7-factor model integrating the Cloninger, the Livesley, and the DSM taxonomies. Thirty-six indicators of clinical outcome covering three areas - dissatisfaction, functional difficulties, and clinical severity - were also assessed. The unique contribution of each personality dimension to clinical outcome was estimated through multiple regressions. RESULTS Overall, personality dimensions explained 17.6% of the variance of clinical outcome, but varied substantially in terms of their unique contributions. Negative Emotionality had the greatest impact in all areas, contributing 43.9% of the explained variance. The remaining dimensions led to idiosyncratic patterns of clinical outcomes but had a comparatively minor clinical impact. A certain effect was also found for combinations of dimensions such as Negative Emotionality × Impulsive Sensation Seeking, but most interactions were clinically irrelevant. CONCLUSIONS Our findings suggest that the most relevant dimensions of personality pathology are associated with very different clinical consequences and levels of harmfulness. PRACTITIONER POINTS The relative clinical impact of seven basic dimensions of personality pathology is examined. Negative Emotionality (Neuroticism) is 6-14 times as harmful as other pathological dimensions. The remaining dimensions and their interactions have very specific and comparatively minor clinical consequences. LIMITATIONS We examine only a handful of clinical outcomes. Our results may not be generalizable to other clinical or life outcomes. Our variables are self-reported and hence susceptible to bias. Our design does not allow us to establish causal relationships between personality and clinical outcomes.

Which Spanish Living Kidney Donors Fear Post Donation Kidney Failure

PI15/00550 - Characterization of the fear of kidney failure in the living kidney donor. Background The impact of fearing the failure of the non-donated kidney is unknown in Spanish donors. For this reason, we aimed at assessing the validity of the Spanish version of the Fear of Kidney Failure Questionnaire (FKF), along with characterizing living donors with higher fear of kidney failure. Methods 205 living kidney donors (LKDs) were randomly selected and stratified by year of donation (2005-2015). 139 general population participants without history of, or a current renal disease and/or without first-degree relatives suffering a renal disease were recruited as comparison group. Reliability of the FKF was assessed. The FKF criterion validity was evaluated by calculating its linear relationship with anxiety, depression, and fear-related personality dimensions. Divergent validity was verified by assessing whether the FKF was unrelated to personality dimensions non-relevant for fear states. LKDs were grouped by Cluster Analysis of the FKF scores. Clusters were compared on demographic and clinical variables to describe those LKDs with higher scores in the FKF, which were further characterized by calculating the most specific logistic regression model. Results The internal consistency of the FKF was acceptable for the whole sample (&agr;=0.95), and the LKDs (&agr;=0.91) and general population (&agr;=0.94) subsamples. Temporal stability of the FKF was acceptable (ICC=0.93). Factor analysis showed that the FKF was composed by a single factor explaining 83.5% of variance. Both for the whole sample and the LKDs and general population subsamples, the FKF was positively correlated with depressive and anxiety symptoms, and neuroticism (convergent validity). The FKF was unrelated to extroversion, openness to experience and conscientiousness (divergent validity). Fear of Kidney Failure in the general population subsample almost doubled the mean of the LKDs subsample. The FKF Cluster Analysis classified LKDs in three groups: absence of fear (68%), moderate fear (20%), and high fear of kidney failure (12%). Groups did not differ in demographics or donation outcomes. No differences were observed between groups in regret for having donated. However, higher FKF scorers were somewhat less satisfied with the experience of donation. This subgroup also showed a higher percentage of potential cases of depressive (16%) and anxiety disorders (20%), a worse quality of life, and higher scores in neuroticism. A higher percentage of these donors (20%) were followed both by the Nephrologist and the Family Doctor. Multivariate logistic regression showed that, once controlled the effect of presenting a potential depressive or anxiety disorder, FKF higher scorers were best characterized by higher scores in neuroticism. Conclusions Post donation fear of kidney failure is infrequent in Spanish LKDs. However, a subgroup of them, best characterized by a higher neuroticism, shows elevated FKF scores, a worse quality of life, and might present with anxiety and depressive disorders. This work has been funded by the project PI15/00550, integrated in the Plan Nacional I+D+I and co-funded by ISCIII-Subdirección General de Evaluación and European Regional Development Fund (ERDF).

Unilateral pallidal stimulation for disabling dystonia due to Rasmussen’s disease

Objective To describe an adult patient with Rasmussen’s disease with focal dystonia as the most disabling symptom and the good response to unilateral globus pallidus internus (GPi) deep brain stimulation (DBS). Methods Retrospective review of clinical records and diagnostic tests. Results The patient had displayedmild focal seizures with sensory and motor symptoms on the left arm and hemiface since the age of 22. Ten years later she experienced abrupt onset of focal left dystonia involving mainly the leg. Brain MRI showed progressive right hemisphere atrophy, and 18 fluorodeoxyglucose-positron emission tomography (18FDG-PET) showed right hypometabolism mainly over the frontal and insular regions. Brain biopsy confirmed chronic encephalitis. The dystonia became very severe and made walking extremely difficult. Different treatments including dopaminergic, anticholinergic, immunomodulatory drugs and botulinum toxin were ineffective. Finally the patient was treated with unilateral GPi DBS. Shortly after the onset of the stimulation, the dystonia started to improve. Parameters have been adjusted, and 18 months after surgery the patient is able to walk and run unaided, although a mild left leg dystonia persists. Conclusion Rasmussen’s disease may be difficult to diagnose in adult patients. Associated movement disorders may be more disabling than seizures. Focal dystonia may be treated successfully with DBS.

CRF test in melancholic depressive patients with partial versus complete relapses: A 2-year follow-up study

Background: Patients with depressive disorders present abnormalities in the hypothalamic pituitary adrenal (HPA) axis. The effects of a partial relapse with regard to HPA axis has not been studied so far. Aim: To assess whether patients with partial relapse have a different neuroendocrine profile compared with those with complete relapse and with those without relapse over a 2-year follow-up. Methods: The adrenocorticotropin hormone (ACTH) and cortisol responses to corticotrophin releasing factor (CRF) stimulation was assessed in 62 outpatients diagnosed with unipolar depressive disorder with melancholic features according to DSM-IV. Twenty-three healthy controls were included in the study for comparison. Monthly follow-up visits were performed over a 2-year period after remission; partial and complete relapses were established using the Hamilton Depression Rating Scale (HDRS) and according to Franks criteria. Fifty-four patients completed the study. A comparative statistical analysis was performed. Results: Stratifying the net area under cortisol curve (NAUCC) (µg/ml/min) at three levels—< 150, 150–350 and ≤ 350—significant differences appear between the three depressive groups of patients (non-relapsers, partial relapsers and complete relapsers). Particularly, there are more patients with a NAUCC ≤ 350 who show partial or complete relapses than patients with a NAUCC ≤ 350 who do not relapse (P ≤ 0.05). Conclusions: Our results show an increasingly altered HPA axis in those depressive patients with complete or partial relapses compared with those who did not relapse or with healthy controls, but there are not differences in HPA axis between partial and complete relapsers.