Association of Comorbid Psychopathology with the Duration of Cannabis Use Disorders

Risk factors for the development of cannabis use disorders (CUDs) have been well–researched. Comparatively little is known, however, about factors associated with the persistence of CUDs over time. 

This research explored whether the temporal sequencing of comorbid psychiatric disorders in relation to the onset of the index CUD episode were associated with the length of this episode. 

Four comprehensive diagnostic assessments were conducted between ages 16 and 30 with a large and regionally representative community sample (n = 816), among which 173 persons were diagnosed with a lifetime CUD. In separate unadjusted analyses, any internalizing disorder and any mood disorder with onset prior to that of the index CUD episode were each significantly and negatively associated with CUD duration. These effects, however, were reduced to trend-level in adjusted analyses that controlled for putative confounders. Following the onset of the index CUD episode, the subsequent occurrence of any axis I disorder, internalizing disorder, externalizing disorder, or other substance use disorder during the index CUD episode was significantly and positively associated with the duration of that episode in both unadjusted and adjusted analyses. 

These findings collectively suggest that the presence of internalizing-spectrum disorders prior to the onset of the index CUD episode affords some modest protection against protracted episodes, whereas the emergence of broad-spectrum psychopathology within the index CUD episode, most notably non-cannabis substance use disorders, is associated with greater disorder persistence. 

The relevance of these findings for various motivational models of cannabis addiction is discussed.

Descriptive Statistics for Demographic Variables and Bivariate Associations with the Duration of Index Cannabis Use Disorder Episode (n = 173)

Predictor	% (SE) or M (SD)	Coef (SE)	p	r2
Participant Characteristics, % (SE)
Male	52 (4)	26.1 (6.7)	.001	.082
Non-white	9 (2)	1.7 (12.0)	.890	<.001
Pubertal timing
Early vs. on-time	25 (4)	−6.2 (7.9)	.428	.004
Late vs. on-time	18 (3)	16.4 (10.7)	.127	.017
Early vs. late	60 (6)	−22.7 (12.8)	.082	.050
History of repeating grade before age 12	14 (3)	4.0 (10.0)	.694	.001
Family Demographic Variables
Dual versus single parent household, % (SE)	44 (4)	−4.5 (7.0)	.523	.002
At least one parent completed college, % (SE)	41 (4)	−4.6 (7.1)	.516	.003
Mean parent age at T1, M (SD)	41.5 (5.6)	−1.1 (0.3)	.081	.018
Number of older siblings, M (SD)	0.9 (1.1)	−2.8 (3.1)	.359	.005

Notes. SE = standard error; M = mean; SD = standard deviation; Coef = regression coefficient estimate.

Full article at:   http://goo.gl/pcfeg4

By:   Richard F. Farmer, Derek B. Kosty, John R. Seeley, Jeff M. Gau, Susan C. Duncan, Denise D. Walker, and Peter M. Lewinsohn

Richard F. Farmer, Oregon Research Institute;

Contributor Information.

Correspondence concerning this report should be directed to Richard Farmer, Oregon Research Institute, 1776 Millrace Drive, Eugene, Oregon, 97403, United States of America. Email: gro.iro@remrafr

Richard F. Farmer, Derek B. Kosty, John R. Seeley, Jeff M. Gau, Susan C. Duncan, and Peter M. Lewinsohn, Oregon Research Institute; Denise D. Walker, School of Social Work, University of Washington.

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HIV Risk Behavior & Internalizing/Externalizing Psychopathology among Adolescents in Court-Ordered Treatment

BACKGROUND:

The confluence of drug use behaviors, sexual risk, and psychopathology may complicate human immunodeficiency virus (HIV) prevention intervention for adolescents engaging in substance use and criminal behavior. However, few studies have examined these risk associations.

OBJECTIVE:

This study identified HIV risk behavior subgroups among adolescents in court-ordered substance abuse treatment and examined linkages with dimensions of internalizing and externalizing psychopathology.

METHODS:

Internalizing and externalizing behaviors were assessed with the Millon Adolescent Clinical Inventory (MACI). Latent class analysis was used to identify subgroups on the basis of involvement in substance use proximal to sex, number of partners, and consistency of condom use.

RESULTS:

Participants (n = 301) were identified as demonstrating high, medium, or low levels of sexual risk behavior. Greater externalizing psychopathology distinguished the high risk class from the medium risk class and from the low risk class.

CONCLUSION:

Detained youth with particularly serious oppositional-defiant behavioral characteristics, substance use, and sex risk behavior likely require intensive interventions that address the multiple systemic factors that contribute to the development and maintenance of this pattern.

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By:  McMahon RC1, Stanforth ET1, Dévieux JG2, Jean-Gilles M2.

• 1 Department of Educational and Psychological Studies , University of Miami , Coral Gables , FL , USA.
• 2 Department of Health Promotion and Disease Prevention , Florida International University , Miami , FL , USA.
• Am J Drug Alcohol Abuse. 2016 Feb 10:1-9. 

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Boldness and Its Relation to Psychopathic Personality: Prototypicality Analyses among Forensic Mental Health, Criminal Justice, and Layperson Raters

Research on psychopathic personality has been dominated by a focus on criminality and social deviance, but some theoretical models argue that certain putatively adaptive features are important components of this construct. In 3 samples (forensic mental health practitioners, probation officers and a layperson community sample), we investigated adaptive traits as conceptualized in the Triarchic model of psychopathy (Patrick et al., 2009), specifically the relevance of boldness to construals of psychopathic personality. 

Participants completed prototypicality ratings of psychopathic traits, including 3 items created to tap components of boldness (Socially bold, Adventurous, Emotionally stable), and they also rated a series of attitudinal statements (e.g., perceived correlates of being psychopathic, moral judgments about psychopaths). 

The composite Boldness scale was rated as moderately to highly prototypical among forensic mental health practitioners and probation officers and positively associated with other theoretically relevant domains of psychopathy. Across samples, higher composite Boldness ratings predicted greater endorsement of adaptive traits (e.g., social skills) as characteristic of psychopathy. For the individual items, Socially bold was rated as highly prototypical and was associated with theoretically relevant correlates. Adventurous also was seen as prototypical, though to a lesser degree. Only forensic mental health practitioners endorsed Emotionally stable as characteristic of psychopathy. 

Our results provide partial support for the contention that the boldness concept is viewed as an important component of psychopathy, particularly among professionals who work directly with offender populations. 

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By:  Sörman K, Edens JF, Smith ST, Clark JW, Kristiansson M, Svensson O.

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Dissociative Experiences and Psychopathology among Inmates in Italian and Portuguese Prisons

The association between dissociation and psychopathological symptoms is well established, yet studies with inmates are lacking. If higher rates of dissociation and psychiatric symptoms are reported in inmate samples, it is not clear whether they represent two separate, albeit related, characteristics. 

We examined the association between dissociation and psychopathological symptoms among 320 Italian subjects (122 inmates and 198 community participants) and a Portuguese inmate sample (n = 67). Then, we tested whether dissociation and psychopathology levels were higher among inmates. 

Both hypotheses were supported, confirming the relevance of dissociative, paranoid, and psychotic symptoms among inmates, as well as their interrelations. Notably, the group difference in dissociation remained significant after partialing out the variance associated with other psychopathological symptoms. Conversely, only the difference in paranoid symptoms remained—marginally—significant when controlling for the influence of dissociation. 

This finding suggests that dissociation may have unique relevance for the psychological functioning of inmates.

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By:  Giulio Cesare Zavattini1, Carlo Garofalo1,2, Patrizia Velotti3⇑, Marco Tommasi4, Roberta Romanelli4, Helena Espírito Santo5, Mara Costa5, Aristide Saggino4

¹Sapienza University of Rome, Italy

²Tilburg University, The Netherlands

³University of Genoa, Italy

⁴University of Chieti-Pescara, Italy

⁵Miguel Torga Institute, Coimbra, Portugal

Patrizia Velotti, Department of Education Sciences, University of Genoa, Corso Andrea Podestà, 2, 16126, Genoa, Italy. Email: patrizia.velotti@unige.it

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Sexual Orientation & Gender Identity: Review of Concepts, Controversies & Their Relation to Psychopathology Classification Systems

Numerous controversies and debates have taken place throughout the history of psychopathology (and its main classification systems) with regards to sexual orientation and gender identity. These are still reflected on present reformulations of gender dysphoria in both the Diagnostic and Statistical Manual and the International Classification of Diseases, and in more or less subtle micro-aggressions experienced by lesbian, gay, bisexual and trans patients in mental health care. The present paper critically reviews this history and current controversies. It reveals that this deeply complex field contributes (i) to the reflection on the very concept of mental illness; (ii) to the focus on subjective distress and person-centered experience of psychopathology; and (iii) to the recognition of stigma and discrimination as significant intervening variables. Finally, it argues that sexual orientation and gender identity have been viewed, in the history of the field of psychopathology, between two poles: gender transgression and gender variance/fluidity...

...The present paper argues that sexual orientation and gender identity have been viewed, in the history of the field of psychopathology, between two poles: gender transgression and gender variance/fluidity.

On the one hand, aligned with a position of “transgression” and/or “deviation from a norm,” people who today are described as LGBT were labeled as mentally ill. Inevitably, classification systems reflect(ed) the existing social attitudes and prejudices, as well as the historical and cultural contexts in which they were developed (Drescher, 2012; Kirschner, 2013). In that, they often failed to differentiate between mental illness and socially non-conforming behavior or fluidity of gender expressions. This position and the historical roots of this discourse are still reflected in the practices of some clinicians, ranging from “conversion” therapies to micro-aggressions in the daily lives of LGBT people, including those experienced in the care by mental health professionals.

On the other hand, lined up with a position of gender variance and fluidity, changes in the diagnostic systems in the last few decades reflect a broader respect and value of the diversity of human sexuality and of gender expressions. This position recognizes that the discourse and practices coming from the (mental) health field may lead to changes in the broader cultural beliefs (Drescher, 2012). As such, it also recognizes the power of medical classifications, health discourses and clinical practices in translating the responsibility of fighting discrimination and promoting LGBT people’s well-being.

In conclusion, it seems crucial to emphasize the role of specific training and supervision in the development of clinical competence in the work with sexual minorities. Several authors (e.g., Pachankis and Goldfried, 2004) have argued for the importance of continuous education and training of practitioners in individual and cultural diversity competences, across professional development. This is in line with APA’s ethical guidelines (American Psychological Association, 2000, 2012), and it is even more relevant when we acknowledge the significant and recent changes in this field. Furthermore, it is founded on the very notion that LGBT competence assumes clinicians ought to be aware of their own personal values, attitudes and beliefs regarding human sexuality and gender diversity in order to provide appropriate care. These ethical concerns, however, have not been translated into training programs in medicine and psychology in a systematic manner in most European countries, and to the mainstreaming of LGBT issues (Goldfried, 2001) in psychopathology.

  

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By: Moleiro C1, Pinto N1.

• 1Instituto Universitário de Lisboa ISCTE-IUL CIS, Lisboa, Portugal.  

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

Below: Dimensional raw scores of PSY-5 scales according to gender and type of group.

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.

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