Browsing by Author "Lochner, Christine"
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- ItemOpen AccessAntisocial Personality Disorder Comorbidity in Methamphetamine Use Disorder: Sociodemographic, clinical and childhood trauma correlates(2021) Rall, Edrich; Kaminer, Debra; Lochner, ChristinePersonality pathology, especially antisocial personality disorder (ASPD), often occurs in patients with methamphetamine use disorder (MAUD). However, little is known about potential risk factors for this dual diagnosis, and the impact of this comorbidity on both the severity of MAUD and levels of functional impairment. Casting light on such phenomena may aid in early identification of treatment targets, assist in the management of patients in this particular population, and contribute to development of treatment strategies. This crosssectional study described and compared sociodemographic, clinical and childhood trauma correlates in patients with a dual diagnosis of MAUD and ASPD (MAUD+ASPD) and those with MAUD without ASPD (MAUD-ASPD). The contribution of sociodemographic and childhood trauma variables in predicting membership of the MAUD+ASPD group was also investigated. A sample of 62 adult patients with a primary diagnosis of MAUD took part in the study. A sociodemographic questionnaire was completed and well established diagnostic measures of ASPD (The Mini-International Neuropsychiatric Interview; MINI) and MAUD (Structured Clinical Interview; SCID - 5) were used to determine diagnostic status. Illness severity was evaluated with the Yale-Brown Obsessive Compulsive scale (adapted for MAUD) (Y-BOCS-du) and functional impairment was assessed with the Sheehan Disability Scale (SDS). Histories of exposure and severity of childhood trauma (CT) were measured using the CTQ-SF. Of the 62 participants, 14 (23%) had MAUD and had MAUD+ASPD whereas 48 (77%) had MAUD without ASPD (MAUD-ASPD). Bivariate analyses found significant group differences in terms of gender (df =1) = 8.05; p =< 0.01), language (df = 2) = 7.12; p = 0.03), and level of physical neglect (F(1, 60) = 2.33; M = 9.85; SD = 4.23; p = 0.04). The MAUD+ASPD group members were mostly male (N = 9; 64%), English-speaking and with histories of increased physical neglect. Logistic regression suggested that male gender (beta = 1.08; OR = 8.65; p = 0.01) and English language (beta = 1.55; OR = 11.38; p = 0.03) significantly predicted ASPD comorbidity. There were no significant differences in clinical severity or functional impairment between the MAUD+ASPD and MAUD-ASPD groups. In conclusion, this study indicated that male gender and having English as a first language are associated with MAUD+ASPD but other sociodemographic variables, CT histories and clinical severity and impairment were not. Men who use MA are thus more prone to antisocial behaviour, which complicates their substance use condition. Treatment approaches for MAUD may benefit from developing adaptations that cater for challenges specific to comorbid ASPD. Additionally, the finding regarding first language warrants further investigation. Recommendations for future research are suggested.
- ItemOpen AccessCluster analysis of disorders characterized by impulsivity in patients with methamphetamine use disorder(2019) Rall, Edrich; Lochner, Christine; Temmingh, HenkBackground Individuals with methamphetamine use disorder (MUD) frequently present with psychiatric comorbidities with impulsive features. Little research has been conducted on comorbidity with impulsive features in MUD. Therefore, this cross-sectional study aimed to delineate comorbid disorders with impulsivity in adult patients with a primary diagnosis of MUD. Methods Participants with lifetime MUD were included. Well established measures screened for comorbid psychiatric disorders with impulsive features. Illness severity was measured by the Yale Brown Obsessive-Compulsive Scale – adapted for drug use. The UPPS-P Impulsive Behavior Scale was used to assess impulsivity levels. A cluster analysis (CA) of lifetime comorbid disorders with impulsive features was performed. Demographic and clinical correlates of each identified cluster were identified. Results Sixty five (n = 65) adults with a primary diagnosis of MUD took part in the study. They were predominantly female (44 females; 21 males), with ages ranging between 18 and 44 years (mean = 30 years; SD = 6.53). The CA rendered 4 groups. Cases (n=12) in the “alcohol cluster” presented with AUD as their only impulsive disorder other than MUD. Cases (n=19) in the “healthy cluster” had no comorbidity. Cases (n=15) in the “antisocial cluster” all had comorbid antisocial personality disorder as well as polysubstance use disorders. Cases (n=19) in the “borderline cluster” had borderline personality disorder and polysubstance use disorders. Illness severity (Y-BOCS-du: p=0.03) and impulsivity levels (UPPS-P: p=0.01) differed significantly between the clusters. The “alcohol cluster” had the highest illness severity and the “antisocial cluster reported the highest levels of impulsivity. Conclusion The findings of this contribute to the paucity data on impulsivity in MUD and may have implications for treatment. Understanding how these conditions cluster in MUD, and remaining cognizant of the demographic and clinical correlates of each cluster in MUD, could potentially enable clinicians to identify patients who are at higher risk for engaging in risky behaviors rendering them more vulnerable to treatment non-adherence or relapse
- ItemOpen AccessFunctional impairment in South African children and adolescents with obsessive-compulsive disorder(2009) Hoppe, Lara Judy; Thomas, Kevin; Lochner, ChristineThis research aimed to increase current understanding of functional impairment in children and adolescents with Obsessive-Compulsive Disorder (OCD). Twenty-six South African children and adolescents with OCD participated in the study. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (KSADS-PL), the Mini International Neuropsychiatric Interview For Children and Adolescents Version 5 (MINIKID5.0), the Children's Global Assessment Scale (CGAS), the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and the Child Obsessive-Compulsive Impact Scale-Revised (COIS-R) were used to assess the children's and adolescent's past and current psychopathology, OCD symptom severity and OCD-related functional impairment. Findings suggest that most of the children (88.46%) in this study had one or more comorbid disorders. Parents and children agreed on very few of the rating items common the COIS-R-P and COIS-R-C. Parents, however, consistently reported higher rates of significant problems than did their children. Correlations between the various instruments revealed that parents are more accurate than their children in rating their child's global impairment and OCD-specific impairment. Therefore, collateral information from parents is vital for the clinician to accurately assess and fully understand the child's OCD-related functional impairment. Moreover, the number of comorbid disorders, and whether the child had ADHD or not, did not impact on the COIS-R total scores, suggesting that the COIS-R is a useful measure to assess OCD-specific impairment. Parents and children both reported that the most significant domain of impairment is the school domain. Moreover, parents reported that the most significant functional problem is "concentrating on his/her work" and children reported that the most significant functional problem is "getting good grades." Findings from studies such as this help clinicians to have a better understanding of childhood OCD-related functional impairment, which helps them to accurately diagnose and treat children with OCD.
- ItemOpen AccessInequality and mental healthcare utilisation among first-year university students in South Africa(2020-01-25) Bantjes, Jason; Saal, Wylene; Lochner, Christine; Roos, Janine; Auerbach, Randy P; Mortier, Philippe; Bruffaerts, Ronny; Kessler, Ronald C; Stein, Dan JAbstract Background Addressing inequalities in mental healthcare utilisation among university students is important for socio-political transformation, particularly in countries with a history of educational exclusion. Methods As part of the WHO World Mental Health International College Student Initiative, we investigated inequalities in mental healthcare utilisation among first-year students at two historically “White” universities in South Africa. Data were collected via a web-based survey from first-year university students (n = 1402) to assess 12-month mental healthcare utilisation, common mental disorders, and suicidality. Multivariate logistic regression models were used to estimate associations between sociodemographic variables and mental healthcare utilisation, controlling for common mental disorders and suicidality. Results A total of 18.1% of students utilised mental healthcare in the past 12 months, with only 28.9% of students with mental disorders receiving treatment (ranging from 28.1% for ADHD to 64.3% for bipolar spectrum disorder). Of those receiving treatment, 52.0% used psychotropic medication, 47.3% received psychotherapy, and 5.4% consulted a traditional healer. Treatment rates for suicidal ideation, plan and attempt were 25.4%, 41.6% and 52.9%, respectively. In multivariate regression models that control for the main effects of mental health variables and all possible joint effects of sociodemographic variables, the likelihood of treatment was lower among males (aOR = 0.57) and Black students (aOR = 0.52). An interaction was observed between sexual orientation and first generation status; among second-generation students, the odds of treatment were higher for students reporting an atypical sexual orientation (aOR = 1.55), while among students with atypical sexual orientations, the likelihood of mental healthcare utilisation was lower for first-generation students (aOR = 0.29). Odds of treatment were significantly elevated among students with major depressive disorder (aOR = 1.88), generalised anxiety disorder (aOR = 2.34), bipolar spectrum disorder (aOR = 4.07), drug use disorder (aOR = 3.45), suicidal ideation (without plan or attempt) (aOR = 2.00), suicide plan (without attempt) (aOR = 3.64) and suicide attempt (aOR = 4.57). Likelihood of treatment increased with level of suicidality, but not number of mental disorders. Conclusion We found very low mental healthcare treatment utilisation among first-year university students in South Africa, with enduring disparities among historically marginalised groups. Campus-based interventions are needed to promote mental healthcare utilisation by first-year students in South Africa, especially among male and Black students and first-generation students with atypical sexual orientations.
- ItemOpen AccessPrevalence and sociodemographic correlates of common mental disorders among first-year university students in post-apartheid South Africa: implications for a public mental health approach to student wellness(2019-07-10) Bantjes, Jason; Lochner, Christine; Saal, Wylene; Roos, Janine; Taljaard, Lian; Page, Daniel; Auerbach, Randy P; Mortier, Philippe; Bruffaerts, Ronny; Kessler, Ronald C; Stein, Dan JAbstract Background There is growing awareness of the need for effective prevention, early detection, and novel treatment approaches for common mental disorders (CMDs) among university students. Reliable epidemiological data on prevalence and correlates are the cornerstones of planning and implementing effective health services and adopting a public health approach to student wellness. Yet, there is a comparative lack of sound psychiatric epidemiological studies on CMDs among university students in low- and middle-income countries, like South Africa (SA). It is also unclear if historically marginalised groups of students are at increased risk for mental health problems in post-apartheid SA. The objective of the study was to investigate the prevalence and sociodemographic correlates of lifetime and 12-month CMDs among university students in SA, with a particular focus on vulnerability among students in historically excluded and marginalised segments of the population. Methods Data were collected via self-report measures in an online survey of first-year students registered at two large universities (n = 1402). CMDs were assessed with previously-validated screening scales. Data were weighted and analysed using multivariate statistical methods. Results A total of 38.5% of respondents reported at least one lifetime CMD, the most common being major depressive disorder (24.7%). Twelve-month prevalence of any CMD was 31.5%, with generalised anxiety disorder being the most common (20.8%). The median age of onset for any disorder was 15 years. The median proportional annual persistence of any disorder was 80.0%. Female students, students who reported an atypical sexual orientation, and students with disabilities were at significantly higher risk of any lifetime or 12-month disorder. Female gender, atypical sexual orientation, and disability were associated with elevated risk of internalising disorders, whereas male gender, identifying as White, and reporting an atypical sexual orientation were associated with elevated risk of externalising disorders. Older age, atypical sexual orientation, and disability were associated with elevated risk of bipolar spectrum disorder. Conclusions Despite advances to promote greater social inclusion in post-apartheid SA, students who identify as female, students with atypical sexual orientations, and students with disabilities are nonetheless at increased risk of CMDs, although students who identify as Black and first-generation students are not.
- ItemOpen AccessProblematic use of the Internet is a unidimensional quasi-trait with impulsive and compulsive subtypes(2019-11-08) Tiego, Jeggan; Lochner, Christine; Ioannidis, Konstantinos; Brand, Matthias; Stein, Dan J; Yücel, Murat; Grant, Jon E; Chamberlain, Samuel RAbstract Background Problematic use of the Internet has been highlighted as needing further study by international bodies, including the European Union and American Psychiatric Association. Knowledge regarding the optimal classification of problematic use of the Internet, subtypes, and associations with clinical disorders has been hindered by reliance on measurement instruments characterized by limited psychometric properties and external validation. Methods Non-treatment seeking individuals were recruited from the community of Stellenbosch, South Africa (N = 1661), and Chicago, United States of America (N = 827). Participants completed an online version of the Internet Addiction Test, a widely used measure of problematic use of the Internet consisting of 20-items, measured on a 5-point Likert-scale. The online questions also included demographic measures, time spent engaging in different online activities, and clinical scales. The psychometric properties of the Internet Addiction Test, and potential problematic use of the Internet subtypes, were characterized using factor analysis and latent class analysis. Results Internet Addiction Test data were optimally conceptualized as unidimensional. Latent class analysis identified two groups: those essentially free from Internet use problems, and those with problematic use of the Internet situated along a unidimensional spectrum. Internet Addiction Test scores clearly differentiated these groups, but with different optimal cut-offs at each site. In the larger Stellenbosch dataset, there was evidence for two subtypes of problematic use of the Internet that differed in severity: a lower severity “impulsive” subtype (linked with attention-deficit hyperactivity disorder), and a higher severity “compulsive” subtype (linked with obsessive-compulsive personality traits). Conclusions Problematic use of the Internet as measured by the Internet Addiction Test reflects a quasi-trait - a unipolar dimension in which most variance is restricted to a subset of people with problems regulating Internet use. There was no evidence for subtypes based on the type of online activities engaged in, which increased similarly with overall severity of Internet use problems. Measures of comorbid psychiatric symptoms, along with impulsivity, and compulsivity, appear valuable for differentiating clinical subtypes and could be included in the development of new instruments for assessing the presence and severity of Internet use problems.
- ItemOpen AccessThe structural neurobiology of social anxiety disorder : a clinical neuroimaging study(2015) Hattingh, Coenraad Jacobus; Stein, Dan J; Lochner, Christine; Brooks, Samantha JWhile a number of studies have explored the functional neuroanatomy of social anxiety disorder (SAD), comparatively few studies have investigated the structural underpinnings in SAD. 18 psychopharmacologically and psychotherapeutically naïve adult patients with a primary Axis I diagnosis of generalized social anxiety disorder and 18 demographically (age, gender and education) matched healthy controls underwent 3T structural magnetic resonance imaging. A manual tracing protocol was specifically developed to compute the volume of the most prominent subcortical gray matter structures implicated in SAD by previous functional research. Cortical thickness was estimated using an automated algorithm and whole brain analyses of white matter structure were performed using FSL's tract - based spatial statistics comparing fractional anisotropy (FA), mean diffusivity (MD) in individuals with SAD. Manual tracing demonstrated that compared to controls, SAD patients showed an enlarged right globus pallidus. Cortical thickness analyses demonstrated significant cortical thinning in the left isthmus of the cingulate gyrus, the left temporal pole, and the left superior temporal gyrus. Analyses of white matter tractographic data demonstrated reduced FA in in the genu, splenium and tapetum of the corpus callosum. Additionally reduced FA was noticed in the fornix and the right cingulum. Reduced FA was also noted in bilateral corticospinal tracts and the right corona radiata. The results demonstrate structural alterations in limbic circuitry as well as involvement of the basal glanglia and their cortical projections and input pathways.
- ItemOpen AccessThe relationship between childhood adversity, recent stressors, and depression in college students attending a South African university(BioMed Central, 2018-03-09) Mall, Sumaya; Mortier, Philippe; Taljaard, Lian; Roos, Janine; Stein, Dan J; Lochner, ChristineBackground College students are at risk of depression. This risk may be increased by the experience of childhood adversity and/or recent stressors. This study examined the association between reported experiences of childhood adversity, recent stressors and depression during the last 12 months in a cohort of South African university students. Methods Six hundred and eighty-six first year students at Stellenbosch University in South Africa completed a health-focused e-survey that included items on childhood adversity, recent stressors and mood. Individual and population attributable risk proportions (PARP) between experiences of childhood adversity and 12-month stressful experiences and 12-month depression were estimated using multivariate binomial logistic regression analysis. Results About one in six students reported depression during the last 12 months. Being a victim of bullying and emotional abuse or emotional neglect during childhood were the strongest predictors of depression in the past year at both individual and population level. With regard to recent stressors, a romantic partner being unfaithful, serious ongoing arguments or break-ups with some other close friend or family member and a sexual or gender identity crisis were the strongest predictors of depression. The predictor effect of recent stressors was significantly reduced in the final model that adjusted for the type and number of childhood traumatic experiences. At a population level, academic stress, serious ongoing arguments or break-ups with a close friend or family member, and serious betrayal by someone close were the variables that yielded the highest PARP. Conclusions Our findings suggest a significant relationship between early adversity, recent stressors, and depression here and throughout, consistent with the broader literature on predictors of depression. This study contributes to the limited data on college students’ mental health in low and middle income countries including on the African continent. The findings provide information on the population level effect sizes of trauma as a risk factor for depression, as well as on the relationship between specific recent stressors and depression in college students.
- ItemOpen AccessToward identifying reproducible brain signatures of obsessive-compulsive profiles: rationale and methods for a new global initiative(2020-02-14) Simpson, Helen B; van den Heuvel, Odile A; Miguel, Euripedes C; Reddy, Y. C J; Stein, Dan J; Lewis-Fernández, Roberto; Shavitt, Roseli G; Lochner, Christine; Pouwels, Petra J W; Narayanawamy, Janardhanan C; Venkatasubramanian, Ganesan; Hezel, Dianne M; Vriend, Chris; Batistuzzo, Marcelo C; Hoexter, Marcelo Q; de Joode, Niels T; Costa, Daniel L; de Mathis, Maria A; Sheshachala, Karthik; Narayan, Madhuri; van Balkom, Anton J L M; Batelaan, Neeltje M; Venkataram, Shivakumar; Cherian, Anish; Marincowitz, Clara; Pannekoek, Nienke; Stovezky, Yael R; Mare, Karen; Liu, Feng; Otaduy, Maria C G; Pastorello, Bruno; Rao, Rashmi; Katechis, Martha; Van Meter, Page; Wall, MelanieBackground Obsessive-compulsive disorder (OCD) has a lifetime prevalence of 2–3% and is a leading cause of global disability. Brain circuit abnormalities in individuals with OCD have been identified, but important knowledge gaps remain. The goal of the new global initiative described in this paper is to identify robust and reproducible brain signatures of measurable behaviors and clinical symptoms that are common in individuals with OCD. A global approach was chosen to accelerate discovery, to increase rigor and transparency, and to ensure generalizability of results. Methods We will study 250 medication-free adults with OCD, 100 unaffected adult siblings of individuals with OCD, and 250 healthy control subjects at five expert research sites across five countries (Brazil, India, Netherlands, South Africa, and the U.S.). All participants will receive clinical evaluation, neurocognitive assessment, and magnetic resonance imaging (MRI). The imaging will examine multiple brain circuits hypothesized to underlie OCD behaviors, focusing on morphometry (T1-weighted MRI), structural connectivity (Diffusion Tensor Imaging), and functional connectivity (resting-state fMRI). In addition to analyzing each imaging modality separately, we will also use multi-modal fusion with machine learning statistical methods in an attempt to derive imaging signatures that distinguish individuals with OCD from unaffected siblings and healthy controls (Aim #1). Then we will examine how these imaging signatures link to behavioral performance on neurocognitive tasks that probe these same circuits as well as to clinical profiles (Aim #2). Finally, we will explore how specific environmental features (childhood trauma, socioeconomic status, and religiosity) moderate these brain-behavior associations. Discussion Using harmonized methods for data collection and analysis, we will conduct the largest neurocognitive and multimodal-imaging study in medication-free subjects with OCD to date. By recruiting a large, ethno-culturally diverse sample, we will test whether there are robust biosignatures of core OCD features that transcend countries and cultures. If so, future studies can use these brain signatures to reveal trans-diagnostic disease dimensions, chart when these signatures arise during development, and identify treatments that target these circuit abnormalities directly. The long-term goal of this research is to change not only how we conceptualize OCD but also how we diagnose and treat it.