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Biomedical subjects

Peter Tyrer

Publications and source records attributed to Peter Tyrer.

At least 37 records · Page 2Linked to original sources
PubMed2005

The problem of severity in the classification of personality disorder.

The articles in this series are very valuable but have one omission that is very important in clinical practice; they do not address the question of severity. In this article I argue that the measure of severity, using what are described as hybrid models, is a critical component of practice and can be recorded easily using standard systems, both existing and planned. In arguing this case I will use an exemplar, the Personality Assessment Schedule (PAS), mainly because we have so much data from this instrument, but emphasize that other assessment procedures can be easily adapted to produce similar severity assessments.

Factor Analysis, Statistical↗
PubMed2005

Temporal change: the third dimension of personality disorder.

Until fairly recently, almost everyone who learned about, or carried out research into, personality disorders was taken in by the notion that personality disorder was a stable entity whose main characteristic was persistence, at least between the time of adolescence to middle age. We also suspected that those with these disorders, unless they received specific and necessarily powerful interventions, would remain continuously handicapped. Now it is clear that change in personality is possible, often rapidly so in some groups, and undergoes dynamic development from its genesis in childhood onward, and, though often achieving equilibrium, can never be said to be fixed in its manifestations. Longitudinal studies also show that personality abnormality identified early in life, whether temporary or longer-lasting, has a major influence on mental development and disorder generally, and, while it is impossible to say at present whether this influence is causal, it does suggest that early intervention could confer long-term benefits. An initiative such as that currently developed for early intervention in psychosis is at least as apt for personality disorder.

Adolescent↗
PubMed2005

The Social Functioning Questionnaire: a rapid and robust measure of perceived functioning.

BACKGROUND: The Social Functioning Questionnaire (SFQ), an eight-item self-report scale (score range 0-24), was developed from the Social Functioning Schedule (SFS), a semi-structured interview which has been used primarily with non-psychotic patients and has good test-retest and inter-rater reliability as well as construct validity. The SFQ was developed following the need for a quick assessment of perceived social function. AIMS: To give further details of old and new data sets from studies involving over 4000 subjects assessed with the SFQ illustrating its epidemiological and clinical associations. METHOD: New data were analysed from a national epidemiological study, a comparison of key-worker and subject versions of the SFQ, and reanalysis of data from three earlier clinical studies, of psychiatric emergencies, general practice psychiatric patients and those with recurrent psychotic illnesses. These data were examined further to determine their range, their relationship to other clinical measures, and change over time in clinical trials. RESULTS: The population mean score in 4164 subjects was 4.6 and the data from all studies suggested that a score of 10 or more indicated poor social functioning. Those presenting as psychiatric emergencies had the poorest social function (mean 11.4) and psychiatric patients from general practice the best function (mean 7.7) of the clinical populations. The eight item scores had a normal distribution in psychiatric populations and a skewed one in a normal population; scores were relatively stable over the short (weeks) and long-term (months), and were high in the presence of acute mental health disturbance and personality disorder, giving support to the validity of the scale. The results from a UK sample of a randomly selected population specifically weighted for ethnic minorities showed similar social function across groups.

Ethnicity↗
PubMed2005

Managing mood disorders and comorbid personality disorders.

PURPOSE OF REVIEW: To examine the influence of personality disorder comorbidity on the general treatment of mood disorders. RECENT FINDINGS: Personality disorders generally have a negative influence on outcome of mood disorders, both unipolar and bipolar. When the personality features are addressed, however, the outcome is less negative. Recent studies suggest a special role for psychological and educational therapies in the treatment of these comorbid disorders. SUMMARY: The assessment of, and attention to, the management of personality disorder as well as concurrent mood disorder may improve outcome.

Journal Article↗
PubMed2004

Predicting violence in schizophrenia: a prospective study.

BACKGROUND: People with schizophrenia are more violent than the general population, but this increased risk is attributable to the actions of a small subgroup. Identifying those at risk has become an essential part of clinical practice. AIMS: To estimate the risk factors for assault in patients with schizophrenia. METHODS: Two hundred seventy-one patients with schizophrenia were interviewed using an extensive battery of instruments. Assault was measured from multiple data sources over the next 2 years and criminal records were obtained. Multiple sociodemographic and clinical variables measured at baseline were examined as possible predictors of assault during follow-up. RESULTS: Sixty-nine (25%) patients committed assault during the 2-year follow-up. The model that best predicted assault included a history of recent assault (OR 2.33, 95% CI 1.17-4.61), a previous violent conviction (OR 2.02, 95% CI 1.04-3.87), having received special education (OR 2.76, 95% CI 1.22-6.26) and alcohol abuse (OR 3.55, 95% CI 1.24-10.2). CONCLUSIONS: Previously established risk factors including a history of violence and alcohol abuse are replicated in this study. Although low premorbid IQ did not predict violence, a need for special education did.

Adolescent↗
PubMed2004

The Nottingham Study of Neurotic Disorder: predictors of 12-year outcome of dysthymic, panic and generalized anxiety disorder.

BACKGROUND: Controlled prospective studies of the simultaneous long-term outcome of several mental disorders are rare. This study sought to determine if there were important differences between the outcome of anxiety and depressive disorders after 12 years and to examine their main predictors. METHOD: A cohort of 210 people seen in general practice psychiatric clinics with a DSM-III diagnosis of generalized anxiety disorder (71), panic disorder (74), or dysthymic disorder (65), including combined anxiety-depressive disorder (cothymia) (67) was followed up after 12 years. Interview assessments of symptoms, social functioning and outcome were made, the latter using a new scale, the Neurotic Disorder Outcome Scale. Seventeen baseline predictors were also examined. RESULTS: Data were obtained from 201 (96 %) patients, 17 of whom had died. Only 73 (36 %) had no DSM diagnosis at the time of follow-up. Using univariate and stepwise multiple linear regression those with cothymia, personality disorder, recurrent episodes and greater baseline self-rated anxiety and depression ratings had a worse outcome than others; initial diagnosis did not contribute significantly to outcome and instability of diagnosis over time was much more common than consistency. CONCLUSION: Only two out of five people with the common neurotic disorders have a good outcome despite alleged advances in treatment. Those with greater mood symptoms and pre-morbid personality disorder have the least favourable outcome. It is suggested that greater attention be paid to the concurrent treatment of personality disorder and environmental factors rather than symptoms as these may be the real cause of apparent treatment resistance.

Adult↗
PubMed2004

Common mental disorders and ethnicity in England: the EMPIRIC study.

BACKGROUND: There is little population-based evidence on ethnic variation in the most common mental disorders (CMD), anxiety and depression. We compared the prevalence of CMD among representative samples of White, Irish, Black Caribbean, Bangladeshi, Indian and Pakistani individuals living in England using a standardized clinical interview. METHOD: Cross-sectional survey of 4281 adults aged 16-74 years living in private households in England. CMD were assessed using the Revised Clinical Interview Schedule (CIS-R), a standardized clinical interview. RESULTS: Ethnic differences in the prevalence of CMD were modest, and some variation with age and sex was noted. Compared to White counterparts, the prevalence of CMD was higher to a statistically significant degree among Irish [adjusted rate ratios (RR) 2.09, 95% CI 1.16-2.95, p = 0.02] and Pakistani (adjusted RR 2.38, 95 % CI 1.25-3.53, p = 0.02) men aged 35-54 years, even after adjusting for differences in socio-economic status. Higher rates of CMD were also observed among Indian and Pakistani women aged 55-74 years, compared to White women of similar age. The prevalence of CMD among Bangladeshi women was lower than among White women, although this was restricted to those not interviewed in English. There were no differences in rates between Black Caribbean and White samples. CONCLUSIONS: Middle-aged Irish and Pakistani men, and older Indian and Pakistani women, had significantly higher rates of CMD than their White counterparts. The very low prevalence of CMD among Bangladeshi women contrasted with high levels of socio-economic deprivation among this group. Further study is needed to explore reasons for this variation.

Adolescent↗
PubMed2004

Prevalence of personality disorder in alcohol and drug services and associated comorbidity.

AIMS: To compare the prevalence of personality disorder in alcohol and drug populations with special attention to its impact on psychopathology and service characteristics. DESIGN: Cross-sectional survey. SETTING: Three alcohol and four drug services in four urban UK centres. PARTICIPANTS: Two hundred and sixteen drug and 64 alcohol service patients randomly sampled from current treatment populations. MEASUREMENTS: A treatment population census recorded demographic and diagnostic data. Patient interviews assessed the presence, cluster type and severity of personality disorder using the Quick Personality Assessment Schedule (PAS-Q). Other psychopathology was measured using the Comprehensive Psychopathological Rating Scale (CPRS). A case-note audit recorded psychotic psychopathology using the OPCRIT schedule and data regarding social morbidity. FINDINGS: The overall prevalence of personality disorder was 37% in the drug service sample and 53% in the alcohol service sample. The distribution of severity and clusters differed markedly between the two samples. There was a significant association between the severity of personality disorder and psychopathology in both samples. Levels of morbidity associated with clusters B and C were similar. Clinical diagnosis of personality disorder showed high specificity but low sensitivity when compared to PAS-Q. CONCLUSIONS: In both alcohol and drug service populations, personality disorder is associated with significantly increased rates of psychopathology and social morbidity that worsens with increasing severity of the disorder. Despite this, personality disorder is poorly identified by clinical staff. The PAS-Q may be useful as a clinical assessment tool in the substance misuse population for the early identification and management of patients with personality disorder.

Comorbidity↗
PubMed2004

The Dependent Personality Questionnaire (DPQ): a screening instrument for dependent personality.

BACKGROUND: There are no specific instruments for rating dependent personality, although this may be an important subject in clinical practice, where knowledge of dependent personality features may influence treatment. AIMS: To develop a simple self-rating questionnaire for dependent personality features and compare the findings in two groups, one with and one without established dependent personality disorder. METHOD: An 8-item Dependent Personality Questionnaire (DPQ) was developed and its acceptability and validity tested by administration to 30 psychiatric patients, half of whom had dependent personality disorder using clinical and research data, and the other 15 (pair-matched for age and sex) having other psychiatric diagnoses (including other personality disorders) but no dependent personality features. RESULTS: The mean score on the dependent personality questionnaire (DPQ) was 13.7 in those with dependent personality disorder and 7.5 in those without such a disorder (p < .005). The DPQ was also a good predictor of the diagnosis of dependent personality disorder, with sensitivity, specificity, predicted positive, and predicted negative accuracies of 87%. CONCLUSIONS: The results suggest that the DPQ may be a suitable screening instrument for dependent personality characteristics.

Adult↗
PubMed2004

Differential effects of manual assisted cognitive behavior therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT study.

A total of 480 patients were treated in a large, multicenter randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behavior therapy (MACT) versus treatment as usual (TAU) for recurrent deliberate self-harm. Each patient was randomized after a self-harm episode assessed at an accident and emergency center and followed up over 1 year. The main hypothesis tested was that those allocated to MACT would have a lower proportion of self-harm episodes in the succeeding year. A total of 60% of those allocated to MACT had face-to-face treatment and 430 (90%) of all patients had self-harm data recorded after 1 year. Although the results showed no significant difference between those repeating self-harm in the MACT group (39%) compared with the TAU group (46%) (P = 0.20), the treatment was cost effective (10% cheaper than TAU) and the frequency of self-harm episodes was fewer (50%) in the MACT group. A total of nine of 10 patients had some personality disturbance (42% of these with disorder), and for those where information on parasuicide events was collected, the proportion having a repeat episode ranged from 33% to 63% for different personality disorders. Those with BPD were most likely to repeat episodes quickly (mean 89 days for 25% to repeat) with dissocial personality disorder (equivalent mean 384 days) the slowest to repeat. Total costs were significantly greater in those with personality disorder and were reduced in those allocated to MACT; this saving was reversed in those with borderline disorder. On average, MACT appeared to increase the cost of those patients with BPD (BPD) and reduce the cost of those with other personality disorders. It is concluded that MACT has value in preventing self-harm cost effectively but this appears to be confined mainly to those who do not have BPD.

Adult↗
PubMed2004

Personality disorder and future-directed thinking in parasuicide.

Parasuicide patients have been found to lack positive expectations for the future. The aim of the present study was to look at variations in this lack of positive future-thinking as a function of personality status. A sample (N = 442) of repeat parasuicide patients was assessed on positive and negative future-thinking and the presence of personality disorder or personality difficulty. Those with a Cluster B personality disorder (borderline or dissocial) were significantly lower in positive future-thinking than those with no Cluster B symptoms or those with Cluster B personality difficulty. Neither Cluster A nor Cluster C symptomatology was related to positive future-thinking. Negative future-thinking was not significantly related to any type of personality disorder or difficulty. The results are interpreted as evidence of the importance of personality status in influencing positive future-thinking and gives some indications of why those with Cluster B personality disorder have such high rates of recurrent self-harm.

Adult↗
PubMed2003

The value of therapeutic communities in the treatment of personality disorder: a suitable place for treatment?

In the United Kingdom, a government program investigating the links between offending and personality disorder has stimulated renewed interest in the treatment of personality disorders. One psychosocial treatment option for patients with personality disorders is the therapeutic community (TC). In 2000, the authors conducted a small qualitative study with a sample of psychiatrists which suggested that TCs were not well understood and that the status of evidence on efficacy might be partly responsible for low referral numbers. This article reviews the evidence for the efficacy and cost-effectiveness of TCs as a treatment for personality disorders and considers which types of disorders are amenable to TC treatment. We conclude that there is a strong case for more rigorous evaluation and that some of the difficulties anticipated in applying randomized clinical trial (RCT) methodology to the study of TCs could be overcome.

Journal Article↗
PubMed2003

Service variation in baseline variables and prediction of risk in a randomised controlled trial of psychological treatment in repeated parasuicide: the POPMACT Study.

The treatment protocol and baseline characteristics of 480 subjects with a history of repeated parasuicide recruited in five centres to a randomised therapeutic trial of manual assisted cognitive-behaviour therapy (MACT) and treatment as usual (TAU) are described. Most patients had significant anxiety and depressive disturbance with 42% having a personality disorder. Variation in service policies influenced recruitment, with earlier assessment centres seeing people with more frequent episodes of self-harm and greater parasuicide risk than later ones. Parasuicide risk was also significantly greater in those with their first parasuicide episode at an earlier age and in those with a more recent latest episode.

Adult↗
PubMed2003

Impact of comorbid personality disorder on violence in psychosis: report from the UK700 trial.

BACKGROUND: The impact of comorbid personality disorder on the occurrence of violence in psychosis has not been fully explored. AIMS: To examine the association between comorbid personality disorder and violence in community-dwelling patients with psychosis. METHOD: A total of 670 patients with established psychotic illness were screened for comorbid personality disorder. Physical assault was measured from multiple data sources over the subsequent 2 years. Logistic regression was used to assess whether the presence of comorbid personality disorder predicted violence in the sample. RESULTS: A total of 186 patients (28%) were rated as having a comorbid personality disorder. Patients with comorbid personality disorder were significantly more likely to behave violently over the 2-year period of the trial (adjusted odds ratio=1.71, 95% CI 1.05-2.79). CONCLUSIONS: Comorbid personality disorder is independently associated with an increased risk of violent behaviour in psychosis.

Adult↗