R T Mulder — Page 4 | Search PubMed

PubMedDate not supplied

Temperament and early environment influence comorbidity and personality disorders in major depression.

Measures of temperament and early environment were obtained from 108 patients with major depression using the Tridimensional Personality Questionnaire (TPQ) and Parental Bonding Instrument (PBI). TPQ and PBI measures distinguished between depressed patients and controls. Depressed patients with comorbid axis I disorders appear to be temperamentally different from those who do not have these disorders. Those with alcoholism have higher novelty seeking (NS) scores; those with panic disorder have higher harm avoidance (HA) scores; and those with simple phobia have higher persistence (P) scores. More than half the patients had an axis II disorder. Those with a comorbid personality disorder recall worse parental care and have lower reward dependence (RD) scores. Individual personality disorders and DSM-III-R personality disorder clusters reflect to a significant degree underlying temperament as measured by the TPQ. These results suggest that it is possible to better understand the patterns of comorbidity between major depression, other axis I disorders, and personality disorders by studying the underlying temperament dimensions in these patients.

Adolescent↗

PubMedDate not supplied

Identifying personality disorders: towards the development of a clinical screening instrument.

The study objective was to identify a set of personality disorder (PD) criteria from the DSM PD diagnostic sets that can be used to detect subjects with an increased likelihood of having a PD diagnosis. In a series of outpatients evaluated systematically in two waves for every criteria item for 12 DSM-III-R PDs, stepwise logistic regression identified 45 criteria as discriminative for their specific PDs, which are selected for further analysis to assess their ability to discriminate for any PD. Receiver operating characteristic (ROC) analysis is used to evaluate their discriminative power in an independent conjoined sample (N = 1,342) from six centers that assessed every PD criteria item by structured instrument (Structured Clinical Interview for DSM-III-R PDs [SCID-II, Personality Disorder Examination [PDE], and Structured Interview for DSM-III-R PDs [SIDP-R]). The cutoff that maximizes information gain is used to determine the diagnostic threshold (DT). Initially, 15 of 45 criteria are identified. At the 0.43 PD prevalence, a DT of 2 or more of the 15 PD criteria across samples is optimal. The maximum information gain (MIG) is .42 bits, and the AUR is 0.94+/-.007. Other performance indices at this cutoff are .90 sensitivity, .84 specificity, .81 positive predictive power (PPP), .91 negative predictive power (NPP), and .86 hit rate (HR). Taken collectively, the 15 PD criteria selected by the data reduction techniques suggest a narrowed set to be assessed in screening for the presence or absence of any PD with comparable or better psychometric properties than other tests routinely used for diagnosing medical and psychiatric disorders. If specific PD categorization is needed, a second-step comprehensive assessment should follow.

Algorithms↗