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PubMedDate not supplied

Antihypertensive medication adherence and blood pressure control in patients with psychotic disorders compared to persons without psychiatric illness.

The authors compared antihypertensive medication adherence and blood pressure control among middle-aged and older outpatients with schizophrenia and related those with psychotic disorders versus persons without any psychiatric illness. A total of 178 subjects were included in the investigation (89 patients with a psychotic disorder and 89 randomly selected, age-matched comparison subjects). Although the two groups had similar antihypertensive medication adherence, the patients with a psychotic disorder were significantly less likely to have had controlled blood pressure during the 1-year study period. The results highlight the need for clinicians to monitor closely the management of medical comorbidity in patients with schizophrenia and related disorders.

Aged↗
PubMed2005

Personality and comorbidity of common psychiatric disorders.

BACKGROUND: We know little about the degree to which comorbidity, socommonly seen among psychiatric disorders, arises from variation in normal personality. AIMS: To study the degree to which variation in normal personality accounts for the comorbidity of eight common psychiatric and substance use disorders. METHOD: Internalising disorders (major depression, generalised anxiety and panic disorders, phobias), externalising disorders (alcohol and drug dependence, antisocial personality and conduct disorders) and personality dimensions of neuroticism, extraversion and novelty seeking were assessed in 7588 participants from a population-based twin registry. The proportion of comorbidity explained by each personality dimension was calculated using structural equation modelling. RESULTS: Neuroticism accounted for the highest proportion of comorbidity within internalising disorders (20-45%) and between internalising and externalising disorders (19-88%). Variation in neuroticism and novelty seeking each accounted for a modest proportion (10-12% and 7-14%, respectively) of the comorbidity within externalising disorders. Extraversion contributed negligibly. CONCLUSIONS: High neuroticism appears to be a broad vulnerability factor for comorbid psychiatric disorders. Novelty seeking is modestly important for comorbid externalising disorders.

Adult↗
PubMed2006

The validity of Cloninger's psychobiological model versus the five-factor model to predict DSM-IV personality disorders in a heterogeneous psychiatric sample: domain facet and residualized facet descriptions.

The validity of Cloninger's psychobiological model and the Five-Factor Model of personality to predict DSM-IV personality disorders was examined in a psychiatric in-patient sample of 130 individuals. Patients completed Dutch authorized versions of the TCI (Cloninger, Svrakic, & Przybeck, 1993) and the NEO PI-R (Costa & McCrae, 1992) and were also administered the ADP-IV (Schotte & De Doncker, 1994), a Dutch self-report questionnaire to assess Axis-II disorders. No personality-descriptive model proved to be superior in explaining personality disorder symptoms at the higher-order level: the TCI dimensions better explained the Obsessive-Compulsive and the Narcissistic disorders, whereas the FFM accounted for more variance of the Avoidant disorder. However, differences were apparent at the lower-order level with the NEO facets out performing the TCI subscales for six to four personality disorders. FFM facet-level predictions of Widiger, Trull, Clarkin, Sanderson, and Costa (2002) were partially confirmed, with substantially better results using residualized facet scores. A set of TCI subscale personality disorder relationships is suggested.

Adolescent↗
PubMed1993

Psychotherapy of the victims of massive violence: countertransference and ethical issues.

Psychotherapy with severely traumatized patients is a long, draining process that often produces strong countertransference reactions. It is difficult to therapeutically and ethically handle these personal responses. We feel that at different stages in therapy different ethical principles should guide the therapy. At the early stages, fidelity and nonmaleficence should be the guiding principles. As trust and confidence develop, therapists may have more personal freedom to act; beneficence, i.e., providing specific confident care then becomes the primary ethical principle. In later stages of therapy, promoting the principles of autonomy and justice come into play. As therapy further progresses, therapists' own needs, the principle of self-interest, may be utilized in the therapeutic relationship. Throughout therapeutic contacts with traumatized patients, therapists need to monitor their own needs, and find appropriate ways outside of therapy to cope with these often intense feelings. Continuing to feel therapeutically competent and ethically grounded, yet maintaining the personal strength and balance to treat traumatized patients, pose major challenges for therapists.

Adult↗
PubMed1997

Extent of comorbidity between mental state and personality disorders.

Comorbidity between major psychiatric disorders (Axis I) and personality disorders (Axis II) is widespread, often extremely strong, and invariably confusing. The strongest associations are found between substance use and the cluster B (flamboyant) personality disorders, anxiety disorders and the anxious/fearful personality group (cluster C), and between somatisation and both cluster B and C disorders. The significance of these associations is far from clear, and almost certainly include more than one type of relationship. Empirical studies of patients with and without Axis I and II comorbidity show that the presence of a personality disorder can affect the outcome of treatment, both positively and negatively, in a way that currently appears unpredictable. One useful way of interpreting this comorbidity is by postulating personality dispositions that make some people prone to certain mental state disorders.

Comorbidity↗
PubMed2006

[Forensic psychiatric patients in Denmark].

INTRODUCTION: In Denmark the number of forensic psychiatric patients is increasing. The objective of this study was to explore whether the increased number of forensic psychiatric patients has been reflected in the use of psychiatric inpatient facilities. Furthermore, we wanted to investigate differences in the treatment of various diagnostic groups of forensic patients and of forensic and non-forensic patients with schizophrenia. MATERIALS AND METHODS: Information about admissions and outpatient contact was extracted from the Danish Psychiatric Central Research Register for all Danish patients sentenced to psychiatric treatment in the period 1994-2003. Furthermore, a group of first-admission forensic patients suffering from schizophrenia was compared to a control group of first-admission non-forensic patients with schizophrenia, matched for sex, age and time of admission. RESULTS: The number of forensic psychiatric patients increased markedly in the period 1994-2003; at the same time, the use of inpatient facilities for this group of patients did not increase to a similar degree but actually decreased. Forensic patients in the group F20-F29 spent more time in hospital than did forensic patients with affective disorders and personality disorders. Forensic psychiatric patients with schizophrenia had significantly longer periods of hospitalization than did non-forensic patients with schizophrenia. CONCLUSION: Forensic psychiatric patients' use of psychiatric inpatient facilities during the last 10 years did not increase to the extent expected relative to the increasing number of forensic psychiatric patients. This raises the question of whether these patients are receiving necessary and sufficient treatment.

Adult↗
PubMed1998

Psychiatric illness in mentally retarded adolescents: clinical features.

Attempts have been made to establish objective diagnostic criteria for psychiatric disorders in persons with mental retardation. This paper describes the clinical features of the most important psychiatric disorders in mentally retarded adolescents: mood disorders, psychotic disorders, severe behavioral disorders, personality disorders, anxiety disorders, and attention deficit disorder with hyperactivity. The impact of mental retardation on personality development is confirmed by the high psychopathological vulnerability of the mentally retarded. All types of mental disorders can be observed, with an incidence estimated to be at least three or four times higher than in the general population. Adolescence is a particularly important phase for the mentally retarded, since adolescent turmoil can increase the risk of psychopathology.

Adolescent↗
PubMed2002

Preventive detention must be resisted by the medical profession.

A policy of "preventive detention" has recently been debated in the British Parliament. Alarmed by the high-profile criminal activities of people suspected of having dangerous severe personality disorder (DSPD), the government have made clear their intention to "indeterminately but reviewably detain" people with DSPD, after diagnosis by forensic psychiatrists, even if the individuals are yet to commit an offence. Such a policy may improve the safety of the public, but has obvious implications for civil liberties. This essay criticises the morality of the government's intention and rejects the notion that the medical profession could ethically collude with such a policy.

Attitude of Health Personnel↗