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PubMedDate not supplied

Left turning (swivel) in medicated chronic schizophrenic patients.

34 medicated schizophrenic inpatients, 34 normal control subjects, 18 affective disorder patients (four in manic phase), nine schizoid personality disorder subjects, and nine anxiety/histrionic disorder patients were tested on a two-button task which required turning 180 degrees to collect coin reinforcers. Schizophrenic patients turned consistently left (16 times) significantly more (nine of 34) than normal controls, all of whom turned consistently right (chi 2 = 10.37, P = 0.005). Schizophrenic patients also turned left significantly more than the 18 affective disorder subjects, all of whom turned consistently right (chi 2 = 5.76, P = 0.02). All schizoid personality disorder subjects turned consistently right, and eight of nine anxiety histrionic disorder subjects turned consistently right. Left turning was not correlated with any other variables measured, including handedness, demographic, diagnostic and symptom variables. Left rotation has been previously measured during free ambulation in acute, non-medicated patients (Bracha, Biol. Psychiatry 22 (1987), 995-1003). Left turning bias in a subset of medicated, chronic schizophrenic inpatients may be linked to an underlying asymmetric striatal dopaminergic activity, specifically, an ipsilateral hypoactivity or contralateral hyperactivity, which would lead to left turning and right hemi-spatial neglect.

Adult↗
PubMed1990

Reliability and validity of the structured interview for personality disorders in adolescents.

The Structured Interview for the DSM-III Personality Disorders was administered to 23 currently affectively ill adolescents and their parents. Interviews were videotaped and rerated; interrater agreement was moderate (weighted K = 0.49; unweighted K = 0.59). Moreover, there was evidence of convergent validity for Cluster II traits and disorders (borderline, histrionic, narcissistic), insofar as these diagnoses were associated with higher scores on the novelty-seeking subscale of the Tridimensional Personality Questionnaire as predicted. Cluster II patients tended to have higher rates of attention deficit disorder and bipolar disorder, and higher rates of suicidal gestures among second-degree relatives. Some difficulty was encountered differentiating symptoms of affective illness from those of personality disorder and in deciding when personality traits were impairing enough to call them disorders. Reliability may be improved by: (1) interviewing patients when out of affective episode; and (2) using standardized functional impairment criteria for differentiating personality style from disorder. Additional work is advocated to learn if personality disorders are precursors, epiphenomena, or the consequences of affective disorder.

Adjustment Disorders↗
PubMed1991

Antisocial behavior and personality disorders.

Present classifications fall short of helping clinicians to systematically approach syndromes of antisocial (A-S) behavior. Various clinical forms of A-S behavior derive from different levels of personality organization (normal, neurotic, and borderline level) whereas certain personality disorders (PD) display specific antisocial "profiles" and form the horizontal continuum of antisocial behavior. The borderline level of personality and pathological narcissism stand behind A-S PD, Narcissistic PD, and Histrionic PD. The authors propose that the disorders should be regarded as spectrum disorders. Paranoid PD and "pure" Borderline PD complete the list of PDs manifesting A-S behaviors. Finally, diagnostic instruments for clinical approach to and research of A-S PD are presented.

Antisocial Personality Disorder↗
PubMedDate not supplied

[Relations between mood disorders and personality. Recent data].

In the field of studies of links between mood disorders and personality, the need to study only completely remitted patients has been demonstrated recently. Indeed, the clinically depressed state strongly influences the assessment of some personality traits in a more pathological direction (for instance for emotional stability, extraversion, interpersonal dependency, ego strength). The studies concerning unipolar depression have been mainly made according to two methodological approaches which results are relatively consistent. The first one uses batteries of standard self-report personality inventories such as the Hirschfeld and Klerman battery which includes the Guilford-Zimmerman Temperament Survey, the Interpersonal Dependency Inventory, the shortened version of the Lazare-Klerman-Armor Personality Inventory and two subscales of the MMPI. This approach shows that compared to normal population, recovered depressive, have less emotional strength more interpersonal dependency and a more introverted personality. The second approach uses diagnostic criteria of personality disorders according to DSM III. The clinical evaluation can be performed with the help of the Structured Interview for DSM III Personality Disorders (SIDP) or with of the help the Millon Clinical Multiaxial Inventory (MCMI), a self rated questionnaire. The most frequent personality disorder among recovered unipolar patients is dependent personality, followed by the avoidant and histrionic personalities and lastly the schizoïd, schizotypal, borderline, compulsive and passive-aggressive personalities. But the interpretation of all these results must be cautious given that a recent study dealing with premorbid personality invites one to consider that not only depression influences personality assessment during illness, but also that depression may result in personality change after recovery. Few studies are available concerning bipolar patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Depressive Disorder↗
PubMed1987

Was Queen Victoria depressed? 1. Natural history and differential diagnosis of presenting problem.

For some years we have speculated as to whether Queen Victoria suffered a definable psychiatric illness in her notorious and prolonged seclusion after the Prince Consort's death. We here summarize criteria for grief and depression from three authorities. Against these, we examine the natural history of the Queen's bereavement and restitution. We find that her suffering and her portrayal of the role of widow were related to her personal style and were culturally accepted. Her self-esteem, ego functions, and object relatedness were preserved. While some clinicians might favour a diagnosis of Dysthymic Disorder, we find the evidence strongly in favour of an intense, prolonged, normal human grief (Uncomplicated Bereavement of DSM III) coloured by a romantic and histrionic personal style. Intensity and duration do not, in this case, establish a diagnosis of depression.

Depressive Disorder↗
PubMedDate not supplied

Clinicians' practices in personality assessment: does gender influence the use of DSM-III axis II?

We assessed clinicians' practices in the process of personality assessment according to DSM-III axis II criteria. Forty-six clinicians rated personality traits and disorders on two versions of a clinical profile constructed to meet DSM-III axis II diagnoses of histrionic, narcissistic, borderline, and dependent, differing only in the sex of the patient. Clinicians tended to use only a single diagnostic category and to make significantly different personality attributions and diagnoses depending on the patient's sex. The sex of the clinician had no impact on the process. We conclude that clinicians viewing a case study tend to make global judgments about personality disorders and are influenced by the patient's gender, even when it has no known relevance. We interpret these findings in terms of critical set theory.

Diagnosis, Differential↗
PubMedDate not supplied

[Panic disorder--psychobiological aspects of personality dimensions].

INTRODUCTION: Attempts to understand the underlying mechanisms of association between psychological factors and panic disorder have been mostly based on psychodynamic description. Evidence of the importance of serotonergic (5-HT) system in panic disorder (PD), however, has substanti ally increased in recent years. OBJECTIVE: The objective of our study was to determine whether there was a specific personality profile of panic disorder patients and how it was related to possible neurobiological mechanisms underlying personality dimensions. PATIENTS AND METHODS: Sample consisted of 14 inpatients with ICD-X diagnosis of panic disorder and 34 healthy control subjects. Personality dimensions were assessed by Minnesota Multiphasic Personality Inventory (MMPI-201) and Tridimensional Personality Questionnaire (TPQ). To assess central 5-HT function, platelet monoamine-oxidase (MAO) activity was measured. RESULTS: In panic disorder group, higher scores of histrionic, depressive and hypochondriac subscales and significant increase of harm avoidance (HA) scale as well as low MAO activity were found. Negative correlation was established between MAO activity and psychopathic deviance MMPI scale. CONCLUSION: The obtained results might indicate a specific personality profile of patients with panic disorder, which is characterized by high neuroticism, fearfulness, inhibition, shyness and apprehensive worry. Low MAO activity and high HA scores possibly indicate underlying hyperserotonergic state. The observed correlation between personality traits and MAO activity provide additional support for the hypothesized functional relationship between underlying central monoaminergic activity and temperament traits associated with anxiety, depression and impulsivity.

Adult↗
PubMedDate not supplied

Is the diagnosis of hysterical psychosis justified?: Clinical study of hysterical psychosis, reactive/psychogenic psychosis, and schizophrenia.

Using the method of a "blind" retrospective evaluation of clinical charts, 21 female patients with hysterical psychosis were compared with 21 patients diagnosed as suffering from nonhysterical reactive/psychogenic psychosis and 42 patients diagnosed as schizophrenic according to the Ninth Revision of the International Classification of Diseases (ICD-9). All three groups were restricted to first admissions and matched with regard to sex, age, and year of admission. Many significant differences were found between hysterical psychosis and schizophrenia; the only significant differences between hysterical and nonhysterical reactive/psychogenic psychosis were the presence of histrionic personality and the frequent shift in symptomatology in the former. Thus, both disorders seem to be identical.

Adolescent↗
PubMed1990

The relationship between the MCMI personality scales and DSM-III, axis II.

Compared were the personality scales of the Millon Clinical Multiaxial Inventory (MCMI) to the diagnosis of personality disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. [DSM-III]; American Psychiatric Association, 1980), obtained by means of the Structured Interview for the DSM-III Personality Disorders (SIDP). The results from 272 psychiatric outpatients show a good correspondence for the Avoidant and the Dependent scales, a fairly good correspondence for the Schizotypal, the Histrionic, the Borderline, the Narcissistic, and the Paranoid scales, and no correspondence for the Schizoid, the Passive-Aggressive, and the Compulsive scales. The Passive-Aggressive scale seems to be positively correlated to personality disorders in general, whereas the Compulsive scale seems to be negatively correlated to a number of personality disorders.

Adolescent↗
PubMed1999

Anxious-bipolar comorbidity. Diagnostic and treatment challenges.

This article describes multiple anxiety comorbidity in the setting of unstable bipolar syndromes, associated with alcohol and substance abuse. Also described are panic attacks during mania, social phobia followed by hypomania as well as bipolar disorder manifesting as episodic obsessive-compulsive disorder. The use of psychotropic combinations is necessary because of the syndromic complexity and the contrasting effects of pharmacologic treatments. The identification of differential patterns of comorbidity may provide important information in distinguishing more homogeneous clinical subtypes of affective disorders from the genetic, temperamental, and therapeutic point of view. The pattern of complex relationships among these disorders requires better-designed prospective observations. This is also true for putative temperamental (e.g. cyclothymia, interpersonal sensitivity) and personality (e.g. histrionic and borderline) factors, which might play a predisposing role in several clinically comorbid syndromes.

Adult↗
PubMedDate not supplied

A comparison of DSM-III personality disorders in panic/agoraphobia and obsessive-compulsive disorder.

One hundred eighty-seven patients meeting DSM-III criteria for panic disorder (161 with agoraphobia) and 51 patients meeting DSM-III criteria for obsessive-compulsive disorder (OCD) were assessed with the Personality Diagnostic Questionnaire (PDQ), a self-rating scale designed to assess axis II personality disorders and traits. The results showed that the personality profiles were similar between the two diagnostic groups and that the major personality characteristics identified in panic/agoraphobic patients, e.g., avoidant, dependent, histrionic, and borderline, were more pronounced in patients with OCD. These findings support our earlier suggestion of a nonspecific link between panic disorder/agoraphobia and personality disorder (PD)/traits.

Adult↗
PubMed1993

Cluster B personality disorder characteristics predict outcome in the treatment of bulimia nervosa.

The Personality Disorders Examination (PDE) was administered to 71 bulimia nervosa patients at baseline assessment in a study comparing the effectiveness of cognitive-behavioral treatment with desipramine or the combination of both treatments. Personality disorder subscales were combined into single DSM-III-R cluster scores. A high cluster B score (consisting of antisocial, borderline, histrionic, and narcissistic features) significantly predicted poor outcome at 16 weeks and was a better predictor of outcome than borderline personality characteristics alone or any other DSM-III-R cluster score or combination of cluster scores. In contrast pretreatment depression level, self-esteem, degree of dietary restraint, frequency of purging, and history of anorexia nervosa were not significantly related to outcome. At 1-year follow-up there was still a trend toward high cluster B scores predicting poor treatment outcome. Cluster B score was not significantly correlated with percentage of sessions attended nor did subjects with higher cluster B scores have a better outcome with either specific treatment. These results suggest that further investigation of alternative treatments is warranted with high cluster B individuals to determine if treatment effectiveness can be improved.

Adolescent↗
PubMed1999

Personality, personality disorders, and defense mechanisms.

The prototype approach was used to assess the presence of personality features associated with borderline, narcissistic, histrionic, and psychopathic personality syndromes in a sample of 91 young adults from the Block and Block (1980) longitudinal study. These personality prototypes were found to be related to the use of denial and projection, and especially to the immature manifestations of those defenses, in ways consistent with theory.

Adult↗
PubMedDate not supplied

Correlates of DSM-III personality disorder in obsessive-compulsive disorder.

Forty-three patients with primary obsessive-compulsive disorder (OCD) completed the Personality Diagnostic Questionnaire (PDQ), a self-rating scale designed to assess axis II personality disorders (PD) from DSM-III. Results showed that 53% of the patients received at least one PD diagnosis. The most frequent diagnoses were avoidant (30%), histrionic (26%), dependent (19%), and schizotypal (16%). Consideration of the personality traits irrespective of diagnostic category showed that in addition to avoidant and dependent personality characteristics, the sample had strong passive aggressive and compulsive tendencies and substantial histrionic, paranoid, and schizotypal traits. Patients exhibiting a greater number of personality traits were also significantly more symptomatic. However, anxiety, phobic, and obsessive-compulsive symptoms were not selected as unique predictors of any personality variables in the regression analyses. Rather, the most important correlate of PD in these patients consisted of dysphoric mood as assessed by the Beck Depression Inventory (BDI) and, to a lesser degree, younger age or shorter duration of illness. These findings do not support a specific link between OCD and PD in general and compulsive PD in particular.

Adult↗
PubMed2001

Adjectival descriptions of personality disorders: a convergent validity study of the MCMI-III.

The responses to a 469-item list of adjectives (consensually validated by national experts as representing key descriptors for each personality disorder) from 202 male substance abusers in outpatient treatment were correlated with their responses to the MCMI-III, a frequently used test for the assessment of personality disorders. Results suggested good convergent validity for the interpersonal descriptive domain for the MCMI-III scales. The Histrionic scale had extremely high convergent validity.

Adult↗
PubMed1991

Diagnosing personality disorders in psychiatric inpatients.

This study investigated assumptions made by DSM-III and DSM-III-R regarding Axis I-Axis II associations and sex differences for the 11 personality disorders (PD). A total of 112 patients formed 4 Axis I diagnostic groups: recent-onset schizophrenia (n = 35); recent-onset mania (n = 26); unipolar affective disorder (n = 30); and a mixed diagnostic group (n = 21). The prevalence of PD was determined using the Structured Interview for DSM-III Personality Disorders (SIDP). Schizophrenia was associated with antisocial PD and schizotypal PD; manic disorder was associated with histrionic PD; and unipolar affective disorder was associated with borderline, dependent and avoidant PD. Some of these results were consistent with DSM-III/DSM-III-R postulates. However, there was little support for the DSM-III/DSM-III-R statements on sex differences in the prevalence of PD, except for antisocial PD. The implications of the results for DSM-III/DSM-III-R assumptions are discussed.

Adult↗
PubMed1990

An American view of the ICD-10 personality disorders.

The 1986 version of the ICD-10 diagnostic criteria for the personality disorders was analyzed. In one part of the study, clinicians in the United States were asked to assign the ICD-10 criteria to the ICD-10 categories. In a second part, the ICD-10 criteria were assigned to DSM-III-R categories. In the first part, the face validities of the ICD-10 criteria were highly variable. Thirty percent of the criteria were assigned to the correct parent category by over 80% of the clinicians. In contrast, 34% of the criteria failed to be correctly assigned by at least half of the clinicians. Concerning the correspondence between ICD-10 and DSM-III-R categories, only anankastic (ICD) and obsessive-compulsive (DSM) showed a high level of correspondence. The correspondences of anxious (ICD) with avoidant (DSM), impulsive (ICD) with borderline (DSM), and histronic (ICD) with histrionic (DSM) were poor.

Diagnosis, Differential↗
PubMed1990

Characteristics of patients with multiple personality and dissociative disorders on psychological testing.

We describe a new psychological testing procedure used on a consecutive series of 14 patients with multiple personality and dissociative disorders who met DSM-III-R and research criteria for dissociative disorders. Once dissociative phenomena were accounted for in testing, most patients displayed response patterns markedly different from those of schizophrenic and borderline patients. Patients showed striking variability on cognitive and projective tests, often related to posttraumatic intrusions. Rorschach protocols showed unusual thinking accompanied by psychological complexity and highly developed self-observing capacity. In contrast to classical conceptualizations about these patients, most subjects had personality profiles that were intellectualized, obsessive, and introversive, not histrionic or labile.

Adaptation, Psychological↗