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PubMed1999

Antisocial personality disorder and psychopathy in cocaine-dependent women.

OBJECTIVE: The goal of this study was to examine the lifetime prevalence of antisocial personality disorder according to five diagnostic systems and the prevalence of psychopathy in a study group of women. The relationship between antisocial personality disorder and psychopathy was also examined. Finally, differences in treatment admission variables based on the presence or absence of antisocial personality disorder and/or psychopathy were evaluated. METHOD: Antisocial personality disorder was diagnosed in 137 treatment-seeking, cocaine-dependent women according to the Feighner criteria, Research Diagnostic Criteria (RDC), and DSM-III, DSM-III-R, and DSM-IV criteria. Psychopathy was assessed by the Revised Psychopathy Checklist. RESULTS: Rates of antisocial personality disorder varied from 76% according to the Feighner criteria to 11% for the RDC. Nineteen percent (N = 26) of the women scored in the moderate to high range on the Revised Psychopathy Checklist. All of these women were diagnosed with antisocial personality disorder according to DSM-III and Feighner criteria, but only 15 of the 26 were diagnosed according to DSM-III-R, 12 according to DSM-IV, and six with the RDC. Moderate levels of psychopathy were associated with a history of illegal activity at treatment admission, whereas antisocial personality disorder was not. CONCLUSIONS: There was relatively little diagnostic agreement between classification systems. This study indicates that antisocial personality disorder and psychopathy are not synonymous terms for the same disorder. Findings support a need to redefine antisocial personality disorder diagnostic criteria to make them gender neutral by including behaviors associated specifically with antisociality in women.

Adult↗
PubMed1987

First-rank symptoms as a diagnostic clue to multiple personality disorder.

Thirty patients with multiple personality disorder had one or more of Schneider's 11 first-rank symptoms at initial assessment (mean = 3.6; range = 1-8). The author describes these symptom categories, eight of which were noted in the patients he interviewed, and illustrates them from the patients' case material. He suggests that inquiry about first-rank symptom phenomena may be a valuable diagnostic clue to the presence of multiple personality disorder.

Delusions↗
PubMed1999

The factor structure of schizophrenia spectrum personality disorders: signs and symptoms in relatives of psychotic patients from the UCLA family members study

The dimensions and limits of the concept of schizotypy are examined using an exploratory factor analysis of the 36 signs and symptoms in the Cluster A DSM-III-R personality disorders as well as those in Borderline Personality Disorder and Avoidant Personality Disorder in the 307 first-degree relatives and half-siblings of 123 probands with schizophrenia/schizoaffective disorder. The personality disorders examined were assessed using sections of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and hospital and clinic records. Interviewers were blind to the proband diagnosis. The resulting six-factor solution accounted for 40% of the variance. The results of the six-factor solution accounted for the greatest variance and gave the most easily interpretable simple structure of all the solutions examined. The six factors are labeled as (1) Borderline Symptoms, (2) Schizoid Symptoms, (3) Paranoid Symptoms, (4) Avoidant Symptoms, (5) Positive Schizotypy Symptoms, and (6) Disorganized Symptoms. The Schizotypal Personality items are spread across all but the 'Borderline Symptoms' factor. We conclude schizotypy is a multidimensional construct that is not adequately characterized by any one DSM-III-R personality disorder. It appears to consist of six distinct dimensions, which, interestingly, parallel current thinking on dimensions in schizophrenia.

Journal Article↗
PubMed1985

An empirical study of psychosis in borderline personality disorder.

To assess the nature and prevalence of psychotic symptoms in borderline personality disorder, the authors reviewed the cases of 33 patients meeting DSM-III criteria for borderline personality disorder, using both "narrow" and "broad" definitions of psychosis. Only eight patients displayed psychotic symptoms meeting the "narrow" DSM-III definition; in all of these cases, the symptoms appeared to be attributable to either severe drug abuse or major affective disorder, present simultaneously with borderline personality disorder. The remaining patients displayed only "broadly defined" psychotic symptoms or symptoms that appeared to be under voluntary control. These findings weigh against the assumption that borderline personality disorder lies "on the border" of classical psychotic disorders.

Adolescent↗
PubMed2003

Effectiveness of nursing interventions in people with personality disorders.

BACKGROUND: Nurses usually provide care for people with personality disorders on a day-to-day basis. Consequently, it is important to establish how effective nursing interventions are for those with personality disorders, both in terms of general management and more specific therapeutic approaches. These are also issues of current political and professional debate. The crucial question, however, for planners, providers and commissioners of services is, What research evidence is there about effectiveness? There is also a need to determine what further research is necessary to evaluate programmes for managing or modifying behaviours. AIM: The aim of this paper is to report on a systematic review of the literature on the effectiveness of nursing interventions in people with personality disorders, whether delivered by nurses alone or in combination with other health care professionals. METHOD: The review was conducted according to the United Kingdom National Health Service Centre for Reviews and Dissemination guidelines. Literature was identified from electronic database searching, footnote chasing, hand searching of journals and contact with authors of studies. Narrative synthesis was undertaken in relation to study design, participants, and type of intervention. FINDINGS: Eighteen separate studies were included in the review: four randomized controlled trials, four non-randomized controlled trials, seven before-and-after studies and three case studies. CONCLUSIONS: There is a weak evidence-base for what constitutes effective nursing intervention with people with personality disorders. There is stronger evidence from mixed disciplines intervention studies than from nursing only intervention studies. Studies of interventions based on psychological approaches show greater improvements in outcomes than nursing management studies.

Adolescent↗
PubMed1992

Therapeutic community treatment for personality disordered adults: changes in neurotic symptomatology on follow-up.

Personality disordered patients are important as they place high continuing demands on services and are often refractory to traditional treatments. Often personality disorders may co-exist with neurotic symptomatology, worsening prognosis of the latter. This paper reports change in neurotic symptomatology following intensive, long term, therapeutic community treatment for such patients. Sixty two subjects with personality disorder were followed up for eight months after discharge (response rate 65%). Results showed a highly significant reduction in symptomatic distress as measured by the SCL-90R questionnaire. Investigation of the reliability and clinical importance of the change in individual subjects demonstrated that 55% of subjects had improved reliably, and in 32% this change was also clinically significant, whilst only 6.5% of subjects had deteriorated reliably.

Adolescent↗
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↗
PubMed2003

Chronic depression and comorbid personality disorders: response to sertraline versus imipramine.

BACKGROUND: Chronic subtypes of depression appear to be associated with high rates of Axis II personality disorder comorbidity. Few studies, though, have systematically examined the clinical correlates of Axis II personality disorder comorbidity or its effect on treatment response or time to response. METHOD: 635 patients diagnosed with DSM-III-R chronic major depression or "double depression" (dysthymia with concurrent major depression) were randomized to 12 weeks of double-blind treatment with either sertraline or imipramine between February 1993 and December 1994. Axis II diagnoses were made using the personality disorders version of the DSM-III-R Structured Clinical Interview. The effect of study treatment was measured utilizing the Hamilton Rating Scale for Depression and the Clinical Global Impressions scale. RESULTS: Forty-six percent of patients met criteria for at least 1 comorbid Axis II personality disorder, with cluster C diagnoses being the most frequent at 39%; 21% met criteria for at least 2 Axis II personality disorders. A cluster C diagnosis was associated with significantly higher rates of early-onset depression (before age 21; 47% vs. 32% for no cluster C; p =.005) and comorbid anxiety disorder (34% vs. 18% for no cluster C; p <.001). Overall, the presence of Axis II personality disorder comorbidity had minimal-to-no effect on the ability to achieve either an antidepressant response or remission and had inconsistent effects on time to response. The presence of Axis II personality disorder comorbidity did not appear to reduce functional and quality-of-life improvements among patients responding to acute treatment with sertraline or imipramine. CONCLUSION: In this treatment sample, rates of Axis II personality disorder comorbidity were substantial in patients suffering from chronic forms of depression. Axis II personality disorder comorbidity did not appear to diminish symptomatic response to acute treatment or associated improvement in functioning and quality of life.

Adult↗
PubMed1993

Psychiatric illnesses in families of subjects with schizophrenia-spectrum personality disorders: high morbidity risks for unspecified functional psychoses and schizophrenia.

OBJECTIVE: The authors determined morbidity risks for psychiatric illnesses in the families of probands with schizophrenia-spectrum personality disorders. METHOD: Subjects were recruited from the community through newspaper advertisements. Subjects were identified as having schizophrenia-spectrum personality disorders (N = 30) if they met at least three, four, or three DSM-III-R criteria for schizoid (N = 14), schizotypal (N = 20), and/or paranoid (N = 15) personality disorder, respectively. The comparison subjects had no psychiatric diagnoses (N = 8) or had other personality disorders (N = 12); none of the subjects in either group had any DSM-III-R axis I diagnosis. Trained interviewers collected family history information about the relatives of the two groups; the interviewers were blind to the probands' diagnoses. RESULTS: The risks for schizophrenia, other functional psychoses, and schizophrenia-spectrum personality disorders were significantly higher in the relatives of subjects with schizophrenia-spectrum personality disorders than in the families of the comparison subjects. CONCLUSIONS: The high rate of schizophrenia in the families of probands with schizophrenia-spectrum personality disorders is consistent with the previous findings of higher than normal rates of these personality disorders in the biological relatives of schizophrenic patients. The significance of the high rate of unspecified functional psychoses is unclear. Use of the family study method, by which valid differential diagnosis of psychoses is possible, is indicated. The results from the current study do not rule out the possibility that the schizophrenia-spectrum personality disorders are related to psychoses in general rather than specifically to schizophrenia.

Adult↗
PubMed2005

Temporal reliability of psychological assessments for patients in a special hospital with severe personality disorder: a preliminary note.

BACKGROUND: The new programme for assessing those with dangerous and severe personality disorder relies heavily on psychological assessments of personality disorder and risk. METHODS: The temporal reliability of assessments of psychopathy (PCL-R), risk (HCR-20) and personality was assessed using the International Personality Disorder Examination (IPDE) in 15 randomly selected male prisoners in a high secure hospital carried out at intervals varying between a mean of nine and 19 months after initial assessments by a variety of assessors. RESULTS: Using the intra-class correlation coefficient the agreement varied between 0.57 (HCR-20), 0.58 (PCL-R) and 0.38-0.70 for IPDE personality disorders, with the best agreement for antisocial personality disorder (0.70). COMMENT: These levels of agreement are consistent with other recent work on temporal reliability of personality instruments but are a little too low for confidence in these measures alone in the assessment process.

Adult↗
PubMed1994

Borderline personality disorder in adolescents: ubiquitous or specific?

The authors sought to identify diagnostic criteria that are relatively specific to borderline personality disorder in severely ill adolescent inpatients and that may predict a stable borderline personality disorder during this turbulent time. Twenty-one adolescent inpatients with borderline personality disorder were contacted 2 years after the index hospitalization (baseline). Seven of these patients met criteria for borderline personality disorder at follow-up. The ability of baseline criteria for borderline personality to predict the diagnosis of borderline personality disorder at follow-up was determined. Criteria for borderline personality disorder were sensitive for the stable disorder but not very specific. Without follow-up data, the diagnostic significance of symptoms of borderline personality disorder in adolescents appears uncertain.

Adolescent↗
PubMed1998

Clinical outcome of psychopharmacologic treatment of borderline and schizotypal personality disordered subjects.

This paper reviews the biological and psychopharmacologic nature of personality disordered subjects, specifically those with borderline (BPD) and schizotypal (ScPD) personality disorder. Generally speaking, there is no agent of choice for the treatment of either BPD or ScPD. Many agents of different classes appear to offer some benefit to selected subjects depending upon their symptom presentation. For example, ScPD or BPD subjects with prominent cognitive/perceptual distortion may respond to neuroleptic agents, while some BPD subjects with depressed mood may respond best to antidepressants. The hypothesis that biological and behavioral dimensions underlie the psychopharmacologic response to treatment in personality disordered subjects, proposed over the past decade, is now being tested. The most salient example of this is the testing of serotonin-specific agents (e.g., fluoxetine) for potential antiaggressive efficacy in personality disordered subjects with prominent histories of impulsive aggressive behavior and putative reduced serotonin system function.

Anti-Anxiety Agents↗
PubMed1988

Phenomenological overlap of multiple personality disorder and obsessive-compulsive disorder.

Three patients with multiple personality disorder and three with obsessive-compulsive disorder were compared on a variety of self-report measures and on two structured interviews. Amytal Sodium interviews had been conducted on the obsessive patients; alter personality-like entities claiming responsibility for the obsessions and compulsions were contacted in two patients. The one obsessive patient with no alter personality differed markedly from the other five on the SCL-90, the Lynfield Inventory, and the Dissociative Experiences Scale. Structured interviews with the Anxiety Disorders Interview Schedule and the Dissociative Disorders Interview Schedule also clearly differentiated this patient from the other five. It appears that there is a phenomenological overlap between multiple personality disorder and some cases of obsessive-compulsive disorder. Obsessive patients with prominent dissociative features may be a psychologically and biologically distinct subgroup.

Adult↗
PubMed1999

Gender differences in the frequency of personality disorders in depressed outpatients.

We examined gender differences in the frequency of DSM-III-R personality disorder diagnoses and symptomatology in a sample of 225 depressed outpatients. This research partially replicates and extends one of the first studies in this area by Golomb et al. (1995). Males were significantly more likely than females to meet diagnoses for schizotypal, paranoid, narcissistic, antisocial, obsessive compulsive, and borderline personality disorder. Compared to females, males were also significantly more likely to have schizoid, schizotypal, narcissistic, antisocial, and obsessive-compulsive personality disorder symptomatology. Females did not predominate in any personality disorder symptomatology or diagnoses. A possible explanation for these findings is discussed. The results of this study challenge traditional assumptions about gender differences in the frequency of personality disorders, and confirm the need for future studies to investigate the relation between gender and personality disorders in specific Axis I samples.

Adult↗
PubMed2003

Neither antisocial personality disorder nor antisocial alcoholism is associated with the MAO-A gene in Han Chinese males.

BACKGROUND: Recent studies on the genetics of alcoholism have suggested an association between antisocial alcoholism and the MAO-A gene. However, previous studies have failed to include subjects with antisocial personality disorder without alcoholism even though there is a high comorbidity between antisocial personality disorder and alcoholism. Consequently, the finding of an association between the MAO-A gene and alcoholism or antisocial personality disorder seems tenuous. In Taiwan, about 70% of the Han Chinese population have the ADH2*2 allele and 50% show ALDH2*1/*2 or ALDH2*2/*2 genotypes, which offer protection against drinking behavior and the risk of developing alcoholism. Thus, it is possible to recruit individuals with antisocial personality disorder but without alcoholism in Taiwan. Therefore, association studies of alcoholism or antisocial personality disorder in Chinese may be more reliable if pure antisocial alcoholics, pure antisocial personality disorders, and normal controls as MAO-A gene are examined. METHODS: In this study, the associations among antisocial alcoholism, antisocial personality disorder, and the uVNTR and EcoRV polymorphisms of the MAO-A gene, both individually and as a haplotype, were investigated among male adults recruited from jails in Taipei. A total of 129 Chinese Han males were studied, including 41 with antisocial personality disorder with alcoholism, 50 with antisocial personality disorder but without alcoholism, and 38 without either disorder as a jail control group. The diagnoses of alcohol dependence and antisocial personality disorder were made according to DSM-IV criteria. In addition, 77 normal controls were collected from the community. RESULTS: Strong linkage disequilibrium was found for the uVNTR and EcoRV variants of MAO-A gene in each study group. CONCLUSIONS: No significant association was observed between these two polymorphisms and antisocial personality disorder with alcoholism, either individually or for the haplotype, or for antisocial personality disorder without alcoholism. Thus, neither antisocial alcoholism nor antisocial personality disorder was associated with the genetic variants of MAO-A gene.

Alcoholism↗
PubMed1995

Reliability of observer ratings in the assessment of personality disorders: a preliminary study.

A 200-item, self-report personality disorder inventory (Coolidge Axis II Inventory; CATI) was administered to 52 married target subjects. Their spouses and a close friend completed a significant-other form about the targets. The mean correlation across all personality disorder scales was .51 for the targets-spouses, .36 for the targets-friends, and .41 for the spouses-friends. Twenty-eight target-spouse correlations were significant and ranged from .99 to -.40. The mean correlation for the individual 13 personality disorder scales was .46 for target-spouses and ranged from .63 for the histrionic scale to .27 for the paranoid scale. The results were interpreted as establishing a basis for significant other assessment of personality disorders.

Adult↗
PubMed1976

[Systematics and differentiation of personality disorders in children and adolescents with behavioral disorders].

The author discusses some problems of systematization and differential diagnoses of personality disorders which are accompanied by disturbances of behaviour in children and adolescents. An original classification of personality disorders and transient personality reactions in childhood and adolescence is proposed. Special attention is paid to the criteria of delineating pathological and nonpathological forms of personality disorders and personality reactions in this group of children as well as to the differential diagnosis of constitutional and organic psychopathy. On the other hand residual-organic psychopath-like conditions and psychogenic pathocharacterological personality development are analyzed.

Adolescent↗