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PubMed1987

Dysphoria associated with methylphenidate infusion in borderline personality disorder.

Two patients with borderline personality disorder experienced dramatic dysphoric episodes after acute administration of intravenous methylphenidate in a double-blind manner. These dysphoric episodes were similar to those which occurred spontaneously under conditions of psychological stress. Case histories and the behavioral and cardiovascular effects of the infusions are described. The pharmacology of methylphenidate is discussed in order to elucidate possible mechanisms mediating the observed responses to this drug.

Adult↗
PubMedDate not supplied

[Influence of personality disorder on the course of manic-depressive illness].

In these past years, comorbidity of manic-depressive illness with personality disorders were the subject of many studies. In order to study the influence of personality disorder on the course of the disease, the authors have compared a group of manic depressive patients with personality disorders to an other group of manic depressive patients without personality disorders. The comparison between the outcome and prognosis of each group has leaded to the conclusion that manic depressive patients with personality disorders evaluate worse than those without personality disorders: they are more often hospitalized and have more suicide attempts, they are more vulnerable to stress factors and finally they have low scores on the Global Assessment of Functioning scale (GAF).

Adolescent↗
PubMed2003

Sympathetic reactivity in agoraphobic patients with and without personality disorders.

OBJECTIVE: To compare sympathetic activity in agoraphobic patients with and without personality disorders before and after 11 weeks inpatient treatment. METHODS: Agoraphobic patients (n=38), 84% with panic disorder and 47% with personality disorders underwent cold pressure test (CPT), mental stress test (MST), and a specific anxiety test (SAT). Psychological assessments were done by the Bodily Sensations Questionnaire (BSQ), the Agoraphobic Cognitions Questionnaire (ACQ), Spielberger STAI-1 and -2, and a Stress Test Anxiety (STA) questionnaire. Sympathetic activity was measured by blood pressure, heart rate, epinephrine, and norepinephrine. RESULTS: The sympathetic activity did not differ significantly between patient groups, and the reactivity to stress was very low. The sympathetic reactivity remained unchanged after treatment, whereas psychiatric symptoms decreased. Correlations between sympathetic activity and psychological distress were not significant. CONCLUSION: Interpretation of bodily signals seems to be more important than the actual sympathetic activity in agoraphobic patients.

Adult↗
PubMed1993

Genetic and environmental contributions to dimensions of personality disorder.

OBJECTIVE: The authors estimated the heritability of the basic dimensions of personality disorder and the relative proportions of the variance attributable to genetic and environmental sources. METHOD: The subjects were 175 volunteer twin pairs (90 monozygotic and 85 dizygotic) from the general population. Each twin completed the Dimensional Assessment of Personality Pathology, a questionnaire that assesses 18 dimensions of personality disorder. The questionnaire was developed on the basis of factor analytic studies that identified a stable structure underlying personality disorders in clinical and nonclinical subjects. Structural equation model-fitting methods were used to estimate the influence of additive genetic, common environmental, and unique environmental effects. RESULTS: The estimates of broad heritability ranged from 0%, for conduct problems, to 64%, for narcissism. Behaviors associated with submissiveness and attachment problems had low heritability. For most dimensions, the best-fitting model was one that specified additive genetic and unique environmental effects. CONCLUSIONS: These results are similar to those reported for normal personality and suggest a continuity between normal and disordered personality.

Adolescent↗
PubMed1998

Personality disorders in substance abusers: relation to substance use.

Previous studies have documented high but variable rates of DSM personality disorders (axis II) in clinical samples of substance abusers. Distinguishing between personality disorder symptoms that are independent versus substance-related (SR) is a particular challenge for diagnosing comorbid axis II disorders in substance abusers. DSM-IV guidelines currently recommend excluding axis II symptoms that are accounted for by an axis I disorder, including a substance use disorder. In this study, axis II diagnoses were made on a heterogenous clinical sample of 370 patients entering treatment for substance use disorders. Axis II diagnoses were made according to DSM-III-R criteria using the Structured Clinical Interview for DSM-III-R (SCID-II), which was modified to determine, on an item-by-item basis, whether symptoms were attributed to subjects' substance use disorders or independent of these disorders. The majority (57.0%) of substance use disorder patients met criteria for at least one comorbid axis II disorder, with cluster B (45.7%) being particularly prominent, especially antisocial personality disorder (ASP) (27.0%) and borderline personality disorder (BPD) (18.4%). Notably, inclusion of SR symptoms led to a substantial number of newly diagnosed cases, especially for ASP (19.2%) and BPD (11.4%). Including SR symptoms improved the reliability of ASP and did not change the reliability of BPD diagnoses. Generally, patients with SR and independent personality disorders had a similar clinical profile.

Adult↗
PubMed1994

Personality disorder in the elderly depressed.

The objectives of this study were to examine the association of personality disorder with outcome of depression in older patients (age > or = 60) treated in a psychiatric day hospital for depression and to compare the clinical diagnosis of personality disorder at admission with the results of a semi-structured interview at follow-up. Sixty-four patients were followed up for a mean interval of 30 (13-49) months after admission to the psychiatric day hospital and the semi-structured interview, Social Support Scale, Life Events Inventory, Hamilton Depression Rating Scale and Mini-Mental State Examination administered by a psychiatrist blind to the details of the index admission. Forty-nine informants (a close friend or relative) were also interviewed using the semi-structured interview. Axis II diagnoses at the time of admission were determined from patient records. Personality disorder diagnoses were analysed according to DSM-III-R clusters. Twenty-one (33%) patients fulfilled criteria for personality disorder at admission and 23 (36%) at follow-up. There was strong agreement (k = 0.78) between patient and informant semi-structured interview results and moderate agreement (k = 0.41) between diagnosis at admission and at follow-up. Presence of a personality disorder, and in particular a cluster B personality disorder diagnosis was associated with chronic outcome of depression and with impaired social support. Personality is a significant factor in the outcome of depression in the elderly. It remains unclear whether current methods of assessment tap enduring characteristics, or manifestations of affective state.

Adjustment Disorders↗
PubMed1986

The challenge of working with patients diagnosed as having a borderline personality disorder.

Patients with a borderline personality disorder evoke unique problems and treatment dilemmas among members of an inpatient treatment team. This article explores the essential interplay of various treatment modalities during the course of intensive inpatient hospitalization and also describes guidelines, approaches, and therapeutic interventions aimed at reducing destructive influences and maximizing treatment outcome.

Attitude of Health Personnel↗
PubMed2002

Prediction of personality disorder traits by psychosis proneness scales in a German sample of young adults.

Prior research has focused on schizophrenia-spectrum disorder traits in psychosis-prone subjects. The whole range of personality disorders were only explored in patient samples and with the relatives of patients. In light of this situation, the predictive value of Physical Anhedonia (PhA), Perceptual Aberration (PER), and Magical Ideation (MI) for personality disorder traits were examined dimensionally and categorically in a non-patient sample. We selected a non-student sample (n = 404) and focused on two risk groups (PhA: n = 14; combined PER/MI: n = 36), and a control group (n = 19) using the SCID II to assess personality disorders at a time period two years later. MI explained most of the variance in clinically relevant schizotypal personality disorder symptoms, while PER and PhA dimensionally were associated with the number of diagnostic criteria met for other personality disorders. While both risk groups exceeded the control group in clinically relevant borderline traits, only the PER/MI-individuals differed in fulfilling more criteria for schizotypal personality disorder.

Adolescent↗
PubMed1997

Personality disorders in people with learning disabilities: a community survey.

The prevalence of personality disorders has been determined by studies of both the general population and mental handicap hospitals. The present study attempts to determine the prevalence of personality disorders in a community sample and to check the implications for treatment. A community sample of learning disability service users was surveyed by obtaining a rating from a good informant to establish demographic data, level of functioning and the nature of personality disorders, if any, using the ICD-10 version of the Standardized Assessment of Personality (SAP). Fifty per cent of the sample had personality abnormalities, and 31% had sufficient impairment of the social and occupational domains and personal distress to warrant a diagnosis of personality disorder. These findings are compared with previous studies. Paranoid, schizoid, impulsive and dissocial personality abnormalities were seen to be associated with a high referral rate to psychiatric services and needed considerable therapeutic input. The prevalence of personality abnormalities in community populations with a learning disability is high. The SAP is a useful instrument for screening. This subpopulation makes significant demands on community psychiatric services.

Adult↗
PubMedDate not supplied

Pathological narcissism and narcissistic personality disorder in Axis I disorders.

This paper presents available information on the comorbidity of narcissistic personality disorder (NPD) and pathological narcissism with major mental illness. A review of empirical studies reporting on the prevalence of NPD in Axis I disorders, and of theoretical and clinical literature on narcissistic pathology in major mental illness, forms the basis for an analysis of this interface. The results show that prevalence rates of NPD in Axis I disorders rarely exceed those found in the general psychiatric or personality disorder populations (i.e., less than 22%). NPD was found at high rates in individuals with a substance use disorder (12-38%) or bipolar disorder (4-47%); it was present at very low rates or absent in persons with obsessive-compulsive disorder. Higher prevalence rates were reported in the studies that used the Millon Clinical Multiaxial Inventory I or II than in those that employed the Structured interview for DSM-III Personality Disorders or the Structured Interview for DSM-III-R Personality Disorders--Revised. There is no evidence implicating a significant relationship between NPD and any specific Axis I disorder. A comparison of theoretical and clinical studies with empirical ones reveals major differences in the views regarding the presence and significance of NPD in Axis I disorders. However, the results highlight trends of interacting comorbidity between NPD and substance use disorders, bipolar disorder, depression, and anorexia nervosa.

Anxiety Disorders↗
PubMed1998

The impact of personality disorders on treatment outcome of anxiety disorders: best-evidence synthesis.

Thirty-five studies were traced addressing the impact of comorbid personality disorders on treatment outcome of anxiety disorders. The conclusions of this review are based on the best-evidence procedure. We used two selection criteria that studies had to meet to be included in the present review. The study design had to be prospective and a (semi)structured interview had to be used for the assessment of personality disorders. From the fifteen selected studies it cannot be concluded that, in general, personality disorders affect treatment outcome for anxiety disorders negatively. We can only suspect that some personality disorders may have an adverse impact upon treatment outcome in anxiety disorders, and they should be investigated further. For the time being, in clinical practice one has to be cautious in relating personality disorders to less well treatment outcome in axis I anxiety disorders.

Anxiety Disorders↗
PubMed1997

Depressive response to physostigmine challenge in borderline personality disorder patients.

The purpose of this study was to examine the relationship between mood and hormonal responses to cholinergic challenge with physostigmine in order to assess cholinergic system responsiveness in borderline personality disorder (BPD) patients, other non-BPD personality disorder patients, and normal controls. Thirty-four personality disorder patients, 10 of whom met criteria for BPD and 24 of whom met criteria for other, non-borderline, personality disorders, and 11 normal controls participated in a double blind, placebo controlled physostigmine challenge paradigm. The Profile of Mood States depression subscale (POMS-D) self report measure was obtained at baseline and following the physostigmine or placebo infusions. A repeated measures ANOVA of POMS-D scores in placebo and drug conditions indicated a significantly greater depressive response in the total cohort of personality disorder patients than in the normal comparison group (p < 0.05). However, the depressive response to physostigmine was significantly greater in BPD patients, but not other personality disorder patients, compared to normal controls (p < 0.05). There was a correlation between the peak placebo-corrected depressive response to physostigmine and a group of BPD traits related to affective instability but not a group of BPD traits related to impulsivity. There was no correlation in any group between mood response to physostigmine and changes in plasma cortisol, prolactin, or growth hormone, or to nausea or other side effects following physostigmine infusion. These data suggest that there is an association between BPD and acute depressive responses to physostigmine challenge, and that the cholinergic system may be involved in the regulation of affect in Axis II disorders.

Adult↗
PubMed2002

Relationship between perfectionism, personality disorders and agoraphobia in patients with panic disorder.

OBJECTIVE: In earlier reports, we found that perfectionism might be involved in the development and/or maintenance of agoraphobia in panic disorder. The present report extends this work by examining the relationship between perfectionism and comorbidity with personality disorders in panic disorder patients with agoraphobia (PDA) and those without agoraphobia (PD). METHOD: We examined comorbidity of personality disorders by Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and assessed perfectionism using multidimensional perfectionism scale in 56 PDA and 42 PD patients. RESULTS: The PDA group met criteria for at least one personality disorder significantly more often than the PD group. With stepwise regression analyses, avoidant and obsessive-compulsive personality disorders emerged as significant indicators of perfectionism in patients with panic disorder. CONCLUSION: These findings suggest that perfectionism in panic disorder patients may be more common in those with comorbid personality disorders, and may be an important target for preventive and therapeutic efforts.

Adult↗
PubMed1990

Diagnosing personality disorders in recent-onset schizophrenia.

The present study aimed to determine the prevalence of personality disorders (PDs) and personality disorder traits in 40 recent-onset schizophrenic patients, to establish the degree of concordance between the Structured Interview for DSM-III Personality Disorders (SIDP) and the Million Multiaxial Clinical Inventory (MCMI-I), and to examine the interrater reliabilities for the diagnosis of SIDP disorders and traits. During their recovery phase, patients underwent the SIDP and completed the MCMI-I, a self-report inventory. Results showed that 57% of all patients had PDs according to the SIDP. The most common PDs were antisocial, borderline, and schizotypal, whereas the most common according to the MCMI-I were dependent, narcissistic, and avoidant. Both instruments indicated that multiple PD diagnoses were common. Paranoid and schizotypal traits were found to be ubiquitous across instruments. The level of agreements between the two instruments was poor on diagnostic assignment but better when trait scores were considered.

Adult↗
PubMed2005

Suicide in borderline personality disorder: a meta-analysis.

Suicide is the major cause of death among patients with borderline personality disorder; however, the literature on completed suicides in such disorder is inconclusive, as suicide rates vary greatly among cohorts of patients. We searched MedLine, Excerpta Medica and PsycLit from 1980 to 2005 to identify papers dealing with suicide in borderline personality disorder. We also searched the World Health Statistics Annual to ascertain the suicide rate in the age groups for specific years and country. We selected eight studies comprising 1179 patients with a diagnosis of borderline personality disorder. Of these patients, 94 committed suicide. Results obtained for each study were processed together to calculate the mean figure for each year of suicides for 100,000 individuals suffering from borderline personality disorder. Our meta-analysis shows that suicide among patients with borderline personality disorder is more frequent when compared with the general population. All study analyses reported that patients with borderline personality disorder committed suicide more often than their counterparts in the general population. Suicide seems more alarming in the first phases of follow-up than during chronic phases of illness.

Borderline Personality Disorder↗
PubMed2000

Twelve-month outcome in bipolar patients with and without personality disorders.

BACKGROUND: We studied the 12-month course of illness after hospitalization for patients with a DSM-III-R diagnosis of bipolar disorder, manic or mixed episode, to identify the impact of a co-occurring personality disorder on measures of outcome. METHOD: Fifty-nine patients with bipolar disorder hospitalized for the treatment of a manic or mixed episode were recruited. Diagnostic, symptomatic, and functional evaluations were obtained at the index hospitalization. Personality disorders were assessed using the Structured Clinical Interview for DSM-III-R, personality disorders version (SCID-II). Patients were then reevaluated at 2, 6, and 12 months after discharge to assess syndromic, symptomatic, and functional recovery. Factors associated with outcome were identified using multivariate analyses. RESULTS: Survival analyses showed that in the 12-month follow-up period, subjects with bipolar disorder and co-occurring personality disorder were significantly less likely to achieve recovery. Logistic regression analyses indicated that both a diagnosis of personality disorder and noncompliance with treatment were significantly associated with lack of syndromic recovery. CONCLUSION: Co-occurring personality disorders in patients with bipolar disorder are associated with poor outcome after hospitalization for mania.

Adult↗
PubMedDate not supplied

[Organic personality disorder: response to carbamazepine].

Organic Personality Disorder is a clinical diagnosis included in ICD-10 classification and also, under a different name, in DSM-IV. Many different treatments have been proposed to improve this condition, carbamazepine being one of them. A case report is presented of a 28 years old patient who, six years before, had suffered a severe brain injury in a car accident. From then on, an intensification of previous personality traits could be observed besides sexual exhibitionism, promiscuity, aggressive episodes, suspiciousness and low impulse control. A chaotic socio-familial situation induced two psychiatric admissions. The patient was initially treated with neuroleptics, benzodiazepines and antidepressants, with no response. Treatment with carbamazepine was then started, reaching a dose of 1,200 mg/day and maintaining plasma levels of 8.8 mcg/ml. After two months of this treatment a marked improvement was observed with absence of exhibitionistic behavior and aggressive episodes, a tendency towards normalization of mood and anxiety, stabilization of his social and family relationships and starting some paid work.

Adult↗
PubMed1998

Frequency of personality disorders in two age cohorts of psychiatric inpatients.

OBJECTIVE: The authors examined the frequency of DSM-III-R personality disorders in adolescent and young adult psychiatric inpatients. METHOD: Structured diagnostic interviews were reliably performed with a series of 255 consecutively admitted inpatients (138 adolescents and 117 young adults). RESULTS: Most personality disorders were diagnosed in similar frequencies in the two study groups. Passive-aggressive personality disorder was diagnosed with lower frequency and dependent personality disorder with higher frequency in the young adult than in the adolescent group. CONCLUSIONS: The isomorphism of relative frequencies among psychiatric inpatients suggests that what is seen in adolescents are valid forms of most adult personality disorders.

Adolescent↗