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PubMed2005

Oxcarbazepine in the treatment of borderline personality disorder: a pilot study.

BACKGROUND: According to available studies concerning treatment of patients with borderline personality disorder, mood stabilizers have been found effective in controlling core symptoms of borderline pathology, in particular impulsive behavior and mood instability. Oxcarbazepine, an anticonvulsant structurally related to carbamazepine, has been tested in psychiatric settings for treating patients with bipolar disorders, substance abuse, resistant psychosis, and schizoaffective disorder. The present article is a pilot study on the efficacy and tolerability of oxcarbazepine in the treatment of borderline personality disorder. METHOD: Seventeen outpatients diagnosed with DSM-IV-TR borderline personality disorder were included. Patients were administered oxcarbazepine, 1200 to 1500 mg/day supplied twice daily, and tested at baseline, week 4, and week 12 using the Clinical Global Impressions scale-Severity of Illness item (CGI-S), the Brief Psychiatric Rating Scale (BPRS), the Hamilton Rating Scales for Depression and Anxiety (HAM-D, HAM-A), the Social Occupational Functioning Assessment Scale, and the Borderline Personality Disorder Severity Index (BPDSI). Adverse effects were collected and serum sodium level was measured. Statistics were performed by using the analysis of variance for repeated measures. RESULTS: Four patients discontinued treatment in the first 4 weeks due to noncompliance. A statistically significant response to oxcarbazepine was observed according to CGI-S and BPRS mean score (p = .001), HAM-A mean score (p = .002), BPDSI total score (p = .0005), and 4 BPDSI items, including interpersonal relationships (p = .0005), impulsivity (p = .0005), affective instability (p = .0005), and outbursts of anger (p = .045). No cases of significant hyponatremia or severe adverse effects were reported. Mild to moderate adverse effects included sedation, dizziness, nausea, and headache. Seven patients reported no adverse effects. CONCLUSION: Oxcarbazepine was found an effective and well-tolerated treatment in the management of borderline personality disorder patients.

Adult↗
PubMed2003

An MRI study of superior temporal gyrus volume in women with schizotypal personality disorder.

OBJECTIVE: An abnormal superior temporal gyrus has figured prominently in schizophrenia research, and left superior temporal gyrus volume has been shown to be smaller in male subjects with schizotypal personality disorder. This is the first structural magnetic resonance imaging study to examine a group of female subjects with schizotypal personality disorder. METHOD: The superior temporal gyrus was drawn on coronal images acquired from female subjects recruited from the community (schizotypal personality disorder group: N=21, comparison group: N=29). RESULTS: There were no gray matter volume differences in the left or right superior temporal gyrus between the subjects with schizotypal personality disorder and the comparison subjects. Within the schizotypal personality disorder group, however, there was an interaction between hemisphere and family history of mental illness. Moreover, subjects with schizotypal personality disorder did demonstrate formal thought disorder and a negative correlation between left superior temporal gyrus volume and odd speech. CONCLUSIONS: This study of female subjects with schizotypal personality disorder showed no superior temporal gyrus volume differences, but preliminary findings indicate that among female subjects with schizotypal personality disorder, there is a left-right difference in those who have a family history of mental illness relative to those who do not. These data also suggest an association between abnormal speech and left superior temporal gyrus volume, a finding similar to that found in schizophrenia. Results from this study thus clearly reinforce the importance of studying female subjects separately.

Adolescent↗
PubMed2003

The representation of four personality disorders by the schedule for nonadaptive and adaptive personality dimensional model of personality.

This study examined the relationships of the Schedule for Nonadaptive and Adaptive Personality (SNAP) model of personality to 4 targeted personality disorders (PDs) in a large multisite sample of patients. Data were examined from 529 patients, who were assigned 1 of 5 primary diagnoses: borderline, schizotypal, avoidant, and obsessive-compulsive PDs and major depression without PD. Patients were administered the SNAP questionnaire and results were compared among diagnostic groups and between patient groups and nonclinical norms. Results indicated that the dimensions of the model appear to have considerable promise in differentiating normal from abnormal personality, particularly in the propensity of individuals with PDs to manifest negative affects and interpersonal detachment. Furthermore, the model appeared to successfully distinguish specific PDs, a property that represents a particular challenge for dimensional models of personality.

Adaptation, Psychological↗
PubMed2000

Three-year follow-up of women with the sole diagnosis of depressive personality disorder: subsequent development of dysthymia and major depression.

OBJECTIVE: The authors sought to determine whether subjects with the sole diagnosis of depressive personality disorder are at higher risk for developing dysthymia and major depression than are healthy comparison subjects. METHOD: Eighty-five women with depressive personality disorder who had no comorbid axis I or axis II disorders and 85 age-matched healthy comparison women were initially recruited and reinterviewed 3 years later to evaluate the cumulative incidence rate of dysthymia and major depression. RESULTS: At the 3-year follow-up assessment, the women with depressive personality disorder had a significantly greater odds ratio for developing dysthymia than did the healthy comparison women. The difference in odds ratios for the development of major depression between women with and without depressive personality disorder did not reach statistical significance. CONCLUSIONS: The present study, the first to determine the subsequent development of dysthymia and major depression in subjects with the sole diagnosis of depressive personality disorder, found that subjects with depressive personality disorder had a greater risk of developing dysthymia than did healthy comparison subjects at 3-year follow-up. Findings of the current study also suggest that depressive personality disorder may mediate the effects of a family history of axis I unipolar mood disorders.

Adult↗
PubMed1996

A comparison of DSM-III-R and ICD-10 personality disorder criteria in an out-patient population.

This study reports the results of a comparison of DSM-III-R and ICD-10 personality disorder criteria by application of both sets of criteria to the same group of patients. Despite the clinical relevance of these disorders and the need for reliable diagnostic criteria, such a comparison has not previously been reported. DSM-III-R and ICD-10 have converged in their classification of personality disorders, but some important differences between the two systems remain. Personality disorder diagnoses from both systems were obtained in 52 out-patients, using the Standardized Assessment of Personality (SAP), a brief, informant-based interview which yields diagnoses in both DSM-III-R and ICD-10. For individual personality disorder diagnoses, agreement between systems was limited. Thirty-four subjects received a personality disorder diagnosis that had an equivalent form in both systems, but only 10 subjects (29%) received the same primary diagnosis in each system. There was a difference in rate of diagnosis, with ICD-10 making significantly more personality disorder diagnoses. The lower diagnostic threshold of the ICD-10 contributed most of this effect. Further modifications in ICD-10 Diagnostic Criteria for Research (DCR) and DSM-IV to the personality disorder category have been considered. The omission in DSM-IV of three categories unique to that system and the raising of the threshold in ICD-10 DCR, do seem to have been helpful in promoting convergence.

Adolescent↗
PubMed2006

Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy.

CONTEXT: Borderline personality disorder is a severe and chronic psychiatric condition, prevalent throughout health care settings. Only limited effects of current treatments have been documented. OBJECTIVE: To compare the effectiveness of schema-focused therapy (SFT) and psychodynamically based transference-focused psychotherapy (TFP) in patients with borderline personality disorder. DESIGN: A multicenter, randomized, 2-group design. SETTING: Four general community mental health centers. PARTICIPANTS: Eighty-eight patients with a Borderline Personality Disorder Severity Index, fourth version, score greater than a predetermined cutoff score. INTERVENTION: Three years of either SFT or TFP with sessions twice a week. MAIN OUTCOME MEASURES: Borderline Personality Disorder Severity Index, fourth version, score; quality of life; general psychopathologic dysfunction; and measures of SFT/TFP personality concepts. Patient assessments were made before randomization and then every 3 months for 3 years. RESULTS: Data on 44 SFT patients and 42 TFP patients were available. The sociodemographic and clinical characteristics of the groups were similar at baseline. Survival analyses revealed a higher dropout risk for TFP patients than for SFT patients (P = .01). Using an intention-to-treat approach, statistically and clinically significant improvements were found for both treatments on all measures after 1-, 2-, and 3-year treatment periods. After 3 years of treatment, survival analyses demonstrated that significantly more SFT patients recovered (relative risk = 2.18; P = .04) or showed reliable clinical improvement (relative risk = 2.33; P = .009) on the Borderline Personality Disorder Severity Index, fourth version. Robust analysis of covariance (ANCOVA) showed that they also improved more in general psychopathologic dysfunction and measures of SFT/TFP personality concepts (P<.001). Finally, SFT patients showed greater increases in quality of life than TFP patients (robust ANCOVAs, P=.03 and P<.001). CONCLUSIONS: Three years of SFT or TFP proved to be effective in reducing borderline personality disorder-specific and general psychopathologic dysfunction and measures of SFT/TFP concepts and in improving quality of life; SFT is more effective than TFP for all measures.

Ambulatory Care↗
PubMed1987

A multidimensional scaling of the DSM-III personality disorders.

The DSM-III employs a categorical model for the classification of personality disorders. A dimensional model provides certain advantages, but there has not yet been an empiric attempt to identify an optimal set of dimensions. We systematically assessed the presence of each of the symptoms for the personality disorders in 84 patients. The number of symptoms of each of the personality disorders possessed by each patient was correlated across patients, and the correlations were subjected to a multidimensional scaling program. A three-dimensional solution was compared with the placements of the personality disorders predicted by dimensions published previously.

Adult↗
PubMed2003

Impulsiveness, impulsive aggression, personality disorder, and spousal violence.

Impulsiveness has become a key concept in thinking about the determinants of violence and aggression. In this study of spouse abusers, the relationship between impulsiveness, impulsive aggression, and physical violence is confirmed. Impulsiveness and impulsive aggression have significant correlations with physical aggression. Impulsiveness and impulsive aggression are also correlated with measures of Borderline Personality Disorder and Antisocial Personality Disorder. In addition, the measures of Borderline and Antisocial Personality Disorder (PD) are significantly correlated with physical aggression. The violent and non-violent groups differed on impulsive aggression and on Borderline Personality Disorder. A partial replication of Tweed and Dutton's findings (1998) revealed sub-groups of high- and low-violence men. The high-violence group was very different from the low-violent and the non-violent groups. The high-violence group had higher pathology scores on all clinical scales, except Mania, of the Personality Assessment Inventory. These findings have implications for violence prediction and for treatment of violent men.

Adult↗
PubMed2006

Aripiprazole in the treatment of patients with borderline personality disorder: a double-blind, placebo-controlled study.

OBJECTIVE: Aripiprazole is a relatively new atypical antipsychotic agent that has been successfully employed in therapy for schizophrenia and schizoaffective disorders. A few neuroleptics have been used in therapy for patients with borderline personality disorder, which is associated with severe psychopathological symptoms. Aripiprazole, however, has not yet been tested for this disorder, and the goal of this study was to determine whether aripiprazole is effective in the treatment of several domains of symptoms of borderline personality disorder. METHOD: Subjects meeting criteria for the Structured Clinical Interview for DSM-III-R Personality Disorders for borderline personality disorder (43 women and 9 men) were randomly assigned in a 1:1 ratio to 15 mg/day of aripiprazole (N=26) or placebo (N=26) for 8 weeks. Primary outcome measures were changes in scores on the symptom checklist (SCL-90-R), the Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), and the State-Trait Anger Expression Inventory and were assessed weekly. Side effects and self-injury were assessed with a nonvalidated questionnaire. RESULTS: According to the intent-to-treat principle, significant changes in scores on most scales of the SCL-90-R, the HAM-D, the HAM-A, and all scales of the State-Trait Anger Expression Inventory were observed in the subjects treated with aripiprazole after 8 weeks. Self-injury occurred in the groups. The reported side effects were headache, insomnia, nausea, numbness, constipation, and anxiety. CONCLUSIONS: Aripiprazole appears to be a safe and effective agent in the treatment of patients with borderline personality disorder.

Aggression↗
PubMed2000

Adolescent personality disorders associated with violence and criminal behavior during adolescence and early adulthood.

OBJECTIVE: A community-based, longitudinal prospective study was conducted to investigate whether personality disorders during adolescence are associated with elevated risk for violent behavior during adolescence and early adulthood. METHOD: A community-based sample of 717 youths from upstate New York and their mothers were interviewed in 1983, 1985-1986, and 1991-1993. Axis I and II disorders were assessed in 1983 and 1985-1986. Antisocial personality disorder was not assessed because most participants were less than 18 years of age in 1983 and 1985-1986. Violent behavior was assessed in 1985-1986 and 1991-1993. RESULTS: Adolescents with a greater number of DSM-IV cluster A or cluster B personality disorder symptoms were more likely than other adolescents in the community to commit violent acts during adolescence and early adulthood, including arson, assault, breaking and entering, initiating physical fights, robbery, and threats to injure others. These associations remained significant after controlling for the youths' age and sex, for parental psychopathology and socioeconomic status, and for co-occurring psychiatric disorders during adolescence. Paranoid, narcissistic, and passive-aggressive personality disorder symptoms during adolescence were independently associated with risk for violent acts and criminal behavior during adolescence and early adulthood after the covariates were controlled. CONCLUSIONS: Cluster A and cluster B personality disorders and paranoid, narcissistic, and passive-aggressive personality disorder symptoms during adolescence may increase risk for violent behavior that persists into early adulthood.

Adolescent↗
PubMed1980

Variability of mood and the diagnosis of hysterical personality disorder.

Twenty patients with the diagnosis hysterical personality disorder were compared with a matched control group pf patients with other personality and neurotic diagnoses. Subjects' moods were assessed with a visual analogue scale 4 times a day for 5 consecutive days. Patients with a primary discharge diagnosis of hysterical personality disorder showed greater variability of mood than controls. Since emotional lability is said to be a characteristic hysterical trait, the results are taken as empirical support for the validity of one of the clinical judgements inherent in the diagnostic process.

Adult↗
PubMed1997

Family history assessment of personality disorders: I. Concordance with direct interview and between pairs of informants.

The present study examined the concordance of the Family History Interview for Personality Disorders (FHIPD) with diagnoses based on direct interviews and between pairs of informants. Subjects were 224 probands participating in a series of studies of the familial transmission of mood and personality disorders and their first-degree relatives. Proband informants and relatives provided information about themselves on the Structured Clinical Interview for DSM-III-R (SCID), Personality Disorder Examination (PDE), and Eysenck Personality Questionnaire (EPQ). Information from informants about relatives was collected with the FHIPD. All assessments were made blindly and independently. Using Kappa, concordance between proband informants' family histories and relative direct reports on specific personality disorders was low, ranging from -.01 to .28, with a median of .10. Kappa for a diagnosis of any personality disorder was .16. When two independent informant reports were compared, Kappas for specific Axis II disorders ranged from .10 to .72, with a median of .28. Kappa for a diagnosis of any personality disorder was .36. These data suggest that subjects and informants provide different perspectives on Axis II psychopathology, and support the use of both sources of information whenever possible.

Adolescent↗
PubMedDate not supplied

[The evaluation of personality disorders among inmates by IPDE and MMPI].

The prevalence of personality disorders in penal population was studied with two instruments, the classic MMPI and the recently published IPDE, authorized by the WHO for the diagnosis of personality disorders in both, DSM-IV and ICD-10 versions. A sample of 56 prisoners from a Spanish prison was studied, mean age 22, all male, 98% of them had never requested psychiatric help. The crimes most frequently committed were related to drug traffic and drug abuse (thefts, robberies, crimes against public health). There were also cases of homicide, homicide attempt, rape and kidnapping. 91% of the studied sample presented one or more personality disorders, being the most frequent: Antisocial (79%), Paranoid (52%) and Borderline (41%). The MMPI scales most frequently obtained were: Psychopathic deviation (59%), Paranoia (46%) and Schizophrenia (41%). There was a good clinical correlation between the IPDE and the MMPI results.

Adult↗
PubMed1994

Personality disorder correlates of late and early onset depression.

OBJECTIVE: To compare the lifetime personality dysfunction of geriatric patients having late and early onset of major depression. DESIGN: Group comparisons. SETTING: Inpatient geriatric psychiatry unit and hospital-based geriatric psychiatry outpatient clinic. PATIENTS: Volunteer sample of recovered elderly depressives with history of early onset of major depression (age < 60) (n = 16) and history of late onset of major depression (age > 60) (n = 14). MAJOR OUTCOME MEASURE: Personality Disorder Examination, containing diagnostic and dimensional scores for DSM-III-R personality disorders. RESULTS: The two groups had similar demographic profiles and levels of depression after treatment. Early onset subjects had significantly higher mean dimensional scores in the avoidant, dependent, and not otherwise specified NOS personality disorders, and higher dimensional scores with a trend toward significance in 6 additional personality disorders. CONCLUSIONS: Early onset geriatric depressives may have more lifetime personality dysfunction than late onset subjects. Greater personality dysfunction in early onset subjects may reflect postdepressive changes, predisposition, or a low grade depressive subtype.

Aged↗
PubMed1995

The reliability and validity of two structured diagnostic interviews for personality disorders.

BACKGROUND: The reliability and validity of Axis II diagnoses were investigated in a sample of 108 patients with nonpsychotic Axis I disorders. METHODS: Patients were assessed for personality disorders (PDs) with either the Personality Disorder Examination (PDE) or the Structured Interview for DSM-III-R Personality (SIDP-R). Validity was examined by comparing interview diagnoses with "best-estimate" consensus diagnoses assigned by a panel of judges. RESULTS: Interrater reliabilities were excellent when using continuous data (eg, total or cluster scores; intra-class correlation coefficients, .82 to .92); they were lower with categorical diagnoses (eg, any PD vs no PD; kappa = 0.55 and 0.58 with the two interviews). Validity coefficients (ie, kappa values reflecting agreement between the interviews and the consensus diagnosis) for the decision of any PD vs no PD were 0.18 (56% agreement) with the PDE and 0.37 (75% agreement) with the SIDP-R; validity coefficients for identifying cases of "marked" PD were 0.21 (62% agreement) with the PDE and 0.24 (60% agreement) with the SIDP-R. CONCLUSIONS: There have been important advances in the development of structured interviews for Axis II diagnoses, but the findings suggest a continued need to be thoughtful about their strengths and weaknesses before accepting their results as definitive diagnostic tests. The findings also demonstrated some of the advantages of continuous vs categorical data.

Adult↗
PubMed2006

Treatment compliance among patients with personality disorders receiving group psychotherapy: what are the roles of interpersonal distress and cohesion?

It is often assumed that patients with personality disorders have worse compliance in psychotherapy (i.e., attend fewer sessions) than patients without personality disorders. Such an assumption can have negative consequences for the treatment of patients with personality disorders. It also denies the presence of variability in session attendance among patients with personality disorders. Research that attempts to identify the factors that are associated with variability in session attendance among patients with personality disorders is needed. The present study examined the role of interpersonal distress as a predictor of session attendance for patients with personality disorders (n = 72) in two different forms of group psychotherapy (interpretive, supportive). The study also investigated whether patients' cohesion to their group mediated the effect of interpersonal distress on attendance. Findings indicated that interpersonal distress had a strong, direct association with attendance in supportive group therapy, but minimal association in interpretive group therapy. High levels of interpersonal distress were associated with higher attendance in supportive therapy. Furthermore, cohesion to the group accounted for about two-thirds of the effect of interpersonal distress on attendance in supportive group therapy, thus providing compelling evidence for its role as a mediator. Possible explanations and clinical implications of these findings are discussed.

Adult↗
PubMed2006

Management of complex and severe personality disorders in community mental health services.

PURPOSE OF REVIEW: To describe the prevalence and specific management of severe and complex personality disorders in community mental health services and similar settings. RECENT FINDINGS: Conflicting reports exist in the literature but the consensus of evidence suggests that more complex personality disorder (more so than simple personality disorder) impairs response to treatment of most psychiatric disorders and complicates their management. Poor adherence to treatment may be one of the mechanisms underlying this. SUMMARY: Increasing evidence now suggests that more complex and severe personality disorders have a negative impact on the outcome of most psychiatric disorders. Some indications, however, are there to show that pharmacological treatments may not handicap the outcome of pharmacological treatment as much as other types of intervention and may be selectively chosen in this group. Severe personality disorder needs to be identified early in community services as by anticipating and adjusting to its effects it is likely to improve treatment plans and prognosis.

Borderline Personality Disorder↗