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PubMed2002

Olanzapine improves social dysfunction in cluster B personality disorder.

Treatment with antipsychotics is a common approach for personality disorder. Conventional antipsychotics may be efficacious particularly against psychoticism, but less against other symptoms in these patients. They are, furthermore, associated with adverse drug reactions poorly tolerated by patients with personality disorder. Atypical antipsychotics have a more convenient pharmacological profile with a lower risk for extrapyramidal symptoms and a broader therapeutic profile, showing some efficacy against impulsivity, aggressivity and affective symptoms. The medical records of ten patients with a DSM-IV diagnosis of a cluster B personality disorder who had received olanzapine treatment were reviewed. A mirror-image design anchored to the start date of olanzapine treatment and extending 8 weeks in either direction was used. The assessment consisted of a qualitative chart review and a retrospective completion of the GCI-C and an adapted French version of the SDAS, using the observer-rated items. The olanzapine dose range was 2.5-20 mg during the 8 weeks of observation. The mean SDAS score (items 1-15) was 28.8+/-8.4 for the 8 weeks preceding olanzapine prescription and was improved to 13.6+/-5.8 after 8 weeks of treatment.

Adult↗
PubMed2005

Personality disorders in medical students: measuring by IPDE-10.

OBJECTIVES: The purpose of the present study was to investigate the personality disorders (PDs) of fifth year medical students of Chiang Mai University according to International Classification of Disease -10 (ICD-10) system by using IPDE-10. MATERIAL AND METHOD: A group of ninety-nine out of 150 of fifth-year medical students of Chiang Mai University undertook personality disorder inventory - International Personality Disorder Examination ICD-10 screening questionnaires (IPDE-ICD 10). Those who received diagnoses of personality disorders were subsequently interviewed by the authors to find definite diagnoses. RESULTS: The prevalence rate of PDs was 9%. The proportion of all PDs was as follows; 1%, 3%, 2%, 2%, and 1% for paranoid, impulsive, histrionic, anankastic, and dependent, respectively. The rate of probable diagnoses of PDs ranged from 1%-22.8%. CONCLUSION: The prevalence rate found in the medical students group did not differ from that in other populations. The benefit of ICD diagnosis system was discussed.

Adult↗
PubMed1998

Developing effective services for patients with personality disorders.

OBJECTIVE: This review focused on empirical research that addressed the effectiveness of service models for the care of patients with personality disorders. METHOD: Services discussed included those delivering acute care, such as crisis and emergency services and acute psychiatric hospitalization; continuing care, such as outpatient services, day hospital treatment, and assertive community treatment programs; and other community programming, such as integrated treatment for comorbid substance abuse and psychoeducational interventions for families of patients with personality disorders. The review focused on studies that included patients with personality disorders, and it measured outcomes relevant to patients with personality disorders. Evidence from randomized controlled trials was highlighted. RESULTS: Few systematic studies of acute services were available. Community programming can decrease the risk of suicide attempts and reliance on inpatient admissions. Services must develop methods of ensuring compliance with treatment. Assertive community treatment for Axis II patients should be developed, implemented, and tested. Comprehensive programming for patients with personality disorders must include integrated treatment for substance abuse and family psychoeducational programs. CONCLUSION: Promising new models of care for patients with personality disorders are ready for testing and wider application.

Aftercare↗
PubMed1997

Self and informant ratings of SCID-II Personality Disorder items for nonreferred college women: effects of item and participant characteristics.

Examined the relationship between self- and informant-ratings on Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) items. Seventy-five female undergraduate student volunteers and their roommates also completed the Brief Symptom Inventory, Rubin's Liking Scale, and the Marlowe-Crowne Social Desirability Scale. Self-rating scores on personality disorder items were significantly higher than informant-ratings on five personality disorder scales. Participants and informants endorsed more personality disorder items rated higher on social desirability. No relationship was found between subjectivity of personality disorder scales and differences between self- and informant-ratings. Participants with higher needs for positive self-presentation rated themselves lower on nine personality disorder scales. A higher level of liking for roommates was associated with lower informant ratings for six personality disorder scales.

Adolescent↗
PubMed2000

Prevalence of personality disorders among combat veterans with posttraumatic stress disorder.

Many combat veterans with PTSD have co-occurring symptoms of other forms of psychopathology; however, there have been limited studies examining personality disorders among this population. The few extant studies typically have assessed only two or three personality disorders or examined a small sample, resulting in an incomplete picture and scope of comorbidity. This study assessed all DSM-III-R personality disorders in 107 veterans in a specialized, inpatient unit. Using the Structured Clinical Interview for DSM-III-R Personality Disorders, 79.4% of the participants were diagnosed with at least one personality disorder: 29.9% received only one diagnosis, 21.5% had two, 15.9% had three, and 12.1% had four or more. The most frequent single diagnoses were Avoidant (47.2%), Paranoid (46.2%), Obsessive-Compulsive (28.3%), and Antisocial (15.1%) personality disorders.

Cluster Analysis↗
PubMed1984

Assessing borderline personality disorder with self-report, clinical interview, or semistructured interview.

The authors compared three methods of assessing borderline personality disorders. Test-retest reliability for the self-report Personality Diagnostic Questionnaire was adequate and compared favorably with the interrater reliability of the DSM-III-oriented clinical interview and the semistructured research interview. The overall prevalence of personality disorders scored on the questionnaire was similar to that generated by the clinical interview. The specificity and sensitivity of the questionnaire for the diagnosis of borderline personality disorder were slightly higher than 60%, which suggests that it may be a useful and economical instrument for identifying patients with borderline personality disorder.

Adolescent↗
PubMed1994

Borderline personality disorder from the patient's perspective.

OBJECTIVES: Patients with a diagnosis of borderline personality disorder were studied to learn how they experienced the disorder and its treatment. METHODS: Life history narratives were obtained from ten patients with borderline personality disorder in a series of 90-minute interviews held over the course of a year. The interviews had minimal structure; patients were simply asked to talk about themselves. RESULTS: The narratives revealed striking similarities in the patients' experience with borderline personality disorder. Reports of their experience differed markedly from clinical descriptions of the disorder. Common themes of estrangement, inadequacy, and despair were identified, as well as common coping strategies, primarily dissociation and avoidance of self-disclosure. CONCLUSIONS: Patients' experiences with borderline personality disorder were highly consistent but differed markedly from clinical descriptions. The patient narratives provided information that could lead to more effective treatment of the disorder.

Adaptation, Psychological↗
PubMed1992

Drug treatment of the personality disorders.

Many people with well defined borderline and schizotypal personality disorders may benefit considerably from small doses of neuroleptics. Depression that occurs with personality disorders, which is frequent, responds poorly to tricyclics but may respond better to neuroleptics, while the response to ECT is usually short lived. Selected borderline subjects may respond to MAOIs, particularly where there is a history of childhood hyperactivity. Carbamazepine and lithium may help some individuals with episodic behavioural dyscontrol and aggression, even in the absence of epileptic, affective or organic features. Drug treatments can be combined with psychotherapy, but further placebo-controlled trials are needed to clarify which drugs are most useful, and whether there are any useful clinical predictors of drug responsiveness.

Antidepressive Agents, Tricyclic↗
PubMed2004

Are personality disorders psychological manifestations of executive function deficits? Bivariate heritability evidence from a twin study.

This study tested whether personality disorders may be the psychological manifestations of executive function deficits by examining their bivariate heritability in a community sample of 314 twins (ages 5-17 years; M age = 9.7; 96 monozygotic pairs and 61 dizygotic pairs). The parents of the twins completed the Coolidge Personality and Neuropsychological Inventory (Coolidge, 1998; Coolidge et al., 2002). Heritability was estimated by structural equation modeling. Executive function deficits and personality disorders were significantly heritable (executive function deficits,.77; 11 out of 12 personality disorders, median =.69). The proportion of the observed correlation attributable to heritable factors or bivariate heritability between executive function deficits and the personality disorder scales ranged from.27 for schizoid to.64 for histrionic. These findings may provide some insight as to why individuals diagnosed with specific personality disorders frequently exhibit chronic difficulties with everyday decisions, selective attention and inhibition, judgments, choices, planning, and flexibility.

Adolescent↗
PubMed2006

Comparison of alternative models for personality disorders.

BACKGROUND: The categorical classification system for personality disorder (PD) has been frequently criticized and several alternative dimensional models have been proposed. METHOD: Antecedent, concurrent and predictive markers of construct validity were examined for three models of PDs: the Five-Factor Model (FFM), the Schedule for Nonadaptive and Adaptive Personality (SNAP) model and the DSM-IV in the Collaborative Study of Personality Disorders (CLPS) sample. RESULTS: All models showed substantial validity across a variety of marker variables over time. Dimensional models (including dimensionalized DSM-IV) consistently outperformed the conventional categorical diagnosis in predicting external variables, such as subsequent suicidal gestures and hospitalizations. FFM facets failed to improve upon the validity of higher-order factors upon cross-validation. Data demonstrated the importance of both stable trait and dynamic psychopathological influences in predicting external criteria over time. CONCLUSIONS: The results support a dimensional representation of PDs that assesses both stable traits and dynamic processes.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed1993

Treatment of multiple personality disorder: a survey of current practices.

OBJECTIVE: Reported cases of multiple personality disorder have increased dramatically in the last decade. Few data are available on the treatment of multiple personality disorder. Current recommendations are based on the experience of individual clinicians rather than on systematic research. METHOD: A questionnaire study of 305 clinicians representing a spectrum of mental health professionals was conducted to survey the types and relative efficacy of treatment modalities currently used with cases of multiple personality disorder. RESULTS: Individual psychotherapy facilitated by hypnosis was uniformly endorsed as the primary treatment by all practitioner groups. The average patient was in twice-weekly psychotherapy facilitated by hypnosis for 3.8 years. Antidepressant and anxiolytic medications were reported to be moderately useful adjunctive treatments. CONCLUSIONS: These findings support current impressionistic treatment recommendations for multiple personality disorder regarding the primacy of psychotherapy and the moderate benefits of psychopharmacology with antidepressant and antianxiety agents.

Adult↗
PubMed2001

Out-patient behaviour therapy in alcoholism: impact of personality disorders and cognitive impairments.

OBJECTIVE: We investigated whether alcoholic patients with comorbid personality disorders and those with cognitive impairments would benefit in a different way from different behaviour therapy strategies. METHOD: After detoxification, 120 alcoholics were assigned randomly to one of three out-patient treatment programmes comprising 'coping skills training', 'cognitive behaviour therapy' or unspecific supportive control therapy. Personality disorders and cognitive impairments were assessed at the beginning of the 6-month treatment period. RESULTS: The impact of concomitant personality disorders or cognitive impairments was generally only moderate and mainly independent from treatment condition. However, alcoholic patients relapsing within 6 months after detoxification showed a higher rate of personality disorders (especially antisocial and borderline) and slightly more cognitive deficits (especially in verbal memory and visuomotor functions) than abstainers even before therapy. CONCLUSION: The high amount of early relapses and drop-outs probably hindered larger differentiated treatment effects. Hypotheses will be retested in treatment completers using forthcoming follow-up data.

Alcoholism↗
PubMed1984

The psychopharmacologic treatment of personality disorders.

We have reviewed both the rationale for and approaches to the use of psychotropic medications in the treatment of personality disorders. Despite some studies that may provide the seeding crystals around which significant data bases regarding the drug treatment of personality disorders will develop, the pharmacologic treatment of personality disorder remains a clouded area governed more by opinion than fact. Clinicians must still be guided by basic clinical sense regarding the use of medications with these patients. Some questions to ask are the following: Has the patient responded to medications in the past? What are the risks for abuse or self-destructive acting out? What is the risk-to-benefit ratio for the introduction of a drug into a psychotherapeutic situation at a given time? Is hospitalization necessary to assess the potential benefits of medication to the patient while minimizing the potential to act out? Although these guidelines may seem inadequate, clinicians can take some solace in the fact that ongoing studies will lead to better informed psychopharmacologic choices for patients with personality disorders.

Anticonvulsants↗
PubMed1997

Temperament and the structure of personality disorder symptoms.

This paper attempts to construct a simplified system for the classification of personality disorders, and relates this system to normally distributed human personality characteristics. One hundred and forty-eight subjects with a variety of psychiatric diagnoses were evaluated using the SCID-II structured clinical interview for personality disorders. A four-factor solution of personality disorder symptoms was obtained and we labelled these factors 'the four As': antisocial, asocial, asthenic and anankastic. The factors related to the four temperament dimensions of the Tridimensional Personality Questionnaire (TPQ), but less closely to Eysenck Personality Questionnaire (EPQ) dimensions. The four factors were similar to those identified in a number of studies using a variety of assessment methods and this lends some credibility to our findings. It suggests that a more parsimonious set of trait descriptors could be used to provide simpler, less overlapping categories that retain links with current clinical practice. In addition, these factors can be seen as extremes of normally distributed behaviours obtained using the TPQ questionnaire.

Adolescent↗
PubMed2004

Neuropsychological profile in patients with schizotypal personality disorder or schizophrenia.

Neuropsychological impairments have been consistently reported in patients with schizophrenia. As little is known whether subjects with schizotypal personality disorder exhibit neurocognitive dysfunction similar to that in schizophrenia, we assessed the neuropsychological profile of 15 subjects with schizotypal personality disorder and compared it with that for 15 patients with schizophrenia and for 15 psychiatrically normal volunteers. All participants were administered a standard neuropsychological battery assessing language ability, spatial ability, visuomotor function, verbal memory, visual memory, auditory attention, visual attention, and executive function. Performance on most of the cognitive domains was impaired in patients with schizotypal personality disorder but less than patients with schizophrenia. Specifically, impairment in verbal memory and visuomotor ability in patients with schizotypal personality disorder and patients with schizophrenia were comparable, while patients with schizophrenia performed worse on the test of executive function than did patients with schizotypal personality disorder. As a whole, cognitive deficits in patients with schizotypal personality disorder were qualitatively similar to, but quantitatively milder than, those for patients with schizophrenia. The results suggest that cognitive abilities related to frontotemporal lobe function are disturbed across these schizophrenia-spectrum disorders.

Adult↗
PubMed2004

Validity of the family history method for diagnosing schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders in first-degree relatives of schizophrenia probands.

This study examined the validity of the family history method for diagnosing schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders in first-degree relatives of schizophrenia probands. This is the first large-scale study that examined the validity of the family history method for diagnosing DSM-III-R personality disorders. The best estimate DSM-III-R diagnoses of 264 first-degree relatives of 117 adult-onset schizophrenia probands based on direct structured diagnostic interviews, family history interview, and medical records were compared to Family History Research Diagnostic Criteria (FH-RDC) diagnoses based on the NIMH Relative Psychiatric History Interview and to family history Structured Clinical Interview for DSM-III-R: Personality Disorders (SCID-II) diagnoses based on the SCID-II adapted to a third person format. Diagnoses of relatives were made blind to proband diagnostic status. The median sensitivity for schizophrenia and the related psychoses was 29% (range 0-50%), the median specificity 99% (range 98-100%), and the median positive predictive value (PPV) 67% (range 20-80%). The median sensitivity for the personality diagnoses was 25% (range 14-71%), the median specificity 100% (range 99-100%), and the median PPV 100% (range 67-100%). The family history method has low sensitivity but has excellent specificity and PPV for schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders. The kappa coefficient for the family history method was moderately good for the psychoses (0.598) and for paranoid and schizotypal personality disorder (0.576). Using the family history method, the validity of making schizophrenia-related personality disorder diagnoses was comparable to that of making psychotic disorder diagnoses.

Adolescent↗
PubMed2004

[Construction of a scale to signal personality disorders in the elderly].

Till now, no specific diagnostic instruments to detect personality disorders in the elderly are available. The aim of our study was to contribute to the construction of a reliable en valid instrument for the detection of personality disorders in older adults. Therefore, a draft version of the instrument was constructed both for the patient and the informant. Both the patient and the informant version of the instrument included 52 items with the same content. These items concerned Habitual behaviour (HAB), Biographical information (BIO) and Observation of actual behaviour (OBS). 159 clients of 60 years and older of a Dutch ambulatory mental health care organisation were assessed with the screening instrument. In 96 of the 159 outpatients one or more informants were included. The results indicate that the internal consistency of seven HAB items, nine BIO items and five OBS items was moderate to good with regard to both the patient and informant instrument. Test-retest reliability of the 21 items of the patient instrument was moderate with regard to HAB, excellent with regard to BIO and moderate with regard to OBS. Interrater reliability of OBS was also moderate. The criterion validity (criterion: DSM-IV TR Axis II classification) of HAB, BIO and OBS based on the 21 items of the patient instrument was fair and with regard to the same 21 items of the informant instrument insufficient. In conclusion, sixteen out of 52 potential items of the patient's draft version of the screening instrument can be used to detect a possible personality disorder. These sixteen items from the HAB and BIO scale are named the Gerontological Personality disorder Scale (GPS). Medical doctors, psychologists and nurses working in ambulatory mental health organisation can use the GPS as a resource during the diagnostic process. Whether the GPS can be used beyond mental health organisations, for example by general practitioners is a subject for future studies.

Aged↗
PubMed1997

Family history assessment of personality disorders: II. Association with measures of psychosocial functioning in direct evaluations with relatives.

To test the convergent validity of the Family History Interview for Personality Disorders (FHIPD), as well as the general utility of informants' reports of personality disorders, we explored the relationship between proband informant reports of Axis II diagnoses on the FHIPD and relative reports of various indices of psychosocial adjustment. Subjects were the first degree relatives (n = 454) of 224 probands participating in a family study of mood and personality disorders. Relatives provided information on the Structured Clinical Interview for DSM-III-R (SCID), the Personality Disorder Examination (PDE), and other variables reflecting aspects of psychosocial dysfunction that are common in personality disorders. Proband informants were interviewed about their relatives using the FHIPD Proband informant reports of personality disorders on the FHIPD were associated with a variety of forms of psychosocial dysfunction as determined in direct assessments with the relatives, even for those with no diagnosable Axis II psychopathology dysfunction as determined in direct assessments with the relatives, even for those with no diagnosable Axis II psychopathology on direct interview. These results support the convergent validity of the FHIPD, and suggest that informants may provide important information on Axis II psychopathology that is not obtained from direct interviews with the subjects themselves.

Adolescent↗