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PubMed1996

Comorbidity of personality disorders and unipolar major depression: a review.

The association of major depressive disorders with personality disorders is relevant in terms of clinical, therapeutic and prognostic aspects. However, the prevalence of this association remains unclear. This may be due to methodological considerations. Nonetheless, it could be estimated from this review that 20% to 50% of inpatients and 50% to 85% of out-patients with a current major depressive disorder have an associated personality disorder. Cluster B personality disorders, in particular borderline (10-30%), histrionic (2-20%) and antisocial (0-10%), seem to be overrepresented, even if the narcissistic one is rare (less than 5%). The main characteristic of Cluster C personality disorders is the great variability of results across studies, except for the obsessive compulsive personality disorder, whose prevalence is consistent and rather high (0-20%). Cluster A personality disorders are an heterogeneous group, since the prevalence of schizotypal personality disorder is rather high (0-20%), the prevalence of paranoid personality disorder is low (less than 5%) and the prevalence of schizoid personality disorder is quite variable from one study to another. The prevalence of personality disorders among patients with a lifetime major depression has been insufficiently studied, although it may concern half of these patients. The prevalence of current of lifetime major depression among patients with a personality disorder has not been sufficiently studied and results are very scattered. Also, the coexistence of personality disorder and major depression is frequent, and this review emphasizes the heterogeneity of the personality styles associated with major depression. Finally, an optimization of methods and the adjunction of a dimensional point of view to the categorical approach may help to study the comorbidity of major depression and personality disorders and its consequences.

Comorbidity↗
PubMed2003

Personality pathology and cognitive-behavioral treatment of fear of flying.

Studies have been inconclusive about the influence of personality pathology on treatment outcome in anxiety disorders. In general, it has been presumed that treatment outcome is negatively influenced by the presence of personality pathology. This is a study of the prevalence of personality pathology among persons who were seeking help for fear of flying. Moreover, the effects of personality pathology on the results of a multimodal, standardized, cognitive-behavioral fear of flying treatment program employed by an agency that specializes in treating people with fear of flying were studied. Personality pathology was determined with a self-report questionnaire, which provides ICD-10 diagnoses of personality disorders and dimensional severity scores for personality pathology. Treatment outcome was assessed with three different fear of flying questionnaires. Based on clinical judgment after individual-case conceptualization, participants (N=922) were assigned to a particular treatment for fear of flying. Self-report data for fear of flying were collected at pretreatment and at 3, 6 and 12-month follow-ups in 659 participants who followed the 2-day treatment program. Moreover, the number of flights made in the year following treatment was determined.The results of this study showed that participants with personality pathology, mainly from cluster C (anxiety), report greater fear of flying before treatment than participants without personality pathology. After treatment fear of flying was significantly reduced. Presence of personality pathology was not predictive of the number of flights after treatment and scores on the VAFAS scale at short or long term. Only on two questionnaires for fear of flying collected at short-term participants with personality pathology obtained significantly higher scores, although the size of the differences was relatively small. It was concluded that participants with personality pathology also benefited from fear of flying treatment and that the presence of personality pathology although cannot be regarded as a contra indication for a standardized, cognitive-behavioral group treatment.

Adolescent↗
PubMed1998

Disordered personality style: higher rates in non-melancholic compared to melancholic depression.

OBJECTIVE: We test whether there is differential representation of disordered personality function across melancholic and non-melancholic depressive sub-types, with levels of differentiation examined against differing sub-typing measures. METHOD: In a sample of 245 subjects meeting criteria for a non-psychotic major depressive episode lasting less than 2 years, we examine for differential rates of disordered personality style across melancholic and non-melancholic depression, using four differing sub-typing measures (i.e., DSM-III-R and DSM-IV criteria, Newcastle Index, and the CORE measure). Disordered personality was assessed by psychiatrist ratings of 15 differing personality styles underpinning disorder classes, and several parameters and domains that reflect the arenas whereby disordered personality may be manifested. RESULTS: However defined, those with non-melancholic depression were distinctly more likely to rate as showing disordered personality function, with over-representation to an avoidant personality disorder style being the most consistently and strongly identified personality disorder class. Because of limitations to several of the sub-typing measures, we focus on the DSM-IV system. Discriminant function analyses indicated that those so identified as having non-melancholic depression were significantly more likely to rate as having avoidant and schizoid personality styles. A principal components analysis of our 15 differing personality disorder classes identified three molar classes corresponding to the three-cluster DSM system. Again, non-melancholic (compared to melancholic) subjects were more likely to return higher scores: in order, an 'anxious and fearful' (Cluster C) personality style, then an 'eccentric' Cluster A, and somewhat less clearly, a 'dramatic' Cluster B personality disorder style. Specificity to the non-melancholic depressive class was again suggested in relation to a large number of the parameters and domains measuring disordered personality function. CONCLUSIONS: Disordered personality function appears distinctly more likely in non-melancholic, compared to melancholic depression.

Adolescent↗
PubMed1997

Predicting medical students' academic performances by their cognitive abilities and personality characteristics.

PURPOSE: To utilize multiple regression analyses with both linear and quadratic models to explore and confirm the relationships among students' cognitive abilities, personality traits, and medical school performances at the University of Los Angeles, California, UCLA School of Medicine. METHOD: Ninety-seven "not-disadvantaged" students' pre-medical grade-point averages (GPAs), Medical College Admission Test (MCAT) scores, and personality traits as measured by the Comrey Personality Scales (administered at their application to medical school in 1985) were used to predict their medical school performances according to several criteria. "Disadvantaged" students were excluded from the study because their poor performances on all criteria would confound the relationships of personality, cognitive ability, and performance. RESULTS: The MCAT score was a strong predictor of medical school performances, particularly those criteria measured by medical school GPAs and the National Board of Medical Examiners examination scores, but its predictive power dropped sharply when clinical performance and personal suitability were part of the performance evaluation. Specific personality traits not only strengthened the predictive power of cognitive and personality variables jointly, they became the primary predictors of clinical performance and personal suitability. A single personality-profile index failed to show any power of prediction. As expected, quadratic relationships were found between some personality traits and some medical school performance measures. CONCLUSION: According to these data it is not realistic to use one or two personality traits to predict personal suitability on all medical performance measures. The multiple regression analysis results indicate that different personality characteristics are incorporated in different types of medical performances, which is perhaps why the overall personality-profile score failed to predict any of the studied criteria. Because of the study's relatively small sample size, however, cross-validation studies are necessary to confirm these findings.

Clinical Competence↗
PubMed2003

The relationship of borderline personality disorder to posttraumatic stress disorder and traumatic events.

OBJECTIVE: The authors examined the relationship of borderline personality disorder to posttraumatic stress disorder (PTSD) with respect to the role of trauma and its timing. METHOD: The Trauma History Questionnaire and the PTSD module of the Structured Clinical Interview for DSM-III-R were administered to 180 male and female outpatients with a diagnosis of one or more DSM-III-R personality disorders. Path analysis was used to evaluate the relationship between borderline personality disorder and PTSD. RESULTS: High rates of early and lifetime trauma were found for the subject group as a whole. Compared to subjects without borderline personality disorder, subjects with borderline personality disorder had significantly higher rates of childhood/adolescent physical abuse (52.8% versus 34.3%) and were twice as likely to develop PTSD. In the path analysis of the relationship between borderline personality disorder and PTSD, none of the different types of paths (direct path, indirect paths through adulthood traumas, paths sharing the antecedent of childhood abuse) was significant. The associations with both trauma and PTSD were not unique to borderline personality disorder; paranoid personality disorder subjects had an even higher rate of comorbid PTSD than subjects without paranoid personality disorder, as well as elevated rates of physical abuse and assault in childhood/adolescence and adulthood. CONCLUSIONS: The associations of personality disorder with early trauma and PTSD were evident, but modest, in borderline personality disorder and were not unique to this type of personality disorder. The results do not appear substantial or distinct enough to support singling out borderline personality disorder from the other personality disorders as a trauma-spectrum disorder or variant of PTSD.

Adolescent↗
PubMed2005

Borderline personality disorder, impulsivity, and the orbitofrontal cortex.

OBJECTIVE: Orbitofrontal cortex lesions produce disinhibited or socially inappropriate behavior and emotional irregularities. Characteristics of borderline personality disorder include impulsivity and affective instability. The authors investigated whether aspects of borderline personality disorder, in particular impulsivity, are associated with orbitofrontal cortex dysfunction. METHOD: Measures of personality, emotion, impulsivity, time perception, sensitivity to reinforcers, and spatial working memory were administered to patients with borderline personality disorder (N=19), patients with orbitofrontal cortex lesions (N=23), patients with lesions in the prefrontal cortex but not in the orbitofrontal cortex (N=20), and healthy comparison subjects (N=39). RESULTS: The patients with orbitofrontal cortex lesions and the patients with borderline personality disorder performed similarly on several measures. Both groups were more impulsive and reported more inappropriate behaviors, borderline personality disorder characteristics, and anger and less happiness than the two comparison groups, and both groups were less open to experience and had a faster perception of time (underproduced time) than the healthy comparison subjects. The patients with orbitofrontal cortex lesions and the borderline personality disorder patients performed differently on other measures. The borderline personality disorder patients were less extraverted and conscientious and more neurotic and emotional than all other groups. Patients with orbitofrontal cortex lesions had deficits in reversing stimulus-reinforcer associations and a faster perception of time (overestimated time) than the healthy comparison subjects. CONCLUSIONS: Orbitofrontal cortex dysfunction may contribute to some core characteristics of borderline personality disorder, in particular impulsivity. Other characteristics of borderline personality disorder, such as high levels of emotionality and personality irregularities, do not appear to be related to the type of dysfunction produced by orbitofrontal cortex damage. The similarities and differences found between the borderline personality disorder patients and the patients with orbitofrontal cortex lesions may lead to a better understanding of the etiology of borderline personality disorder and the functions of the orbitofrontal cortex.

Adolescent↗
PubMed2006

Personality and seasonal affective disorder: results from the CAN-SAD study.

BACKGROUND: Personality factors have been implicated in seasonal affective disorder (SAD). The present study investigated the relationship between the five-factor model of personality (neuroticism, extraversion, openness, agreeableness, conscientiousness) and SAD. METHODS: Ninety-five patients with SAD completed personality measures before and after treatment in a clinical trial and during the summer months. The personality scores of the SAD patients were compared with a matched group of non-seasonal depressed patients and published normative data. Stability and change in personality scores with changes in mood state were assessed. Personality dimensions were evaluated as possible predictors of treatment outcome. RESULTS: SAD patients showed elevated openness scores relative to both non-seasonal depressed patients and norms. Their neuroticism scores were lower than non-seasonal depressed patients, but higher than norms. All personality dimensions showed large and highly significant test-retest correlations but several personality dimensions, particularly neuroticism and extraversion, also showed considerable change with changing mood state. None of the personality dimensions were significantly associated with treatment outcome. LIMITATIONS: Personality assessment relied on self-report. CONCLUSIONS: The personality profile of SAD patients differs from both non-seasonal depressed patients and norms. Elevated openness scores appear to be a unique feature of patients with SAD. Since mood state has a significant impact on personality scores, assessment of personality in SAD patients should ideally be conducted when they are in remission. Further investigation of the relationship between personality and SAD, especially the potential significance of elevated openness scores, is warranted.

Adult↗
PubMedDate not supplied

Psychopathy/antisocial personality disorder conundrum.

Psychopathy has traditionally been characterised as a disorder primarily of personality (particularly affective deficits) and, to a lesser extent, behaviour. Although often used interchangeably, the diagnostic constructs of psychopathy, antisocial personality disorder, and dissocial personality disorder are distinct. In this article, the relevant historical and contemporary literature concerning psychopathy is briefly reviewed. The diagnostic criteria for psychopathy, antisocial personality disorder, and dissocial personality disorder are compared. Consideration is given to the assessment, prevalence, and implications of psychopathy for violence risk and treatment efficacy. The DSM-IV-TR criteria for antisocial personality disorder, in particular, are largely behaviourally based. The ICD criteria for dissocial personality disorder, while paying more attention to affective deficits, also do not represent the broad personality and behavioural components of psychopathy. Since 1980, a great deal of research on these disorders has been conducted, using the Hare Psychopathy Checklist, Revised (PCL-R). The PCL-R assesses both personality (interpersonal and affective) and behavioural (lifestyle and antisocial) deficits. As such, the research and clinical implications of psychopathy, as operationalised by the PCL-R, cannot be readily extrapolated to the diagnoses of antisocial personality disorder and dissocial personality disorder. As currently construed, the diagnosis of antisocial personality disorder grossly over-identifies people, particularly those with offence histories, as meeting the criteria for the diagnosis. For example, research shows that between 50% and 80% of prisoners meet the criteria for a diagnosis of antisocial personality disorder, yet only approximately 15% of prisoners would be expected to be psychopathic, as assessed by the PCL-R. As such, the characteristics and research findings drawn from the psychopathy research may not be relevant for those with antisocial or dissocial personality disorder.

Antisocial Personality Disorder↗
PubMed1998

Reliability and validity of depressive personality disorder.

OBJECTIVE: Depressive personality disorder was introduced into DSM-IV's appendix amid controversy. While that disorder appears to be a reliable and valid one, the authors offer new data about its relationship to major depression, dysthymic disorder, and other personality disorders. METHOD: The authors assessed 54 subjects with early-onset, long-standing mild depressive features for depressive personality disorder, axis I and axis II disorders, family history, and treatment history; they conducted follow-up interviews 1 year after the baseline assessment. Subjects with (N=30) and without (N=24) depressive personality disorder were characterized and compared in terms of those variables. RESULTS: Although depressive personality disorder and dysthymia co-occurred in some subjects, 63% of subjects with depressive personality disorder did not have dysthymia, and 60% did not have current major depression. Although subjects with depressive personality disorder were more likely than the mood disorder comparison group to have another personality disorder, 40% had no such disorder. Contrary to study hypotheses, mood disorder was not more common in first-degree relatives of subjects with depressive personality disorder than in relatives of the comparison group. Subjects with and without depressive personality disorder had similar rates of past treatment with medication and psychotherapy; however, the duration of psychotherapy was significantly longer for subjects with than for those without depressive personality. The depressive personality diagnosis was relatively stable over the 1-year follow-up period. CONCLUSIONS: Depressive personality disorder appears to be a relatively stable condition with incomplete overlap with axis I mood disorders and personality disorders. Further studies are needed to better characterize its treatment response and relationship to axis I mood disorders.

Adult↗
PubMedDate not supplied

[Symptoms of DSM IV borderline personality disorder in a nonclinical population of adolescents: study of a series of 35 patients].

1,363 high school students were solicited to complete a personality disorder questionnaire and were encouraged to continue in the study by signing up for interviews with Master's level psychology students. 107 students (7.8%, 34 males, 73 females, mean age = 16.7 +/- 1.8) manifested themselves for the interview and were assessed by using structured diagnostic interviews for borderline personality disorder and major depressive disorder (DIB-R, Revised Diagnostic Interview for Borderlines; MINI, Mini International Neuropsychiatric Interview). The interviews were audiotaped. Interrater reliability was determined by independent ratings of 12 borderline subjects and 12 non-borderline subjects (kappa: 0.795). The distribution of the 107 subjects based on the number of DSM IV borderline personality disorder criteria indicated a gradual dispersion suggesting a continuum from normality to borderline personality disorder: 8% of the subjects met none of the criteria; 16% met one criterion; 17% met two; 12.5%, three; 13.7%, four; 8.4%, five; 5.6%, six; 9.3%, seven; 4.6%, eight; 4.6%, nine. Thirty-five of these 107 subjects (32.7%, 6 males, 29 females, mean age = 16.7 +/- 1.7) received a diagnosis of borderline personality disorder according to DSM IV criteria. The most frequent symptoms were paranoid ideation or dissociative symptoms (97.1%), affective instability (88.6%), inappropriate, intense anger (85.6%), suicidal gestures or automutilation (82.9%), followed by frantic efforts to avoid abandonment (77%), impulsivity (65.7%), unstable and intense relationships (62.9%), identity disturbance (60%), and emptiness (57.1%). The comparison between borderline and non-borderline subjects showed that all borderline personality disorder criteria discriminated significantly between the two groups. The high incidence of paranoid ideation (97.1%) and dissociative experiences (65.7%) in the borderline group suggests the pertinence of criterion 9 in the diagnosis of borderline personality disorder in adolescents. Two criteria of schizotypal personality disorder were also frequent in this group: 68.6% of the borderline group reported odd beliefs or magical thinking, in particular beliefs in clairvoyance or telepathy and 88.6% reported unusual perceptual experiences, in particular sensing the presence of a force or person and bodily illusions. Moreover, 31.4% of the borderline group reported transient "quasi" psychotic experiences, mainly "quasi" visual hallucinations. Auditory hallucinations or delusional ideas were not observed. This symptomatology suggests a "quasi" psychotic dimension of adolescent borderline personality disorder. Affective instability was the next most frequent symptom which was usually marked by a cyclothymic appearance. Comorbidity with major depressive disorder was high: 85.7% of the borderline subjects had a concurrent diagnosis of major depression versus 45.8% of the non-borderline subjects. Thus, major depression is more frequent than most of the borderline personality disorder criteria, with the exception of the already noted paranoid ideation and affective instability. Hypomanic symptoms were frequent in the borderline group (65.7%) as well as in the non-borderline group (38.8%). This symptomatology suggests that adolescent borderline personality disorder is linked to an attenuated bipolar spectrum characterised by major depressive episodes and soft signs of bipolarity. However, hypomanic symptoms, which were quite frequent in non-borderline subjects, might also be due to a mechanism of defence, i.e. the denial of depression. Comorbidity with anxiety disorders appeared also to be high: anxiety symptoms were found in 91.4% of the borderline subjects who reported symptoms of generalised anxiety disorder, panic disorder, and somatoform disorders. The overall clinical appearance of these borderline adolescents not referred for treatment seemed to be quite similar to that of borderline adolescents in clinical samples. This study shows that adolescent borderline personality disorder in non-clinical population is a serious disorder characterised by the importance of mental suffering and behavioural disturbances the disorganising power of which may fix the developmental process in a pathological pathway. Adolescent borderline personality disorder appears in this study to be strongly associated with major depressive disorder and at-risk behaviours linked to impulsivity, affective instability, and suicidal ideation. However, this study found an absence of precise cut-off between borderline and non-borderline subjects. Two factors might have contributed to the appearance of a continuum. First, some degree of impulsivity and instability in affectivity, self-images and interpersonal relationships is part of normal adolescence. (ABSTRACT TRUNCATED)

Adolescent↗
PubMed1992

The prevalence of personality disorders in 210 women with eating disorders.

BACKGROUND: The purpose of this study was to assess the prevalence, reliability, and predictive value of comorbid personality disorders in a large sample of 210 women seeking treatment for anorexia nervosa (N = 31), bulimia nervosa (N = 91), or mixed disorder (N = 88). METHOD: All subjects were interviewed using the Structured Interview for DSM-III Personality Disorders as part of a longitudinal outcome study of eating disorders currently underway at Massachusetts General Hospital. RESULTS: Of the 210 subjects, 27% had at least one personality disorder; the most commonly observed was borderline personality disorder in 18 subjects (9%). The highest prevalence of personality disorders was found in the anorexia nervosa/bulimia nervosa group at 39%, followed by 22% in the anorexics and 21% in the bulimic sample. We found statistically significant differences regarding the distribution of personality disorders across eating disorder groups. The dramatic personality disorder cluster was differentially distributed across groups; this finding was accounted for by higher rates of borderline personality disorder in the bulimia nervosa and anorexia nervosa/bulimia nervosa groups than in the anorexia nervosa group. The anxious personality disorder cluster was differentially distributed across groups with higher rates in the anorexia nervosa and anorexia nervosa/bulimia nervosa samples. Those subjects with a comorbid personality disorder had a significantly slower recovery rate than those without a comorbid personality disorder. CONCLUSION: The prevalence of personality disorders is not high in treatment-seeking women with eating disorders compared with previously studied samples. The greatest frequency of comorbid personality disorders is in the anorexia nervosa/bulimia nervosa group; this subset also had longer duration of eating disorder illness and much greater comorbid Axis I psychopathology compared with the rest of the sample. Future studies should address whether personality disorders have predictive value in the long-term course and outcome of eating disorders.

Adolescent↗
PubMedDate not supplied

[Substance use, affective problems and personality traits: test of two association models].

UNLABELLED: The International Consortium of Psychiatric Epidemiology has confirmed the high comorbidity in community-drawn samples between substance use disorders and anxiety or depression. In the same way, associations between substance use and specific personality traits (such as novelty seeking, harm avoidance or antisocial personality) have also been extensively documented. Self-medication and social deviance are among the most commonly evoked explanatory models for these forms of comorbidity, and are based on findings that affective disorders and specific personality traits often precede the onset of substance use disorders. The self-medication model postulates that an individual chooses a specific substance according to its psychopharmacologic action on the given psychological state of the person. By contrast, the social deviance model posits that this form of comorbidity is due to the fact that persons consuming certain substances may have affective or personality characteristics that are more severe or more deviant than non-consumers (or than consumers of socially well-accepted substances). In this way, the individual does not use a particular substance to assuage pre-existing disorders but, due to a more deviant personality, is less influenced by social norms and may more easily turn to using illicit substances or to polyconsumption. However, a major limitation of the current scientific literature concerning tests of these models is that previous investigations have been based in overwhelming majority on clinical populations. The examination only of clinical samples renders difficult the identification of causal (or primary) risk factors for the emergence of substance use disorders from the potential consequences of substance use itself. The goal of the current study was therefore to simultaneously compare both models of association using a non clinical population of substance users. In addition to selecting subjects based on use (rather than abuse or dependence), multiple comparisons were corrected with a Bonferroni adjustment. METHOD: A two-phase sampling plan was used with post-stratification on substances use. In the first stage, an initial sample of 685 students was pre-selected based on responses to a battery of self-questionnaires, including information concerning recent consumption of substances (alcohol, cannabis, cocaine, heroin, acid, solvents, and so on), anxiety levels measured by the State and Trait Anxiety Inventory (STAI, Spielberger, 1983) and depression levels evaluated by the Center of Epidemiologic Studies Depression Scale (CES-D, Radloff, 1977). Based on responses to these questionnaires, 98 subjects were selected in the second phase to compose four groups of substance users: non consumers (those who did not use any substance during the last month); consumers of alcohol only, consumers of cannabis (with or without alcohol) and consumers of other illicit substances (with or without cannabis or alcohol). These subjects were then invited to participate in a brief laboratory-based meeting where they completed the Temperament and Character Inventory (TCI, Cloninger, 1992), which assessed different personality characteristics such as novelty seeking (NS), harm avoidance (HA) or antisocial personality disorder (APD). ANALYSES: The hypotheses concerning self-medication were tested by multiple logistic regression by comparing each group of substance consumption to the non-consumer group relative to levels of anxiety, depression and scores of novelty seeking and harm avoidance. The social deviance model was tested by ANOVAs using contrasts which allowed for a test of a linear tendency across the four groups of consumption relative to each of the personality traits (novelty seeking, harm avoidance and antisocial personality). RESULTS: Results of multiple logistic regressions showed no difference between non-consumers and any group of consumers with regard to anxiety, depression and harm avoidance. However, consumers of other illicit substances significantly differed from non-consumers for novelty seeking trait (qOR=8.4; p<0.05). Results of the ANOVA also showed no differences between the four groups with regard to scores of harm avoidance and level of antisocial personality but again a comparison of novelty seeking scores was significant, F(94)=6.46, p<0.05. Moreover, the contrast method demonstrated that novelty seeking scores increased linearly and significantly (p<0.001) from the group of non-consumers to the group of the consumers of the most deviant substances. CONCLUSION: The results obtained in this non-clinical sample are in favor of social deviance model which posits that the personality trait of novelty seeking is associated to the consumption of the most illicit and deviant substances (such as heroin or cocaine). On the other hand, no support was found for the hypothesis of self-medication which assumes that specific substances should be particularly associated with specific psychological characteristics or vulnerabilities.

Adolescent↗
PubMed2003

The prevalence of DSM-IV personality pathology among individuals with bulimia nervosa, binge eating disorder and obesity.

BACKGROUND: There are numerous reports of personality disorder pathology in different eating disorders. However, few studies have directly compared personality pathology in bulimia nervosa, binge eating disorder and obesity. The present study examines group differences in DSM-IV personality pathology, considering the potential utility of understanding personality disorders in terms of diagnosis and dimensional scores. METHOD: Eating disorder diagnoses were established using the Eating Disorder Examination interview. Thirty-five bulimia nervosa patients, 15 binge eating disorder patients and 37 obese patients were assessed and compared on the International Personality Disorder Examination using categorical and dimensional personality disorder scores. RESULTS: For most personality disorders, there was a dichotomy of binge eaters versus non-binge eaters. In contrast, there was a continuum of severity in borderline personality disorder pathology between the groups. The dimensional system of measurement of personality pathology allowed for clearer differentiation between the groups. CONCLUSION: The study strongly indicates that personality disorder difficulties are present in patients who binge eat, while obese patients who do not binge eat display significantly less personality disorder pathology. Assessment of bulimia nervosa, binge eating disorder and obesity needs to address personality disorders and pathology. Dimensional markers of personality pathology can be used to supplement categorical diagnoses, providing information about the traits that underlie diagnosis.

Adult↗
PubMed2005

Risk factors for and outcome of hyperlactatemia in HIV-infected persons: is there a need for routine lactate monitoring?

BACKGROUND: Lactic acidosis is a rare but life-threatening complication of combination antiretroviral therapy (CART). Asymptomatic or mildly symptomatic episodes of hyperlactatemia are more frequent, but their clinical relevance is unknown. METHODS: The incidences of, risk factors for, and courses of hyperlactatemia and lactic acidosis were prospectively assessed in the following 3 groups at the Zurich center of the Swiss HIV Cohort Study: persons already receiving CART at baseline, treatment-naive persons who initiated CART during the observation period, and persons who received no CART before or during the observation period. RESULTS: During 4788 person-years of follow-up, a total of 22,678 lactate assessments were performed for 1566 persons; 662 (42.3%) had at least 1 lactate level measurement of > 2.4 mmol/L, and 49 (3.1%) had severe hyperlactatemia (lactate level of > 5.0 mmol/L). The incidence of hyperlactatemia was 227 cases (95% confidence interval [CI], 210-245) and 59 cases (95% CI, 38-93) per 1000 person-years of follow-up among persons with and persons without CART, respectively. During the observation period, the incidence decreased from 459 cases (95% CI, 415-508) to 85 cases (95% CI, 76-107) per 1000 person-years of follow-up, respectively, because of changing CART prescription patterns. Severe hyperlactatemia occurred in treated persons only. In multivariable Cox proportional hazards models, significant risk factors for severe hyperlactatemia were regimens containing stavudine and didanosine (hazard ratio [HR], 6.65; 95% CI, 2.70-16.3) and regimens containing efavirenz (HR, 2.85; 95% CI, 1.31-6.21). Lactic acidosis was diagnosed in 4 of 1566 persons, all of whom were receiving stavudine and didanosine. CONCLUSIONS: Hyperlactatemia was frequently observed in all 3 groups, but severe hyperlactatemia and lactic acidosis were rarely observed among persons who received CART. Lactate monitoring appears to be indicated primarily for persons receiving stavudine and didanosine and for persons who are symptomatic. Long-term follow-up is needed to investigate the risk of novel treatment regimens for hyperlactatemia.

Acidosis, Lactic↗
PubMed2003

Utilization of lipid-lowering drugs in elderly persons with increased serum low-density lipoprotein cholesterol associated with coronary artery disease, symptomatic peripheral arterial disease, prior stroke, or diabetes mellitus before and after an educational program on dyslipidemia treatment.

BACKGROUND: We report the prevalence of use of lipid-lowering drugs in elderly persons with increased serum low-density lipoprotein (LDL) cholesterol associated with coronary artery disease (CAD), symptomatic peripheral arterial disease (PAD), prior stroke, and diabetes mellitus before and after an educational program on the treatment of dyslipidemia. METHODS: In an academic nursing home, we investigated the prevalence of use of lipid-lowering drugs in persons, mean age 77 +/- 9 years (40% men and 60% women), with a serum LDL cholesterol > or = 100 mg/dl associated with the aforementioned ailments before and after a 5-month educational program on the treatment of dyslipidemia was given to physicians and nurse practitioners. RESULTS: After the educational program, the prevalence of use of lipid-lowering drugs to treat the targeted elderly population increased (p <.001) in persons with CAD from 29% (18 of 63 persons) to 70% (44 of 63 persons), in persons with symptomatic PAD from 28% (5 of 18 persons) to 79% (15 of 19 persons), in persons with prior stroke from 24% (11 of 45 persons) to 64% (28 of 44 persons), and in diabetics from 26% (14 of 53 persons) to 67% (35 of 52 persons). CONCLUSION: A 5-month educational program on dyslipidemia treatment given to physicians and nurse practitioners in an academic nursing home improved the prevalence of use of lipid-lowering drugs in persons with increased serum LDL cholesterol associated with CAD, symptomatic PAD, prior stroke, and diabetes mellitus.

Aged↗
PubMed2005

Ambient gas concentrations and personal particulate matter exposures: implications for studying the health effects of particles.

BACKGROUND: Data from a previous study conducted in Baltimore, MD, showed that ambient fine particulate matter less than 2.5 mum in diameter (PM2.5) concentrations were strongly correlated with corresponding personal PM2.5 exposures, whereas ambient O3, NO2, and SO2 concentrations were weakly correlated with their personal exposures to these gases. In contrast, many of the ambient gas concentrations were reasonable surrogates of personal PM2.5 exposures. METHODS: Personal multipollutant exposures and corresponding ambient air pollution concentrations were measured for 43 subjects living in Boston, MA. The cohort consisted of 20 healthy senior citizens and 23 schoolchildren. Simultaneous 24-hour integrated PM2.5, O3, NO2, and SO2 personal exposures and ambient concentrations were measured. All PM2.5 samples were also analyzed for SO4 (sulfate). We analyzed personal exposure and ambient concentration data using correlation and mixed model regression analyses to examine relationships among (1) ambient PM2.5 concentrations and corresponding ambient gas concentrations; (2) ambient PM2.5 and gas concentrations and their respective personal exposures; (3) ambient gas concentrations and corresponding personal PM2.5 exposures; and (4) personal PM2.5 exposures and corresponding personal gas exposures. RESULTS: We found substantial correlations between ambient PM2.5 concentrations and corresponding personal exposures over the course of time. Additionally, our results support the earlier finding that summertime gaseous pollutant concentrations may be better surrogates of personal PM2.5 exposures (especially personal exposures to PM2.5 of ambient origin) than they are surrogates of personal exposures to the gases themselves. CONCLUSIONS: Particle health effects studies that include both ambient PM2.5 and gaseous concentrations as independent variables must be analyzed carefully and interpreted cautiously, since both parameters may be serving as surrogates for PM2.5 exposures.

Aged↗
PubMed1999

Management of the older person with atrial fibrillation.

OBJECTIVE: To review the management of the older person with atrial fibrillation (AF). DATA SOURCES: A computer-assisted search of the English language literature (MEDLINE) database followed by a manual search of the bibliographies of pertinent articles. STUDY SELECTION: Studies on the management of persons with AF were screened for review. Studies of persons older than age 60 and recent studies were emphasized. DATA EXTRACTION: Pertinent data were extracted from the reviewed articles. Emphasis was placed on studies involving older persons. Relevant articles were reviewed in depth. DATA SYNTHESIS: Available data about the management of persons with paroxysmal or chronic AF were summarized CONCLUSIONS: Management of AF includes treatment of the underlying disease and precipitating factors. Immediate direct-current cardioversion should be performed in persons with AF associated with an acute myocardial infarction, chest pain caused by myocardial ischemia, hypotension, severe heart failure, or syncope. Intravenous verapamil, diltiazem, or beta-blockers should be used to slow a very rapid ventricular rate associated with AF immediately. Oral verapamil, diltiazem, or a beta-blocker should be given if a rapid ventricular rate occurs at rest or during exercise despite digoxin. Amiodarone may be used in selected persons with symptomatic life-threatening AF refractory to other drug therapy. Nondrug therapies should be performed in persons with symptomatic AF in whom a rapid ventricular rate cannot be slowed by drug therapy. Paroxysmal AF associated with the tachycardia-bradycardia syndrome should be treated with a permanent pacemaker in combination with drugs. A permanent pacemaker should be implanted in persons with AF who develop cerebral symptoms such as dizziness or syncope associated with ventricular pauses greater than 3 seconds that are not drug-induced. Elective cardioversion of AF should not be performed in asymptomatic older persons with chronic AF. Unless transesophageal echocardiography has shown no thrombus in the left atrial appendage before cardioversion, oral warfarin should be given for 3 weeks before elective direct-current or drug cardioversion of AF and continued for at least 4 weeks after maintenance of sinus rhythm. Many cardiologists prefer the treatment strategy, especially in older persons, of ventricular rate control plus warfarin rather than maintaining sinus rhythm with antiarrhythmic drugs. Digoxin should be avoided in persons with sinus rhythm who have a history of paroxysmal AF. Older persons with chronic or paroxysmal AF who are at high risk for stroke or who have a history of hypertension and no contraindications to warfarin should receive long-term warfarin to achieve an International Normalized Ratio of 2.0 to 3.0. Older persons with AF who are at low risk for stroke or who have contraindications to warfarin should receive 325 mg of aspirin daily.

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PubMed2002

Outcome of congestive heart failure in elderly persons: influence of left ventricular systolic function. The Cardiovascular Health Study.

BACKGROUND: Most persons with congestive heart failure are elderly, and many elderly persons with congestive heart failure have normal left ventricular systolic function. OBJECTIVE: To evaluate the relationship between left ventricular systolic function and outcome of congestive heart failure in elderly persons. DESIGN: Population-based longitudinal study of coronary heart disease and stroke. SETTING: Four U.S. sites: Forsyth County, North Carolina; Sacramento County, California; Allegheny County, Pennsylvania; and Washington County, Maryland. PARTICIPANTS: 5888 persons who were at least 65 years of age and were recruited from the community. MEASUREMENTS: Total mortality and cardiovascular morbidity and mortality. RESULTS: Of 5532 participants, 269 (4.9%) had congestive heart failure. Among these, left ventricular function was normal in 63%, borderline decreased in 15%, and overtly impaired in 22%. The mortality rate was 25 deaths per 1000 person-years in the reference group (no congestive heart failure and normal left ventricular function at baseline); 154 deaths per 1000 person-years in participants with congestive heart failure and impaired left ventricular systolic function; 87 and 115 deaths per 1000 person-years in participants with congestive heart failure and normal or borderline systolic function, respectively; and 89 deaths per 1000 person-years in persons with impaired left ventricular function but no congestive heart failure. Although the risk for death from congestive heart failure was lower in persons with normal systolic function than in those with impaired function, more deaths were associated with normal systolic function because more persons with heart failure fall into this category. CONCLUSIONS: Community-dwelling elderly persons, especially those with impaired left ventricular function, have a substantial risk for death from congestive heart failure. However, more deaths occur from heart failure in persons with normal systolic function because left ventricular function is more often normal than impaired in elderly persons with heart failure.

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