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PubMed2002

Estimating paid and unpaid hours of personal assistance services in activities of daily living provided to adults living at home.

OBJECTIVE: To estimate the total hours of paid and unpaid personal assistance of daily living provided to adults living at home in the United States using nationally representative household survey data. DATA SOURCES: The Disability Followback Survey of the National Health Interview Survey on Disability (NHIS-D) conducted from 1994 to 1997. DATA COLLECTION/EXTRACTION METHODS: Data were obtained on persons receiving help with up to 5 ADLs and 10 IADLs, for up to 4 helpers, including the activities they helped with, whether the helper was paid or not, and the number of hours of help provided in the two weeks prior to the survey. The sample consists of 8,471 household-resident adults ages 18 and older receiving help with personal assistance. About 22 percent of the sample has missing data on hours, which we impute by multiple regression models using demographic, ADL, and IADL variables. FINDINGS: We estimate that 13.2 million noninstitutionalized adults receive an average of 31.4 hours per week of personal assistance in ADLs and IADLs per week, with 3.2 million people receiving an average of 17.6 hours of paid help and 11.7 million receiving an average of 30.7 hours of unpaid help. More persons ages 18-64 received help than those ages 65 and older (6.9 versus 6.2 million), but working-age recipients had fewer hours (27.4 versus 35.9) per week, due in part to less severe levels of disability. CONCLUSIONS: Personal assistance provided to adults with disabilities amounts to 21.5 billion hours of help per year, with an economic value in 1996 approaching $200 billion. Only 16 percent of this total is paid, representing $32 billion in home health services spent annually. This study, the first to estimate hours of assistance for both working-age and older adults, documents that older persons are more likely to receive paid personal assistance, while working-age people rely to a greater extent on unpaid help. This study begins to articulate the division of labor in the provision of personal assistance. Estimates of paid and unpaid hours of help by number of ADLs should inform policy concerning eligibility boundaries in long term care.

Activities of Daily Living↗
PubMed2004

Prevalence of personality disorder in alcohol and drug services and associated comorbidity.

AIMS: To compare the prevalence of personality disorder in alcohol and drug populations with special attention to its impact on psychopathology and service characteristics. DESIGN: Cross-sectional survey. SETTING: Three alcohol and four drug services in four urban UK centres. PARTICIPANTS: Two hundred and sixteen drug and 64 alcohol service patients randomly sampled from current treatment populations. MEASUREMENTS: A treatment population census recorded demographic and diagnostic data. Patient interviews assessed the presence, cluster type and severity of personality disorder using the Quick Personality Assessment Schedule (PAS-Q). Other psychopathology was measured using the Comprehensive Psychopathological Rating Scale (CPRS). A case-note audit recorded psychotic psychopathology using the OPCRIT schedule and data regarding social morbidity. FINDINGS: The overall prevalence of personality disorder was 37% in the drug service sample and 53% in the alcohol service sample. The distribution of severity and clusters differed markedly between the two samples. There was a significant association between the severity of personality disorder and psychopathology in both samples. Levels of morbidity associated with clusters B and C were similar. Clinical diagnosis of personality disorder showed high specificity but low sensitivity when compared to PAS-Q. CONCLUSIONS: In both alcohol and drug service populations, personality disorder is associated with significantly increased rates of psychopathology and social morbidity that worsens with increasing severity of the disorder. Despite this, personality disorder is poorly identified by clinical staff. The PAS-Q may be useful as a clinical assessment tool in the substance misuse population for the early identification and management of patients with personality disorder.

Comorbidity↗
PubMed1997

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

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

Adult↗
PubMed1998

Pharmacotherapy for personality disorders.

Double-blind, placebo-controlled trials of pharmacotherapy for personality disorders (PD) were reviewed, and the indications concluded were as follows: (1) Severe cases of both Borderline Personality Disorder (BDP) and Schizotypal Personality Disorder (SPD) respond to low dose antipsychotic drugs resulting in improvement of a broad spectrum of symptoms. They also respond to monoamine oxidase inhibitor (MAOI). Amitriptyline causes a paradoxical effect. (2) Borderline personality disorder with behavioral dyscontrol responds to carbamazepine which reduces actual episodes of dyscontrol, to an antipsychotic drug and to MAOI. Alprazolam is associated with an increase in suicidality and dyscontrol. Borderline personal disorder or Histrionic Personality Disorder with a tendency to suicide, responds to a depot antipsychotic drug. Personality disorders with aggressive behavior respond to lithium. Moderately severe PD with explosive behavior respond to oxazepam, but at a dose where the side effect is sedation. (3) Borderline personality disorder and SPD with psychotic symptoms respond to an antipsychotic drug which improves psychotic symptoms as well as neurotic symptoms. Emotionally Unstable Character Disorder with a disturbance of mood swings, responds to lithium. Adolescent PD respond to an antipsychotic drug. (4) Comorbid atypical depression of histrionic personality and BPD respond to MAOI or imipramine. Comorbid neurotic disorder of PD responds to dothiepin. Comorbid social phobia of avoidant and dependent PD responds to MAOI.

Antipsychotic Agents↗
PubMed1989

Multiple personality, dissociation, and C.G. Jung's complex theory.

Jung's contributions to the study of 'dissociation' are outlined here for perhaps the first time. Jung is unique in recognising that the 'dissociability of the psyche' is a fundamental process that extends along the continuum from 'normal' mental functioning to 'abnormal' states. Dissociation is recognised by Jung as a universal and necessary psychic activity for the development of personality through the differentiation of functions. However, when the cohesion of consciousness is shattered by extreme childhood traumata, as it is in the development of multiple personality, this natural differentiation of function is intensified and the dissociative splits between autonomous forces in the psyche become more extreme. This increases the autonomy of these 'splinter psyches' from ego-consciousness and reveals their archetypal core. They then develop into the phenomenon of 'alternate personalities' in multiple personality. In a comparison of the major tenets of the complex theory with recent empirical research on multiple personality, it is demonstrated that essential characteristics of Jung's 'autonomous complexes' are congruent with the phenomenology of the 'alternate personalities' or 'personality states' of this disorder. This underscores the relevance of Jung's complex theory to present understanding of multiple personality. In addition, the phenomenon of multiple personality is, in turn, important for realising the central significance of dissociation in the complex theory and provides an excellent contemporary clinical example of the archetypal ground of the psyche.

Adult↗
PubMed1988

The relationship between DSM-III symptom disorders (Axis I) and personality disorders (Axis II) in an outpatient population.

The relationship between symptom disorder and personality disorder according to DSM-III was studied in 289 consecutive outpatients. It was observed that personality disorders occurred frequently among the chronic affective and anxiety disorders. The "dramatic" personality disorders were observed especially frequently among patients with cyclothymic disorder, and the "eccentric" personality disorders among patients with a diagnosis of dysthymic disorder, social phobia and agoraphobia. Dramatic personality disorder was also common among patients with simple phobia. As expected, a close correspondence was observed between social phobia, agoraphobia and avoidant personality disorder, between substance use disorder and borderline personality disorder, and between obsessive-compulsive disorder and compulsive personality disorder. Even if a relationship was observed, it was not strong enough to warrant a combination of chronic symptom disorder diagnoses and personality disorder diagnoses.

Adolescent↗
PubMed1999

Personality disorder and the Temperament and Character Inventory in the elderly.

OBJECTIVE: The aim of this study was to determine the prevalence of personality disorders in a group of elderly patients without an organic mental disorder and to examine the relationship between the Temperament and Character Inventory (TCI) and personality disorder symptoms in psychogeriatric clinical practice. METHOD: A total of 91 subjects completed the Structured Clinical Interview for DSM-III-R personality questionnaire and the 125-item TCI. RESULTS: Of the 91 subjects, 34 individuals (31%) had at least one DSM-III-R personality disorder diagnosis, with avoidant, dependent and paranoid personality disorder being the most common. The trends and correlations between the temperament and character dimensions and the correlations between individual personality disorder symptoms and the dimensions were similar to those in the original model. The most significant findings were the strong negative correlations of the character scores of self-directedness and co-operativeness with the total number of personality disorder symptoms, and the fact that the self-directedness scores predicted the number of personality disorder diagnoses. CONCLUSION: The reported prevalence rate is comparable to studies of both younger and older patient populations using similar methodology. The TCI provides a useful framework for further research on personality disorders in the elderly.

Aged↗
PubMed2003

How important is personal care in general practice?

OBJECTIVES: To explore patients' perceptions of the features of personal care and how far these are shared by healthcare providers; whether a continuing relationship between a health professional and a patient is essential for personal care; and the circumstances in which a continuing relationship is important. DESIGN: Qualitative analysis of semistructured interviews using the "framework" approach. SETTING: Six general practices in Leicestershire. PARTICIPANTS: 40 patients aged > or = 18 years, 13 general practitioners, 10 practice and community nurses, and six practice administrative staff, recruited through participating practices. RESULTS: Patients' and healthcare providers' accounts cited human communication, individualised treatment or management, and whole person care as features of personal care. Personal care was described in three different contexts-a continuing relationship, a single consultation, and from the practice as a whole. The extent to which a continuing relationship was important for personal care was determined by the reason for consulting, as well as patients' consulting history and lifestyle. CONCLUSIONS: Patients, general practitioners, primary care nurses, and administrative staff hold similar views on the meaning of personal care, despite differences of emphasis reflecting their different roles. Personal care is promoted by but not always dependent on a continuing provider-patient relationship; human communication and individualised care emerged as important in making care personal whatever the context. Most respondents valued relationships in primary care and had clear ideas about when care in the context of a relationship was most valuable.

Adolescent↗
PubMed2004

Cortical regions for judgments of emotions and personality traits from point-light walkers.

Humans are able to use nonverbal behavior to make fast, reliable judgments of both emotional states and personality traits. Whereas a sizeable body of research has identified neural structures critical for emotion recognition, the neural substrates of personality trait attribution have not been explored in detail. In the present study, we investigated the neural systems involved in emotion and personality trait judgments. We used a type of visual stimulus that is known to convey both emotion and personality information, namely, point-light walkers. We compared the emotion and personality trait judgments made by subjects with brain damage to those made by neurologically normal subjects and then conducted a lesion overlap analysis to identify neural regions critical for these two tasks. Impairments on the two tasks dissociated: Some subjects were impaired at emotion recognition, but judged personality normally; other subjects were impaired on the personality task, but normal at emotion recognition. Moreover, these dissociations in performance were associated with damage to specific neural regions: Right somatosensory cortices were a primary focus of lesion overlap in subjects impaired on the emotion task, whereas left frontal opercular cortices were a primary focus of lesion overlap in subjects impaired on the personality task. These findings suggest that attributions of emotional states and personality traits are accomplished by partially dissociable neural systems.

Adult↗
PubMed1999

Influence of child and adolescent psychiatric disorders on young adult personality disorder.

OBJECTIVE: This study examines associations between childhood psychopathology and young adult personality disorder in a random sample of 551 youths, who were 9 to 16 years old at first assessment. METHOD: Subjects were evaluated for DSM-III-R psychiatric disorders. Information was obtained prospectively from youths and their mothers at three points over 10 years. The predictive effects of prior axis I disorders and adolescent axis II personality disorder clusters A, B, and C on young adult personality disorder were examined in logistic regression analyses. RESULTS: The odds of young adult personality disorder increased given an adolescent personality disorder in the same cluster. Prior disruptive disorders, anxiety disorders, and major depression all significantly increased the odds of young adult personality disorder independent of an adolescent personality disorder. In addition, comorbidity of axis I and axis II disorders heightened the odds of young adult personality disorder relative to the odds of a disorder on a single axis. CONCLUSIONS: Assessment of personality pathology before late adolescence may be warranted. Childhood or adolescent axis I disorders may set in motion a chain of maladaptive behaviors and environmental responses that foster more persistent psychopathology over time. Identification and treatment of childhood disorder may help to reduce that risk.

Adolescent↗
PubMed2004

Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission.

OBJECTIVE: The purpose of this study was to assess the prevalence of axis I disorders among patients with borderline personality disorder over 6 years of prospective follow-up. METHOD: A semistructured interview of demonstrated reliability was used to assess presence or absence of comorbid axis I disorders in 290 patients who met Revised Diagnostic Interview for Borderlines criteria and DSM-III-R criteria for borderline personality disorder and 72 patients who did not meet these criteria but did meet DSM-III-R criteria for another axis II disorder. Over 94% of surviving patients were reinterviewed about their axis I disorders at 2-year, 4-year, and 6-year follow-up periods. RESULTS: Although the patients with borderline personality disorder experienced declining rates of many axis I disorders over time, the rates of these disorders remained high, particularly the rates of mood and anxiety disorders. Patients whose borderline personality disorder remitted over time experienced substantial decline in all comorbid disorders assessed, but those whose borderline personality disorder did not remit over time reported stable rates of comorbid disorders. When the absence of comorbid axis I disorders was used to predict time to remission, the absence of substance use disorders was a far stronger predictor of remission from borderline personality disorder than was the absence of posttraumatic stress disorder, mood disorders, other anxiety disorders, or eating disorders, respectively. CONCLUSIONS: The results of this study suggest that axis I disorders are less common over time in patients with initially severe borderline personality disorder, particularly for patients whose borderline personality disorder remits over time. The findings also suggest that substance use disorders are most closely associated with the failure to achieve remission from borderline personality disorder.

Adult↗
PubMed2005

The prevalence of DSM-IV personality disorders in psychiatric outpatients.

OBJECTIVE: The largest clinical epidemiological surveys of personality disorders have been based on unstructured clinical evaluations. However, several recent studies have questioned the accuracy and thoroughness of clinical diagnostic interviews; consequently, clinical epidemiological studies, like community-based studies, should be based on standardized evaluations. The Rhode Island Methods to Improve Diagnostic Assessment and Services project is one of the largest clinical epidemiological studies to use semistructured interviews to assess a wide range of psychiatric disorders conducted in general clinical outpatient practice. In the present report, the authors examined the frequency of DSM-IV personality disorders in a patient group and the comorbidity among them. METHOD: Eight hundred fifty-nine psychiatric outpatients were interviewed with the Structured Interview for DSM-IV Personality upon presentation for treatment. RESULTS: Slightly less than one-third of the patients were diagnosed with one of the 10 official DSM-IV personality disorders (N=270, 31.4%). When the patients with personality disorder not otherwise specified were included, the rate of any personality disorder increased to almost half of the group (N=391, 45.5%). The majority of patients meeting criteria for one of the specific personality disorders were diagnosed with more than one. Avoidant, borderline, and obsessive-compulsive personality disorder were the most frequent specific diagnoses. CONCLUSIONS: Personality disorders, as a group, are among the most frequent disorders treated by psychiatrists. They should be evaluated in all psychiatric patients because their presence can influence the course and treatment of the axis I disorder that patients typically identify as their chief complaint.

Adult↗
PubMed2005

Continuities between emotional and disruptive behavior disorders in adolescence and personality disorders in adulthood.

OBJECTIVE: The purpose of this study was to quasiprospectively investigate continuities between emotional and disruptive behavior disorders in adolescence and personality disorders in adulthood. METHOD: One hundred thirty subjects (age: mean=43.2 years) who had been diagnosed with emotional and disruptive behavior disorders during adolescence (age: mean=14.6 years) and rediagnosed based on hospital records, according to DSM-IV, were interviewed with the Structured Interview for DSM-IV Personality to establish whether they suffered from personality disorders at the 28-year follow-up. RESULTS: Adolescents with disruptive behavior disorders were not more likely to have personality disorders in adulthood than adolescents with emotional disorders. Adolescents with disruptive behavior disorders were significantly more likely to have cluster B personality disorders at follow-up than adolescents with emotional disorders. Logistic regression analyses revealed that disruptive behavior disorders in females were significantly more strongly associated with a high risk of cluster B diagnoses at follow-up than in males. Emotional disorders were significant and independent predictors of cluster C personality disorders in women but not in men. Disruptive behavior disorders were a significant and independent predictor of antisocial personality disorders in men. CONCLUSIONS: These results support the view that personality disorders can be traced back to adolescent emotional and disruptive behavior disorders. The moderating effect of gender in cluster B and cluster C personality disorders suggests that sociocultural and biological factors may contribute to different adult outcomes in men and women with similar adolescent psychiatric disorders.

Adolescent↗
PubMed1993

Personality disorders diagnosed at intake at a public psychiatric facility.

OBJECTIVE: The purpose of the study was to determine the prevalence of personality disorders among a large population of persons seeking treatment in a public psychiatric facility and to examine the role of personality disorders in the clinical conditions of persons frequenting such facilities. METHODS: Clinical and demographic data were retrospectively examined for 18,179 adults who visited a walk-in clinic of a public psychiatric facility between 1983 and 1989. Patients who received a diagnosis of personality disorder were compared with those who did not. RESULTS: A total of 2,344 patients (12.9 percent) were diagnosed as having a personality disorder, a lower prevalence rate than generally found in treatment populations. The most frequent diagnoses were atypical, antisocial, and borderline personality disorders. Compared with other subjects, those with a personality disorder were significantly more likely to be men, to be 35 years old or younger, to have a higher level of social impairment, and to have more symptoms and more severe symptoms. CONCLUSIONS: The relatively low prevalence rate was attributed in part to underdiagnosis, largely due to the need for making rapid assessments in a public intake setting. The authors conclude that clinicians in such facilities may be likely to diagnose personality disorders when patients with certain axis I disorders such as substance use, affective, and adjustment disorders present with an overall greater level of symptomatology and social impairment.

Adult↗
PubMed2005

Personality psychology's comeback and its emerging symbiosis with social psychology.

Psychology's early allegiance to behaviorism and experimental methods led many to disparage personality approaches throughout much of last century. Doubts about personality psychology's viability culminated in Mischel's assertion that measures of personality account for modest amounts of variance in behavior. In the years immediately following this critique, interest in personality research waned and many psychology departments dropped their training programs in personality. Throughout the past two decades, however, personality psychology has enjoyed a resurgence. The authors discuss several possible explanations for personality's comeback and then describe the emergence of a promising symbiosis between personality psychology and its sister discipline, social psychology. The article concludes by noting that although this emerging symbiosis is likely to continue bearing considerable theoretical fruit, the traditional distinction between personal, situational, and interactional determinants of behavior continues to be useful within appropriate contexts.

Humans↗
PubMed1990

[Personality disorders in psychiatry].

Psychiatric patients with personality disorders are among the most difficult because of the counter-transferential strain they put on clinicians and the paucity of specific treatment. The author develops the point that personality disorders are not diseases as implied in Axis I disorders, but social illness syndromes which depict systemic problems in which clinicians can be engulfed and entrapped. The difficult patient does not exist in isolation, a victim of his own drives and psyche, but rather is a specific socio-cultural actor living and emerging from a particular environmental context. Personality disorders are considered to be interpersonal patterns in which a person's debilitating behaviour elicits complementary behaviour that reinforces the original behaviour. Within a systems perspective, there is not a disordered personality so much as a disordering system of relationships. As with families and society, healers too become involved in the vicious cycle of personality disorders if they fail to see the manipulative interpersonal devices used by these patients. If clinicians accept too naively the lay person's simplistic belief that personality disorders are diseases to be treated by psychiatrists, they run the risk of fostering inappropriate passivity in patients in the face of life demands. Overindulgence and angry rejection are the two major pitfalls often seen in clinical practice. The approach proposed here may seem conterintuitive in laying stress on the need to actively resist the temptation to take over responsibility for a patient's life. There is a difference between a behaviour that a patient's illness (Axis I disorder) prevents him from controlling and an impulsive deliberate behaviour stemming from character pathology. It is a logical error to deal with personality disorders in the same manner and with the same conceptual terminology as for depressive and psychotic disorders. Principles of management are detailed and can be summarized as a kind firmness to bring back patients to take on their own responsibilities.

Countertransference↗
PubMed1990

Brain mapping in a case of multiple personality.

Brain maps were recorded on a patient with a multiple personality disorder (10 alternate personalities). Maps were recorded with eyes open and eyes closed during 2 different sessions, 2 months apart. Maps from each alternate personality were compared to those of the basic personality "S", some maps were similar and some were different, especially with eyes open. Findings that were replicated in the second session showed differences from 4 personalities, especially in theta and beta 2 frequencies on the left temporal and right posterior regions. A rank ordering of the differences in the brain maps of the alternate personalities from S were similar to the rank ordering of the differences in personality characteristics, as judged by the psychiatrist dealing with this patient. Maps from S acting like some of her personalities or from a professional actress portraying the different personalities did not reveal significant differences. Some of these findings are consistent with those in the literature, and the importance of detecting artifact in the raw EEG recording is emphasized.

Adult↗
PubMed1994

Personality traits during depression and after clinical recovery.

We investigated whether and how acute depressive symptoms affect the self-report of maladaptive personality traits. Sixty-eight acutely depressed patients underwent the Structured Interview for DSM-III Personality Disorder (SIDP) before and after pharmacological treatment, allowing us to determine whether self-reported maladaptive personality traits are different during depression and after successful clinical recovery. After the initial SIDP administration (during an episode of major depression), patients received desipramine treatment (dose range 150-300 mg/day) over a course of 4-5 weeks before readministration of the SIDP. For those who recovered from their depression (n = 39), cluster III trait scores were significantly lower than those assessed at baseline, and there was a lower frequency of cluster III categorical diagnoses for a personality disorder after treatment than before treatment. Recovered patients also had significantly lower cluster I personality trait scores after treatment as compared with baseline ratings. For those who did not recover from their depression after treatment (n = 29), cluster I trait scores were in fact higher than those measured at baseline, but there were no differences in categorical diagnoses before and after treatment. Cluster II personality traits and categorical diagnoses were not different between those who did and did not recover from their depression. Thus, depression may have a significant effect on the assessment of cluster I and cluster III personality traits. It is possible that cluster I and III 'personality traits' may be interwoven with depressive features and therefore subject to state influences, whereas cluster II personality traits may entail enduring, long-term characteristic modes of thinking, feeling, and behaving.

Adult↗