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PubMed1994

Personality disorder in later life: a community study.

BACKGROUND: This exploratory study compares the prevalence of personality disorders and traits in people over and under 55 years of age. The comorbidity between personality and other psychiatric disorders is also examined. METHOD: Psychiatrists examined 810 subjects in a two-stage community survey. The semi-structured Standardized Psychiatric Examination was used to diagnose all DSM-III personality disorders and other psychiatric disorders. RESULTS: The older subjects were significantly less likely than the younger subjects to have any personality disorder (6.6% v. 10.5%; relative odds = 0.42, 95% confidence interval = 0.25-0.70, P < 0.001). Antisocial and histrionic personality disorders were much less prevalent in the older than younger subjects (P < 0.05). The older subjects also had significantly fewer maladaptive personality traits (chi 2 = 88.9, d.f. = 3, P < 0.001). The patterns of comorbidity between personality disorders and other psychiatric disorders were different in the two age groups. CONCLUSIONS: It is important to evaluate personality in patients of all ages. While some older patients no longer meet criteria for personality disorder, maladaptive traits may become evident during times of stress.

Adolescent↗
PubMed2006

Borderline personality disorder features: the role of self-discrepancies and self-complexity.

OBJECTIVES: Borderline personality disorder (BPD) involves disordered self-conceptions, along with dysphoria and anxiety. The present study examined the role of actual-ideal (AI) and actual-ought (AO) self-discrepancies, and self-complexity as predictors of borderline personality features in a student population. METHOD: AI and AO self-discrepancy magnitudes across all self-domains were assessed, along with self-complexity, idiographically and nomothetically. Borderline personality features were assessed using subscales of the Minnesota Multiphasic Personality Inventory (MMPI-2). RESULTS: Both AI and AO self-discrepancies were directly related to BPD personality features, in that those with larger self-discrepancies of both types reported more features. Self-complexity had no direct relationship to BPD personality features; rather, it moderated the relationship between AI, but not AO, self-discrepancies and BPD personality features. For individuals low in self-complexity, a stronger relationship between AI self-discrepancies and BPD personality features existed. CONCLUSIONS: This study is novel in its consideration of the impact of features of the self-system on BPD personality features. It highlights the important role that AO self-discrepancies, and the combined role of AI self-discrepancies and self-complexity, have in increasing vulnerability to BPD. The findings suggest that different pathways might be involved in the vulnerability to BPD, depending on self-discrepancy type and level of self-complexity.

Adolescent↗
PubMed2001

Heritability of personality disorders in childhood: a preliminary investigation.

The heritability of personality disorder features was investigated in 112 child (ages 4-15 years) twin pairs (70 monozygotic and 42 dizygotic pairs). Parents assessed personality disorder features using the Coolidge Personality and Neuropsychological Inventory for Children (CPNI; Coolidge, 1998) that measures 12 personality disorders according to the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association, 1994). Structural equation model-fitting methods indicated that the median heritability coefficient for the 12 scales was .75 (ranging from .81 for the Dependent and Schizotypal Personality Disorder scales to .50 for the Paranoid and Passive-Aggressive Personality Disorder scales). These results suggest that childhood personality disorders have a substantial genetic component and that they are similar to heritability estimates of personality disorder traits in adults and counter hypotheses that only temperaments and higher-order personality disorder traits have significant genetic components (Paris, 1997).

Adolescent↗
PubMed2003

Treatment rejecting and treatment seeking personality disorders: Type R and Type S.

An important distinguishing feature of one group of personality disorders is the wish of the sufferer to seek treatment. For another group this wish is rarely entertained. Although there is some variation between different types of personality disorder the wish to change is not confined to any one diagnostic category. A useful subclassification of personality disorders is therefore into Type R (treatment rejecting) and Type S (treatment seeking) personality disorders, and these are defined operationally. The classification of 68 personality disordered patients on the caseload of an assertive community team using a simple scale showed a 3 to 1 ratio between Type R and Type S personality disorders with Cluster C personality disorders being significantly more likely to be Type S, and paranoid and schizoid (Cluster A) personality disorders significantly more likely to be Type R than others. It is suggested that this typology is useful for those contemplating treatment with those who have personality disorders.

Humans↗
PubMedDate not supplied

[The contribution of living arrangements in the provision of care for elderly persons with functional impairments in São Paulo, Brazil].

OBJECTIVES: To describe the functional performance, need for assistance, and living arrangements of elderly persons in the city of São Paulo, Brazil, as part of a project called Health, Well-being, and Aging in Latin America and the Caribbean (the "SABE project"). METHODS: In 2000, 2 143 individuals 60 years of age or older were interviewed, using the standardized SABE questionnaire. The sample was obtained in two stages, using census sectors with replacement and probability proportional to population. To have the desired number of respondents 75 or older, additional homes close to the selected census sectors were found, with weighting of the final results. The functional performance of the elderly persons was measured in terms of their ability to perform basic activities of daily living (walking across a room, eating, lying down on a bed and getting up from it, using the bathroom, dressing and undressing, and bathing) and to carry out instrumental activities of daily living (buying and preparing food, performing light and heavy household chores, using the telephone, taking medications, and handling money). Functional impairment was defined as the need for assistance in performing at least one of the basic or instrumental activities. There were 66 types of living arrangements (household composition) identified and grouped into seven categories, according to with whom an elderly person lived and whether the other residents of the household were relatives or not. RESULTS: Of the individuals interviewed, 19.2% presented a functional impairment in basic activities and 26.5% in instrumental activities. The impairments were more common among women and among persons 75 or older. The proportion of elderly persons with an impairment who received help with basic activities ranged from 25.6% (lying down on the bed and getting up) to 70.5% (eating). With instrumental activities, the proportion receiving assistance ranged from 79.7% (light domestic chores) to 97.8% (buying food). With respect to living arrangements, the single largest group (32.1%) of elderly persons lived with the spouse and children or with just the children; the next largest group (20.0%) lived with just the spouse. The living arrangement in which the highest proportion (56.4%) of elderly persons with functional impairments received help was living with nonrelatives. CONCLUSIONS: The elderly persons with functional impairments in São Paulo are not receiving enough assistance from their family members or other persons with whom they live. Further, there are no public policies in Brazil to fill this gap. Taking into account the country's aging population, the health care system in Brazil is at risk of becoming not only inadequate but chaotic.

Activities of Daily Living↗
PubMed2003

Chronic depression and comorbid personality disorders: response to sertraline versus imipramine.

BACKGROUND: Chronic subtypes of depression appear to be associated with high rates of Axis II personality disorder comorbidity. Few studies, though, have systematically examined the clinical correlates of Axis II personality disorder comorbidity or its effect on treatment response or time to response. METHOD: 635 patients diagnosed with DSM-III-R chronic major depression or "double depression" (dysthymia with concurrent major depression) were randomized to 12 weeks of double-blind treatment with either sertraline or imipramine between February 1993 and December 1994. Axis II diagnoses were made using the personality disorders version of the DSM-III-R Structured Clinical Interview. The effect of study treatment was measured utilizing the Hamilton Rating Scale for Depression and the Clinical Global Impressions scale. RESULTS: Forty-six percent of patients met criteria for at least 1 comorbid Axis II personality disorder, with cluster C diagnoses being the most frequent at 39%; 21% met criteria for at least 2 Axis II personality disorders. A cluster C diagnosis was associated with significantly higher rates of early-onset depression (before age 21; 47% vs. 32% for no cluster C; p =.005) and comorbid anxiety disorder (34% vs. 18% for no cluster C; p <.001). Overall, the presence of Axis II personality disorder comorbidity had minimal-to-no effect on the ability to achieve either an antidepressant response or remission and had inconsistent effects on time to response. The presence of Axis II personality disorder comorbidity did not appear to reduce functional and quality-of-life improvements among patients responding to acute treatment with sertraline or imipramine. CONCLUSION: In this treatment sample, rates of Axis II personality disorder comorbidity were substantial in patients suffering from chronic forms of depression. Axis II personality disorder comorbidity did not appear to diminish symptomatic response to acute treatment or associated improvement in functioning and quality of life.

Adult↗
PubMed2003

[Effects of personal controls on cortisol secretion during stress processes].

This study investigated effects of personal control on psychobiological stress responses. Salivary cortisol was used as an index of hypothalamic pituitary-adrenocortical axis response. Healthy males (N = 20) were exposed five times serially to a psychosocial stressor: mental arithmetic under time pressure. "Chance control", "other powerful controls" and "internality" were reported personality-dependent aspects of personal controls; "personal control as coping" under the psychosocial stress situation was also assessed with a questionnaire after the session ended. Cortisol response showed significant increase (F (16,304) = 6.69, p < 0.01). From the view point of personality, the high "chance control" score group showed higher levels of cortisol compared to the low score group before stressful tasks. On the other hand, the high "personal control as coping" score group showed higher levels of cortisol compared to the low score group after the stressful tasks. We inferred that the high "personal control as coping" score group conducted stressful tasks with high concentration and effort. The effects of such personal controls as personality and as ways of coping were demonstrated in this experiment through cortisol secretion in different stress-process phases.

Adaptation, Psychological↗
PubMed1999

[Dyslipidemia and personality--an investigation of 376 aged athletes].

UNLABELLED: There exists much evidence for a close connection between "Type A" personality and a high cardiovascular risk. In addition, there seems to be a strong association between high lipids and personality as well. In this investigation we addressed the question of this relationship. METHODS AND RESULTS: In a sample of n = 376 male life-time athletes, born 1910 to 1940 a retrospective longitudinal study aiming at motor development and influencing factors was conducted including for instance data concerning health status, personality, locus-of-control. In the sample (medium age of 65 years) the prevalence for hypercholesterin-/triglyceridemia equals 35%. The objective of the present study was the identification of sub-samples with significantly higher prevalences defining personality features, locus-of-control and closely related constructs as independent variables. The data analysis was performed using CHAID. The sample is separated into 14 subgroups by the combination of 10 predictors. Above average prevalences were found in people with the key personality features of "tension", "neuroticism", "aggressiveness", and "extraversion" in several combinations. If a low personal-best or many statements "sport becomes less important" gain relevance, the prevalence rises to 100%. A trustworthy occupation and "neuroticism" predict a percentage of 83%. "Aggression" and "extraversion" are related to an unhealthy, "worrying about ones health" to a healthy lifestyle. The latter as well as low "life-satisfaction" and feeling "dependent upon others" correspond to compensatory sport engagement. Many results therefore support findings concerning the protective power of sport and the negative impact of tension, neuroticism, and inactivity. Our results showed a close association between features of "Type A" personality and high lipids in older life-time athletes. It is only possible to speculate about causality. A plausible idea is to consider a common patho-physiological basis of changes in metabolism and personality (e.g. sympathic activity or "drive"). In any case, the above mentioned personality features moderate unhealthy behavior patterns leading to hypercholesterin-/triglyceridemia.

Age Factors↗
PubMed1998

[Personalization concepts of medical ethics in the teachings of John Paul II].

According to John Paul's teaching, the medicine cannot be purely technological, but needs to have some human character. The medicine doctors should consider patients as a whole, not only their problems bound with the treating them as patients, and to cure them from their illnesses, but together considering their feelings, and their intellectual and spiritual life. John Paul's teaching in relation to "the personalizing of medicine" means such a consideration of the human being that is leading to the respect about the body, spirit and their culture. Therefore the knowledge about the biological properties of human life, should be accompanied together with the look onto their dignity. Nobody could be a doctor who cures only one organ of the human's body, but must see the whole human person together with the relations to other persons connected with that patient, because they have very often much of influence on to the health of a patient. That "personalizing of the medicine" should be done on such a way, when it is seen the total ill person. The doctor should be having friendly and even heartily personal relationship to the patient, which should lead to a dialog between them, full of respect and confidence. Nobody is allowed to consider an ill person as a clinical case, but should see a person who is expecting not only professional, competent medical attention, but also the understanding of the patient's spirit, which is being bound with that illness. In this way, John Paul II is telling us, that the health service should not be based entirely on the professional knowledge and skill. The doctor should see in the ill person his own dearest brother or sister, whom we are to love very much, and should be taking part in the illnesses of them.

Attitude of Health Personnel↗
PubMed2000

Personality disorders in elderly patients with dysthymic disorder.

The authors evaluated personality disorders in elderly patients with DSM-IV dysthymic disorder (DD) to identify prevalent personality disorders and their clinical correlates. Outpatients (>/=60 years; N=76) with DD were evaluated; most were male (65.8%) and had late age at onset (>50 years: 60.5%). Axis II disorders were present in 31.2% of patients, with obsessive-compulsive personality disorder (OCD; 17.1%) and avoidant personality disorder (11.8%) being the most common. Personality disorders were associated with an earlier age at onset of depressive illness, greater lifetime history of comorbid Axis I disorders, greater severity of depressive symptoms, and lower socioeconomic status. Personality disorders occurred in a minority of elderly patients with DD and mainly comprised the obsessive-compulsive and avoidant subtypes, similar to reports of personality disorders in elderly patients with major depression. In contrast, young adults with DD have been shown consistently to have personality disorders at high frequency. Together with the predominance of late onset and the lack of psychiatric comorbidity, the current findings on personality disorders reinforce our view that DD in elderly patients is typically a different disorder from DD in young adults.

Age Factors↗
PubMedDate not supplied

[Dysthymia and depressive personality: clinical differentiation].

INTRODUCTION: Personality and depressive disorders are frequently associated in clinical samples. If these are chronical or have residual symptoms, it is more difficult their differentiation from personality traits. An example of this is the present polemic about dysthymia and depressive personality disorder. The aim of this study is to differentiate them clinically. METHOD: A outpatient sample of patients in a MHC with nonpsychotic affective disorders is randomized and recruited. Two groups are made, with dysthymia or depressive personality disorder. They are differentiated according clinical variables and personality disorders comorbidity. RESULTS: Patients with depressive personality disorder are more associated with group C and schizoid personality disorder and dysthymic patients with group B personality disorder (axis II-DSM-IV). There is also some dimensional differentiation between them. CONCLUSIONS: Depressive personality disorder and dysthymia are different constructs, though there is overlapping with several traits. It is necessary a longitudinal study in order to see clearly clinical and comorbidity differences.

Adult↗
PubMed1992

Prevention and control of tuberculosis among homeless persons. Recommendations of the Advisory Council for the Elimination of Tuberculosis.

Because tuberculosis (TB) is a major problem among homeless persons, the Advisory Council for the Elimination of Tuberculosis has developed recommendations to assist health-care providers, health departments, shelter operators and workers, social service agencies, and homeless persons prevent and control TB in this population. TB should be suspected in any homeless person with a fever and a productive cough of more than 1-3 weeks' duration, and appropriate diagnostic studies should be undertaken. Confirmed or suspected TB in a homeless person should be immediately reported to the health department so that a treatment plan can be decided upon and potentially exposed persons located and examined. Patients with TB should be counseled and voluntarily tested for human immunodeficiency virus (HIV) infection because TB treatment recommendations are different for HIV-seropositive and HIV-seronegative persons (1). TB therapy should be directly observed whenever possible. This may require the establishment of special shelters or other long-term-care arrangements for homeless persons with TB. For each person with an infectious case, an investigation should be conducted to identify exposed persons, and those found to be infected should be considered for preventive therapy. Shelter staff should receive a tuberculin skin test when they start work and every 6-12 months thereafter. Those with positive skin test results should be considered for preventive therapy according to current guidelines. Shelters for the homeless should be adequately ventilated. The installation of ultraviolet lamps also may be useful to further reduce the risk of TB transmission.

Adult↗
PubMedDate not supplied

[Evaluation of temperament and personality in bulimia nervosa].

UNLABELLED: Previous studies revealed the possibility of abnormal personality development role in the etiology of eating disorders. It was found that a diagnosis of personality disorders, mostly borderline personality and/or histrionic personality can be made in about 44-46% of bulimic patients. The inconsistencies in identifying personality types using categorical assessment approaches have encouraged a conceptualization of the personality from a dimensional perspective. It was revealed that the Tridimensional Personality Questionnaire (TPQ) and Temperament and Character Inventory (TCI) are useful in studying patients with eating disorders. AIM: The aim of the study was personality dimensions and depression symptoms assessment in bulimic patients. METHOD: We studied 36 women with purging type bulimia according to DSM-IV and ICD 10 criteria. The mean age of the studied women was 19.7 years. The control group were 44 healthy women: university and last year high school students (mean age 20.4). We assessed body height, body mass and Body Mass Index (BMI). Severity of depression symptoms was assessed with the use of Beck Depression Index (BDI), and personality dimensions with the use of (TCI). CONCLUSIONS: Women from the study group had higher harm avoidance (HA) scores, which shows that bulimic patients are shy, fearful, doubtful, tend to be inhibited in most social situations. Mood disorders present in the studied women influenced HA scores. The results of the study revealed lower possibilities of self-directness in bulimic patients in comparison with the control group. Negative correlation between BDI and SD scores, shows that a decrease of depression severity may lead to an increase of self-esteem, independence and effectiveness of bulimic patients.

Adolescent↗
PubMed2005

[Role of personality in depression of the elderly: difference between early and late life depression].

Personality disorders have been implicated in the occurrence of depression in the elderly. The main purpose of this study was to assess the role of personality disorders in depression of the elderly and to distinguish between early and late onset depression. The study included 48 subjects over 65 years of age from a department of psychiatry, who suffered from a major depressive episode according to the criteria of the DSM-III-R, without bipolar characteristics. The patients were examined at two different times. At the first interview, depression was assessed by the mini-GDS and the CES-D scales, and a cognitive disorder was ruled out by the Mini-Mental State Examination. The patients were then classified in two groups according to the time of the first occurrence of depression, before (early onset depression) or after (late onset depression) 65 years of age. A second evaluation was performed after the cure of the depression. The patients' personality was then assessed using the International Personality Disorder Examination, in its VKP French-translated version, which evaluates personality disorders as defined by the criteria of the DSM-III-R and the ICD-10. The frequency of personality disorders was higher in patients with early-onset depression rather than in those with late onset depression. The most frequent personality disorder was avoiding personality (Cluster C) according to categorical as well as dimensional assessment. "Dependant personality" (Cluster C) was also quite often associated with early-onset depression. However this results should be confirmed by a larger study.

Age of Onset↗
PubMed2006

Posttraumatic stress disorder in primary care with special reference to personality disorder comorbidity.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a common and disabling disturbance in primary care. Few studies have been carried out in primary care samples and none have taken into consideration the association between PTSD and personality disorder. AIM: To describe prevalence and risk factors of PTSD and its comorbidity with personality disorder. SETTING: General practice centre in Valencia (Spain). METHOD: Patients who had experienced at least one traumatic event in their lives were selected from a random sample attending a primary healthcare centre in Valencia and blindly assessed by trained professionals. Patients suffering from PTSD were compared with those who were not. PTSD and personality disorder diagnoses were established using CIDI and SCID-II interviews respectively. Sex, age at the time of experiencing trauma, frequency, multiplicity and type of trauma, dissociative symptoms, personality disorder and severity of PTSD were subjected to multivariate analysis to estimate the probability of developing PTSD and its duration. RESULTS: Life prevalence rate was 14% and current prevalence 9%. Dissociative symptoms and personality disorder were significantly associated with PTSD. Cluster analysis based on age, frequency and type of trauma revealed the existence of one subgroup composed mainly of women who had experienced frequent body-contact trauma at an early age, developed severe PTSD and suffer from a variety of personality disorders, particularly paranoid personality disorder. Time to the complete disappearance of symptoms was only explained by the initial severity of PTSD. CONCLUSION: PTSD is a frequent disorder in general practice and it is often associated with personality disorder. Women who experienced high frequency body-contact traumatic events at an early age often suffer from personality disorder and present a particularly severe form of PTSD deserving referral to specialised care.

Adolescent↗
PubMed2006

[Personality disorders in the elderly: diagnostic aspects].

This article describes the usefulness of the DSM personality disorders. In conclusion the presence of personality disorders during a lifetime is not always an enduring pattern of (the same) conduct disorders. Despite this, the DSM describes a static course of mainly interpersonal behaviour. Next to this, the utility of the DSM-Axis-II assessment and general personality assessment in relation to older adults will be discussed. In general these instruments are not very suitable for the assessment of the disposition and gravity of personality disorders in the elderly. It is proposed to develop specific profiles with regard to personality disorders in the elderly by applying the Delphi-technique on existing personality assessment. A Delphi panel of experts in the field of personality pathology in older adults can be asked to mention a certain personality disorder and describe this on a certain personality selfreport list, like the shortened version of the TCI.

Aged↗
PubMed2006

Personality profile of depressive patients with a history of suicide attempts.

AIM: To examine the dimensions and appropriate aspects of personality according to the five-factor model of personality of depressive patients with a suicide attempt history compared to depressive patients without a suicide attempt history and healthy persons. METHOD: Sample of 35 outpatients of both gender (< 60 years), with a diagnosis of ICD-10 non-psychotic recurrent depression in remission (F 33.4) and a group of healthy persons (N = 20) were included in the study. Patients were classified into a group of patients with a suicide attempt history (N = 15) and a group of patients without a suicide attempt history (N = 20). The exclusion criteria were determined. The NEO PI-R (240 self-report items) has been used to evaluate personality dimensions and aspects. RESULTS: Both patient groups had a significantly higher score on the dimension of Neuroticism (p < 0.001), as well as significantly lower scores on the dimensions of Extroversion, (p < 0.001) Openness (p < 0.01) and Conscientiousness (p < 0.001; p < 0.01) compared with a group of healthy persons (ANOVA; Fisher's test-LSD). CONCLUSIONS: Depressive patients with a suicide attempt history were significantly different in all personality domains except in Agreeableness from healthy persons (higher Neuroticism and lower Extroversion, Openness and Conscientiousness). There were no considerable differences in personality domains when major depressives with and without suicide attempt history were compared.

Adult↗
PubMed1989

[Personality markers in patients with sleep apnea syndrome].

In addition to the well-known medically oriented examination procedures and forms of treatment of sleep apnea, we are also interested in the psychological aspects of this pathological condition. Against the background of our experience of patients treated with nCPAP--here we have observed, among other things, an increase in general activity--we investigated the question as to whether typical personality traits are to be observed among persons suffering from sleep apnoea. As a psychodiagnostic procedure, the Freiburg personality inventory (FPI-R) was employed in the following persons: a) Persons with diagnosed sleep apnea, b) persons with unconfirmed suspected sleep apnea, c) persons with diagnosed chronic bronchitis. An initial consideration of the results reveals an unremarkable personality profile of the person with SAS who, however, in comparisons with other groups does reveal certain peculiarities. Although the results presented here do not permit any reliable specific psychodiagnostic statement to be made with the aid of the procedure employed, in several points they do provide clues as to features that should be subjected to a differential investigation.

Arousal↗