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PubMedDate not supplied

[Personality disorders in a nonclinical sample of adolescents].

OBJECTIVE: To examine the comorbidity of borderline personality disorder and other personality disorders in a nonclinical sample of high-school students. METHOD: 311 high-school students who completed the French version of the CES-D (Center for Epidemiological Studies-Depression Scale), were asked to participate to interviews evaluating personality functioning: 60 subjects (19%) accepted to participate in the study. The mean CES-D score of these 60 subjects (16 boys, 44 girls, mean age=17.7 1.7) was significantly higher than the mean score of the whole sample (23.9 10.4 versus 16.7 9.8). Thus the interviewed sample was not representative of the population of high-school students. Subjects were assessed using the major depressive episode module of the MINI (Mini International Neuropsychiatric Interview) and the SIDP IV (Structured Interview for DSM IV Personality). Inter-rater reliability was determined by comparing the independent ratings of interviewers and an experienced clinician on a random sample of 20 interviews. For DSM IV borderline personality disorder diagnosis, the Cohen's kappa coefficient was 0.85. For personality disorder criteria, kappa ranged from 0.6 to 1.0 (average kappa=0.79). RESULTS: Sixteen of these subjects (26,7%, 4 males, 12 females) received a diagnosis of borderline personality disorder according to DSM IV criteria. The mean CES-D score of borderline subjects (30.6 10.2) was significantly higher than the mean score of nonborderline subjects (21.6 10.5). Of the 16 borderline subjects, 11 (75%) received a diagnosis of major depressive disorder versus 14 (31%) of the non borderline subjects. None of the other personality disorders approached the frequency of borderline personality disorder. The next most frequent diagnoses were depressive and dependent personality disorders which occurred in respectively in 16.6% and 10% of the 60 subjects. All the personality-disorders occurred at higher rates in the group with borderline personality disorder with the exception of obsessive-compulsive personality disorder which was diagnosed only in nonborderline subjects. Of the 16 borderline subjects, 11 (68.7%) met the criteria for another personality disorder which were depressive personality disorder (N=5), paranoid personality disorder (N=4), dependent personality disorder (N=3), antisocial personality disorder (N=2), histrionic personality disorder (N=2), avoidant personality disorder (N=2), negativistic personality disorder (N=2), schizotypal personality disorder (N=1), narcissistic personality disorder (N=1), self-defeating personality disorder (N=1). The optional diagnoses (self-defeating, depressive and negati-vistic personality disorders) accounted for 8 of 23 (34.7%) cases of personality disorders diagnosed among borderline subjects. Among these 11 adolescents, 5 received 2 diagnoses of personality disorders (borderline and paranoid personality disorders, N=1; borderline and dependent personality disorders, N=1; borderline and depressive personality disorders, N=3), 3 received 3 diagnoses (borderline, antisocial and histrionic personality disorders, N=1; borderline, avoidant and negativistic personality disorders, N=1; borderline, depressive and negativistic personality disorders, N=1), 3 received 5 diagnoses (borderline, paranoid, histrionic, narcissistic and dependent personality disorders, N=1; borderline, paranoid, dependent, avoidant and depressive personality disorders, N=1; borderline, paranoid, schizotypal, antisocial and self-defeating personality disorders, N=1). Among the 44 adolescents (12 boys, 32 girls) without borderline personality disorder, 10 (22.7%) (3 boys, 7 girls) met the criteria for another personality disorder which were depressive personality disorder (N=5) or cluster C disorders -obsessive-compulsive personality disorder (N=4), dependent personality disorder (N=2), avoidant personality disorder (N=1) - with the exception of one diagnosis of histrionic personality disorder. Two subjects received 2 diagnoses (obsessive-compulsive and depressive personality disorder). The internal consistency of personality disorders criteria was assessed with Cronbach's alpha coefficient. Borderline personality disorder criteria had high internal consistency (0.82). The factor structure of borderline personality disorder criteria was studied with an exploratory factorial analysis which extracted three factors. The eigenvalues were 3.70, 1.06, and 1.01. Confirmatory factorial analyses were conducted. The correlated two-factor model and the three-factor model fit the data well but the correlation between factors was, however, judged too high, ranging from 0.70 to 0.78. The one-factor model proved to have a good fit (Goodness of Fit Index=0.89, Comparative Fit Index=0.90, Root Mean Square Residual=0.07). As a previous study showed the frequency of two schizotypal personality disorder criteria (odd beliefs/magical thinking experiences and unusual perceptual experiences), an exploratory factorial analysis was performed on the combined set of criteria of borderline and schizotypal personality disorders. It yielded 2 factors: the first factor consisted of all the borderline personality disorder criteria, odd beliefs/magical thinking, and unusual perceptual experiences and could be called the borderline factor; the second factor consisted of the paranoid and the social avoidance criteria and could be called the interpersonal hypersensitivity factor. A confirmatory factor analysis showed that this two-factor model provided a good fit to the data (GFI=0.82, CFI=0,91, RMSR=0.10). The correlation between factors was weak (0.25). These results suggest that odd beliefs/magical thinking and unusual perceptual experiences are a component of borderline symptomatology in adolescents. DISCUSSION: The high frequency of major depressive disorder and personality disorders in the interviewed sample may be due to the possibility that adolescents with psychological problems have used the interview as a way to obtain attention and support from a psychologist. The interviewed sample, which was characterized by a high intensity of depressive symptomatology and by a high frequency of borderline personality disorder, could thus be seen as intermediate between a clinical and a community sample. Our results may be more generalizable to an outpatients population of adolescents. This study found conflicting results about the construct validity of borderline personality disorder in adolescent. The high internal consistency and the one-factor structure of the borderline personality disorder criteria argue for their validity in adolescents. However, the high rates of comorbidity of borderline personality disorder with depression and other personality disorders, extended to clusters A, B and C and to optional diagnoses, suggest the lack of construct validity of either borderline personality or cluster B disorders in adolescents. CONCLUSION: Borderline symptomatology in adolescents appears more in adequacy with a dimensional model than with a typological classification. More studies are needed to assess and improve the construct validity of borderline personality disorder in adolescents.

Adolescent↗
PubMed2003

Abuse and neglect in childhood: relationship to personality disorder diagnoses.

BACKGROUND: Childhood history of abuse and neglect has been associated with personality disorders and has been observed in subjects with lifetime histories of suicidality and self-injury. Most of these findings have been generated from inpatient clinical samples. METHODS: This study evaluated self-rated indices of sustained childhood abuse and neglect in an outpatient sample of well-characterized personality disorder subjects (n=182) to determine the relative associations of childhood trauma indices to specific personality disorder diagnoses or clusters and to lifetime history of suicide attempts or gestures. Subjects met criteria for ~2.5 Axis II diagnoses and 24% reported past suicide attempts. The Childhood Trauma Questionnaire was administered to assess five dimensions of childhood trauma exposure (emotional, physical, and sexual abuse, and emotional and physical neglect). Logistic regression was employed to evaluate salient predictors among the trauma measures for each cluster, personality disorder, and history of attempted suicide and self-harm. All analyses controlled for gender distribution. RESULTS: Seventy-eight percent of subjects met dichotomous criteria for some form of childhood trauma; a majority reported emotional abuse and neglect. The dichotomized criterion for global trauma severity was predictive of cluster B, borderline, and antisocial personality disorder diagnoses. Trauma scores were positively associated with cluster A, negatively with cluster C, but were not significantly associated with cluster B diagnoses. Among the specific diagnoses comprising cluster A, paranoid disorder alone was predicted by sexual, physical, and emotional abuse. Within cluster B, only antisocial personality disorder showed significant associations with trauma scores, with specific prediction by sexual and physical abuse. For borderline personality disorder, there were gender interactions for individual predictors, with emotional abuse being the only significant trauma predictor, and only in men. History of suicide gestures was associated with emotional abuse in the entire sample and in women only; self-mutilatory behavior was associated with emotional abuse in men. CONCLUSION: These results suggest that childhood emotional abuse and neglect are broadly represented among personality disorders, and associated with indices of clinical severity among patients with borderline personality disorder. Childhood sexual and physical abuse are highlighted as predictors of both paranoid and antisocial personality disorders. These results help qualify prior observations of the association of childhood sexual abuse with borderline personality disorder.

Adult↗
PubMed2007

Cluster A personality disorders: considering the 'odd-eccentric' in psychiatric nursing.

Psychiatric nurses are familiar with the concept of personality disorder because of their contact with persons with the most common personality disorder in clinical settings - borderline type, who frequently engage mental health services. Perhaps it is this familiarity that has focused research and clinical attention on borderline personality disorder compared with the other personality disorders. The significance of cluster A personality disorders for nursing is multifaceted because of their severity, prevalence, inaccurate diagnosis, poor response to treatment, and similarities to axis I diagnoses. Despite this, literature reviews have established that relatively few studies have focused on the treatment of the cluster A personality disorders - paranoid, schizotypal, and schizoid - resulting in a dearth of evidence-based interventions for this group of clients. A discussion of these disorders in the context of personality disorder and their individual characteristics demonstrates the distinctive and challenging engagement techniques required by psychiatric nurses to provide effective treatment and care. It is also strongly indicated that the discipline of psychiatric nursing has not yet begun to address the care of persons with cluster A personality disorders.

Adaptation, Psychological↗
PubMed1986

Thought, language, and communication in schizophrenia: diagnosis and prognosis.

Using the Scale for the Assessment of Thought, Language, and Communication (TLC), we examined the frequency of "thought disorder" in 94 normal volunteers and 100 psychiatric patients (25 each suffering from manic disorder, schizoaffective disorder, schizophrenic disorder, disorganized type, and schizophrenic disorder, paranoid type). We observed the manics to have a substantial amount of thought disorder and the normals to have a modest amount, suggesting that thought disorder is probably not pathognomonic of schizophrenia. The patients with affective illness did, however, show a somewhat different pattern of abnormality. In particular, patients with affective psychosis have more prominent positive thought disorder, while the schizophrenic patients tend to have more negative thought disorder. Evaluation of the patients 6 months later indicated that most types of thought disorder remit in the manics, while they persist in the schizophrenics; patients with schizoaffective disorder also tend to improve substantially. The strongest predictor of outcome was the presence of negative thought disorder.

Adult↗
PubMed1991

Essential and other fatty acids in plasma in schizophrenics and normal individuals from Japan.

Plasma phospholipid and cholesterol ester fatty acid levels were measured in samples from normal individuals, schizophrenics, and patients with affective and paranoid disorders in Japan. The schizophrenics were divided into groups with normal and reduced platelet sensitivity to the aggregation-inhibiting effects of prostaglandin (PG) E1. As in samples from schizophrenics in several other countries, linoleic acid levels were significantly below normal, as was the ratio of linoleic acid to its metabolites. Phospholipid fatty acid levels were normal in patients with paranoid or affective disorders. When the schizophrenics were divided into those with and without an abnormal response to PGE1, oleic acid was higher and eicosapentaenoic acid lower in those patients with an abnormal response. This study lends further support to the idea that schizophrenics may differ from controls in their essential fatty acid and eicosanoid metabolism.

Adult↗
PubMed1987

A simplex model of the paranoid process: implications for diagnosis and prognosis.

The theory that the paranoid process is gradual and insidious was tested quantitatively by means of LISREL, a computer program designed to trace causal pathways between latent variables. The results clearly confirmed Lorr's simplex model which depicts a progressive sequence of six stages, beginning with hostile attitude and ending with delusions of influence. The model suggests that it is artificial to distinguish paranoid personality, paranoia and paranoid schizophrenia as separate diagnostic entities. Instead, paranoid schizophrenia should be regarded as a more severe form of paranoia which in turn is a more severe form of paranoid personality. The implications of this model for prognosis are also discussed.

Diagnosis, Differential↗
PubMed1999

[Psychiatric disorders following and preceding temporal lobectomy].

We analysed pre- as well as post-operative psychiatric disorders in thirty eight patients with temporal lobe epilepsy. While postoperative paranoid disorders were closely correlated with preoperative acute interictal psychoses, episodes of postictal psychoses prior to surgery were associated with postoperative mood disorders. A good prognosis of postoperative mood disorders was stressed. The literature search supported the predominance of right-sided lobectomy in patients with de novo psychoses after surgery. The relationship between left-sided lobectomy and postoperative mood disorders needs further amplification and remains tentative. We stressed the need for a prophylactic psychotherapy to surgical candidates to cope with unrealistic wishes to get relieved from all the difficulties in their lives after temporal lobectomy.

Adult↗
PubMedDate not supplied

[J. Delay hypothymic disorder. Current aspects and pertinence of the concept in schizophrenic states].

In the first part, the authors re-examined the concept of "hypothymie" described by J. Delay in 1946. "Hypothymie" is characterized by a mood disorder and particularly by an absence of mood and it is a fundamental syndrome of hebephrenia. From this syndrome "hypothymie", others signs will appear such as schizophrenic symptoms (characterized by attention disorder and formal thought disorder), paranoid symptoms or catatonic ones. Several authors, like J. Delay, had emphasized the importance of the mood disorder (an absence) in this pathology. It is the case of Kretschmer, Dide and Guiraud (who evoked the "athymhormie"), Bleuler, Kraepelin and also Stransky, Griesinger and at the beginning of the XIXth century, Haslam in England and Pinel in France. In the present time, "hypothymie" is related to some current concepts, especially the deficit forms of schizophrenia described by Carpenter and the schizophrenia type II defined by Crow. In the second part, the relationships between paranoid symptoms, depression and "hypothymie" were studied. The authors stressed the fact that there is an overlap between depressive and paranoid symptoms at the acute phase. They gave an illustration including 51 patients in an acute phase and in a stabilized one. In the acute phase, there was a negative correlation between positive symptoms and depressive symptoms in particular between conceptual disorganization, suspiciousness/persecution, positive formal thought disorder and depression (r = -0.65, p < 0.01; r = -0.57, p < 0.01; r = -0.66, p < 0.01 respectively). These correlations disappeared at discharge of the hospital and did not exist in the stabilized group.(ABSTRACT TRUNCATED AT 250 WORDS)

Depressive Disorder↗
PubMed1984

An independent analysis of the Danish Adoption Study of Schizophrenia. VI. The relationship between psychiatric disorders as defined by DSM-III in the relatives and adoptees.

In this report, modified DSM-III criteria were applied to all the available interviews with adoptees from the greater Copenhagen sample of the Danish Adoption Study of Schizophrenia. In the adoptees, reasonable agreement was found between our DSM-III diagnoses and the original diagnoses using global DSM-II-based criteria by Kety et al for their categories of chronic and acute, but not borderline, schizophrenia. Comparing DSM-III-based diagnoses in adoptees and relatives, schizophrenia, schizotypal personality disorder, and paranoid personality disorder were all significantly more common in the biologic relatives of schizophrenic v screened control adoptees. These three diagnoses, which together form a tentative "schizophrenia spectrum," were also significantly concentrated in the biologic relatives of adoptees with schizoaffective disorder, mainly schizophrenic subtype, and schizotypal personality disorder, but not in biologic relatives of adoptees with schizophreniform disorder or atypical psychosis.

Adoption↗
PubMed1977

The Odyssean personality. A survival advantage for carriers of genes predisposing to schizophrenia?

To explain the persistence of schizophrenia in human populations at relatively high and constant rates, it is proposed that the schizoid-paranoid personality (designated as the Odyssean personality) which characterizes so many nonpsychotic relatives of schizophrenics, represents a selective advantage. It is assumed that odyssean relatives carry the gene or genes predisposing to schizophrenia, but not in sufficient quantity for the development of the psychosis. It is suggested that because of their schizoid-paranoid out-look, Odysseans have an increased probability of contributing to the gene pool of succeeding generations since, in a world plagued by terror, strife, and war, they, rather than their trusting peers, are the ones more likely to survive long enough to ensure the survival of their progeny.

Adaptation, Psychological↗
PubMed1988

Psychiatric and legal aspects of persistent litigation.

There is a paucity of literature in English about those people who persistently complain. In Germany and in Scandinavia, a diagnosis of querulent paranoia may be made, although this interesting and uncommon syndrome is rarely recognised in the UK. Five cases of litigiousness or persistent complaining are reported, to illustrate the typical psychopathology and the types of diagnosis that occur. Four of these people are barred from further litigation by the courts (vexatious litigants) and were contacted directly for the purpose of this study.

Adult↗
PubMed1996

Querulous paranoia in Chinese patients: a cultural paradox.

OBJECTIVE: There has been no reported case of querulous paranoia from the Asian population. A prospective study was undertaken to identify patients with querulous paranoia in an outpatient clinic. METHOD: One thousand, five hundred and fifty-one new referrals to a university-affiliated psychiatric outpatient clinic in Hong Kong were screened for querulous paranoia during routine clinical work. RESULTS: Three patients with querulous paranoia (0.19%) were identified during 1 year. The case histories of these three patients are reported. CONCLUSION: Possible reasons for the low reporting rate are discussed and the importance of sociocultural traditions in the development and recognition of querulous paranoia is emphasised.

Adult↗