Home About us Contact
|
Home About us Contact | ||
|
|
||
Personality Disorders (personality + disorders)
Kinds of Personality Disorders Selected AbstractsUsing the SWAP-200 in a personality-disordered forensic population: is it valid, reliable and useful?CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2005Luisa E. Marin-Avellan Background Treatment and risk management of forensic patients relies heavily on diagnosing psychopathology, yet the reliability of clinical diagnoses of personality disorder has been found to be only fair to low. Structured instruments for the global assessment of personality disorder are infrequently used in clinical assessments possibly due to their limited validity and clinical utility. Aims/methods The Shedler-Westen Assessment Procedure-200 (SWAP-200) was developed in an effort to address these limitations. Although good reliability and validity in relation to clinicians' diagnosis of personality disorder has been reported, to date the validity of this instrument has not been assessed in relation to other standardized instruments or in a personality-disordered, forensic population. This study aims to establish the reliability and validity of the SWAP-200 against other diagnostic instruments and measures of interpersonal functioning in a personality disordered forensic population. Results This paper reports the results of 30 subjects from a high secure hospital in the UK who were assessed with the SWAP-200, the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), the Adult Attachment Interview (AAI) and the Chart of Interpersonal Reactions in Closed Living Environments (CIRCLE). Preliminary results suggest that the SWAP-200 is a reliable instrument for the diagnosis of personality disorder in forensic patients. Conclusions Although the small sample size allows only preliminary conclusions about the validity of this instrument, early results show a reduction of the diagnosis of comorbidity compared with the SCID-II, together with an increased number of expected associations between independent measures of interpersonal functioning and categories of personality disorder. Copyright © 2005 Whurr Publishers Ltd. [source] New onsets of substance use disorders in borderline personality disorder over 7 years of follow-ups: findings from the Collaborative Longitudinal Personality Disorders StudyADDICTION, Issue 1 2009Marc Walter ABSTRACT Aims The purpose of this study was to examine whether patients with borderline personality disorder (BPD) have a higher rate of new onsets of substance use disorders (SUD) than do patients with other personality disorders (OPD). Design This study uses data from the Collaborative Longitudinal Personality Disorder Study (CLPS), a prospective naturalistic study with reliable repeated measures over 7 years of follow-up. Setting Multiple clinical sites in four northeastern US cities. Participants A total of 175 patients with BPD and 396 patients with OPD (mean age 32.5 years) were assessed at baseline and at 6, 12, 24, 36, 48, 60, 72 and 84 months. Measurements The Structured Clinical Interview for DSM-IV Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders were used at baseline, the Follow-Along version of the DIPD-IV and the Longitudinal Interval Follow-up Evaluation at the follow-up evaluations. Kaplan,Meier analyses were calculated to generate the time to new onsets. Findings BPD patients showed a shorter time to new onsets of SUD. Thirteen per cent of BPD patients developed a new alcohol use disorder and 11% developed a new drug use disorder, compared to rates of 6% and 4%, respectively, for OPD. Non-remitted BPD and remitted BPD patients did not differ significantly in rates of new onsets of SUD. Conclusions BPD patients have a high vulnerability for new onsets of SUDs even when their psychopathology improves. These findings indicate some shared etiological factors between BPD and SUD and underscore the clinical significance of treating SUD when it co-occurs in BPD patients. [source] Screening for personality disorder: a comparison of personality disorder assessment by patients and informantsINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 1 2004Dr Paul Walters Abstract The Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II Version 2.0) is becoming the most favoured instrument to measure personality disorder but takes up to an hour to complete. The Standardized Assessment of Personality (SAP), an informant-based measure, takes 10 to 15 minutes to complete. Both instruments have been validated independently. This study aimed to determine whether the SAP is a suitable screening instrument for personality disorder as measured by the SCID-II. Fifty-seven psychiatric patients were assessed for personality disorder using both the SAP and the SCID-II. The SAP assessments were conducted blind to the results of the SCID-II assessments. Agreement between the two instruments in this population was low (kappa = 0.3). The level of agreement differed between personality disorder categories, ranging from kappa = 0.4 (antisocial) to ,0.1 (narcissistic). In this population of patients, the SAP proved to be a poor screen for the SCID-II. The study highlights the discrepancy between informant and self-report assessments for personality disorder. Copyright © 2004 Whurr Publishers Ltd. [source] Personality Profiles and the Prediction of Categorical Personality DisordersJOURNAL OF PERSONALITY, Issue 2 2001Robert R. McCrae Personality disorders (PDs) are usually construed as psychiatric categories characterized by a unique configuration of traits and behaviors. To generate clinical hypotheses from normal personality trait scores, profile agreement statistics can be calculated using a prototypical personality profile for each PD. Multimethod data from 1,909 psychiatric patients in the People's Republic of China were used to examine the accuracy of such hypotheses in the Interpretive Report of the Revised NEO Personality Inventory. Profile agreement indices from both self-reports and spouse ratings were significantly related to PD symptom scores derived from questionnaires and clinical interviews. However, accuracy of diagnostic classification was only modest to moderate, probably because PDs are not discrete categorical entities. Together with other literature, these data suggest that the current categorical system should be replaced by a more comprehensive system of personality traits and personality-related problems. [source] A Structured Interview for the Assessment of the Five-Factor Model of Personality: Facet-Level Relations to the Axis II Personality DisordersJOURNAL OF PERSONALITY, Issue 2 2001Timothy J. Trull The Structured Interview for the Five-Factor Model (SIFFM; Trull & Widiger, 1997) is an 120-item semistructured interview that assesses both adaptive and maladaptive features of the personality traits included in the five-factor model of personality, or "Big Five." In this article, we evaluate the ability of SIFFM scores to predict personality disorder symptomatology in a sample of 232 adults (46 outpatients and 186 nonclinical college students). Personality disorder symptoms were assessed using the Personality Diagnostic Questionnaire-Revised (PDQ-R; Hyler & Rider, 1987). Results indicated that many of the predicted associations between lower-order personality traits and personality disorders were supported. Further, many of these associations held even after controlling for comorbid personality disorder symptoms. These findings may help inform conceptualizations of the personality disorders, as well as etiological theories and treatment. [source] Personality disorders in first-episode psychosis,PERSONALITY AND MENTAL HEALTH, Issue 4 2008Erik Simonsen The aim of the study was to determine the prevalence of personality disorders in the early course of first-episode psychosis and their likely presence in the premorbid period. Fifty-five patients were enrolled at baseline and premorbid function was evaluated by the Premorbid Adjustment Scale. Thirty-three of these of the patients were assessed at two-year follow-up for comorbid personality disorders by the Structured Clinical Interview for DSM-IV Personality Disorders and by the self-report instrument Millon Clinical Multiaxial Inventory-II. Half of the patients met the criteria of two or more personality disorders, while one-third of the patients did not fulfil the criteria for any personality disorder. The schizoid and the avoidant were the most frequent personality disorders and both were associated with social withdrawal during childhood and adolescence. The limitation of the study is the small sample, the retrospective assessment and a 40% attrition rate. The strengths are that it is a clinical epidemiological sample of first-episode psychotic patients and that different but complimentary measures of the personality disorders were used. Copyright © 2008 John Wiley & Sons, Ltd. [source] The Self-report Standardized Assessment of Personality-abbreviated Scale: Preliminary results of a brief screening test for personality disordersPERSONALITY AND MENTAL HEALTH, Issue 2 2008Sara Germans Objective,The internal consistency, test,retest reliability and validity of the Self-report Standardized Assessment of Personality-abbreviated Scale (SAPAS-SR) as a screening instrument for personality disorders were studied in a random sample of 195 Dutch psychiatric outpatients, using the Structured Clinical Interviews for DSM-IV Personality Disorders (SCID-II) as a gold standard. Method,All patients completed a self-report version of the SAPAS. One week later, they were interviewed with the SCID-II. Two weeks later, the SAPAS-SR was re-administered. Results,According to the SCID-II, 97 patients (50%) were suffering from a personality disorder. The SAPAS-SR correctly classified 81% of all participants. Sensitivity (0.83) and specificity (0.80) were slightly lower compared with the original English version. This difference may be explained by the lower prevalence and severity of personality disorders in the study population. Conclusion,The results provide evidence for the usefulness of the SAPAS as a self-administered instrument for screening personality disorders in clinical populations. Copyright © 2008 John Wiley & Sons, Ltd. [source] The Impact of Personality Disorders on Alcohol-Use Outcomes in a Pharmacotherapy Trial for Alcohol Dependence and Comorbid Axis I DisordersTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 6 2007Elizabeth Ralevski PhD Although antisocial and borderline personality disorders frequently co-occur with alcohol dependence and other Axis I disorders, their effect on alcohol use outcomes in context of pharmacotherapy remains unclear. Patients with Major Axis I disorders, including alcohol dependence, and diagnosis of antisocial (ASPD) or borderline personality disorder (BPD) were enrolled in a 12-week medication trial for treatment of their alcohol dependence. Everyone was randomized to one of four cells: naltrexone alone, placebo alone, open label disulfiram and naltrexone, or open label disulfiram and placebo. Outcome measures included scales for alcohol use and craving. Data were analyzed comparing patients with ASPD vs. those without, and patients with BPD vs. those without. Diagnosis of personality disorder did not adversely affect alcohol outcomes, and patients with ASPD or BPD did not have a poorer response to medication than patients without diagnosis of ASPD or BPD. The findings suggest that naltrexone and disulfiram can be safely and effectively used with patients who have comorbid diagnoses of Axis I and Axis II disorders. [source] Impact of axis II comorbidity on the course of bipolar illness in men: a retrospective chart reviewBIPOLAR DISORDERS, Issue 4 2002Joanne H Kay Objectives: ,The purpose of this study was to investigate whether the presence of comorbid personality disorder influences the course of bipolar illness. Methods: ,Fifty-two euthymic male bipolar I out-patients were assessed using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID II). Bipolar patients with an axis II diagnosis were compared with those without an axis II diagnosis on retrospectively obtained demographic, clinical and course of illness variables. Results: ,Thirty-eight percent of the bipolar patients met criteria for an axis II diagnosis. Two (4%) met criteria for (only) a Cluster A disorder, four (8%) for (only) a Cluster B, and six (12%) for (only) a Cluster C disorder. One (2%) bipolar patient met criteria a disorder in both Clusters A and B, and one (2%) for a disorder in Clusters B and C. Five (10%) met criteria for at least one disorder in Clusters A and C, and one met criteria for disorders in Clusters A, B, and C. The presence of a personality disorder was significantly associated with a lower rate of current employment, a higher number of currently prescribed psychiatric medications, and a higher incidence of a history of both alcohol and substance use disorders compared with the bipolar patients without axis II pathology. Conclusions: ,Our results extend previous findings of an association between comorbid personality disorder in bipolar I patients and factors that suggest a more difficult course of bipolar illness. [source] How to evaluate metacognitive functioning in psychotherapy?CLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 4 2003The metacognition assessment scale, its applications In this article the authors present a method and a scale for the evaluation of the metacognitive profiles of psychotherapy patients. There will be a description of the metacognitive function and of the alterations that occur to it during treatment. Various hypotheses will then be considered: (1) that the metacognitive function has a modular structure; (2) that for each type of psychopathological condition there is a different metacognitive deficit profile; (3) that to be successful psychotherapy needs to involve an improvement in any deficient metacognitive sub-function. There will then be a presentation of the Metacognition Assessment Scale (MAS) for the assessment of metacognitive deficits during psychotherapy. We shall then describe the first results we have on the application of the scale. Finally there will be an analysis of two patients suffering from Personality Disorders and a demonstration of what metacognitive deficit profile each one has and how it is modified over the course of psychotherapy treatment. The article ends with a discussion of the hypotheses made at the start in the light of the results that have emerged.,Copyright © 2003 John Wiley & Sons, Ltd. [source] Personality disorders in prisoners and their motivation for dangerous and disruptive behaviourCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2002Professor Jeremy W. Coid MD FRCPsych Objectives To examine the associations between DSM-III, axis II, personality disorder, motivation and disruptive behaviour in prisoners. Method Interviews were carried out with 81 prisoners in prison special units in England using research diagnostic instruments and an item sheet measuring disruptive behaviours and their motivations. Independent associations were established using logistic regression. Results Specific associations were established between psychopathy and axis II disorders with violent and disruptive behaviour and motivations for these behaviours. Conclusions The study supported a cognitive model explaining the functional association between personality disorder and antisocial behaviour. Personality disorders act as predisposing factors influencing the development of motivations and subsequently facilitate the enactment of disordered behaviour, in a linear progression. Assessment of personality disorder should be routine in disruptive and dangerous prisoners. Copyright © 2002 Whurr Publishers Ltd. [source] Personality disorders improve in patients treated for major depressionACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2010R. T. Mulder Mulder RT, Joyce PR, Frampton CMA. Personality disorders improve in patients treated for major depression. Objective:, To examine the stability of personality disorders and their change in response to the treatment of major depression. Method:, 149 depressed out-patients taking part in a treatment study were systematically assessed for personality disorders at baseline and after 18 months of treatment using the SCID-II. Results:, Personality disorder diagnoses and symptoms demonstrated low-to-moderate stability (overall , = 0.41). In general, personality disorder diagnoses and symptoms significantly reduced over the 18 months of treatment. There was a trend for the patients who had a better response to treatment to lose more personality disorder symptoms, but even those who never recovered from their depression over the 18 months of treatment lost, on average, nearly three personality disorder symptoms. Conclusion:, Personality disorders are neither particularly stable nor treatment resistant. In depressed out-patients, personality disorder symptoms in general improve significantly even in patients whose response to their treatment for depressive symptoms is modest or poor. [source] The characteristics of heroin users entering treatment: findings from the Australian Treatment Outcome Study (ATOS)DRUG AND ALCOHOL REVIEW, Issue 5 2005JOANNE ROSS Abstract The current study aimed to describe the characteristics (demographics, drug use, mental and physical health) of entrants to treatment for heroin dependence in three treatment modalities; and to compare these characteristics with heroin users not in or seeking treatment. Participants were 825 current heroin users recruited from Sydney, Adelaide and Melbourne: 277 entering methadone/buprenorphine maintenance treatment (MT), 288 entering detoxification (DTX), 180 entering drug-free residential rehabilitation (RR) and 80 not in treatment (NT). Treatment entrants were generally long-term heroin users with previous treatment experience. The majority of the sample (55%) were criminally active in the month preceding interview. Injection-related health problems (74%) and a history of heroin overdose (58%) were commonly reported. There were high degrees of psychiatric co-morbidity, with 49% reporting severe psychological distress, 28% having current major depression, 37% having attempted suicide and 42% having a lifetime history of post-traumatic stress disorder. Personality disorders were also prevalent, with 72% meeting criteria for antisocial personality disorder and 47% screening positive for borderline personality disorder. Striking similarities were noted between the non-treatment and treatment groups in length of heroin use career, drug use and treatment histories. [source] Personality disorders in 545 patients with eating disordersEUROPEAN EATING DISORDERS REVIEW, Issue 2 2008*Article first published online: 5 DEC 200, Kristine Godt Abstract Objective Previous research on the prevalence of personality disorders in patients with eating disorders varies greatly in findings, but a general understanding seem to exist that personality disorders are rather common among eating-disordered patients. The present investigation is aimed at establishing the prevalence of DSM III-R or DSM IV personality disorders in a large population seeking treatment for eating disorders. Method Five hundred and forty-five patients with DSM IV- eating disorders have been evaluated using the structured clinical interview for DSM III-R or IV-Axis II and the eating disorder examination. Results The 29.5% of the population have one or more personality disorders according to DSM III-R or DSM IV criteria. Personality disorders, and specifically borderline personality disorder, are significantly more common in patients with bulimia nervosa. Discussion The proportion of eating-disordered patients with co-morbid personality disorder may not be as large as often found in studies. This challenges the understanding of a strong overall connection between the two groups of disorder; however, the connection seems to exist in subsets of eating disorder samples. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Principles for psychosocial treatment of personality disorder: Summary of the APA Division 12 Task Force/NASPR reviewJOURNAL OF CLINICAL PSYCHOLOGY, Issue 6 2006Kenneth L. Critchfield A wide variety of clinical problems and relational styles are collected under the diagnostic heading of personality disorder (PD). These disorders involve maladaptive, persistent ways of thinking, feeling, and behaving that are associated with both functional impairment and disturbed interpersonal relationships. Personality disorders are difficult to treat, and challenge a therapist's ability to intervene helpfully, in part because the maladaptive patterns can impact the therapy relationship itself. Therapeutic principles were derived by Task Force review from the small body of research conducted to date with this family of disorders and include characteristics of clients and therapists, their relationship together, and essential elements of technique. The importance of a collaborative relationship as well as a treatment that is comprehensive, empathic, patiently applied, and flexibly tailored to presenting problems are dominant themes across principles. Treatment research with PD is in its early stages and many important areas remain uncharted. The Task Force principles are here summarized in hopes of providing general guidance to clinicians working with PD, as well as to outline research needs for the area. © 2006 Wiley Periodicals, Inc. J Clin Psychol 62: 661,674, 2006. [source] Personality Profiles and the Prediction of Categorical Personality DisordersJOURNAL OF PERSONALITY, Issue 2 2001Robert R. McCrae Personality disorders (PDs) are usually construed as psychiatric categories characterized by a unique configuration of traits and behaviors. To generate clinical hypotheses from normal personality trait scores, profile agreement statistics can be calculated using a prototypical personality profile for each PD. Multimethod data from 1,909 psychiatric patients in the People's Republic of China were used to examine the accuracy of such hypotheses in the Interpretive Report of the Revised NEO Personality Inventory. Profile agreement indices from both self-reports and spouse ratings were significantly related to PD symptom scores derived from questionnaires and clinical interviews. However, accuracy of diagnostic classification was only modest to moderate, probably because PDs are not discrete categorical entities. Together with other literature, these data suggest that the current categorical system should be replaced by a more comprehensive system of personality traits and personality-related problems. [source] Personality disorders in first-episode psychosis,PERSONALITY AND MENTAL HEALTH, Issue 4 2008Erik Simonsen The aim of the study was to determine the prevalence of personality disorders in the early course of first-episode psychosis and their likely presence in the premorbid period. Fifty-five patients were enrolled at baseline and premorbid function was evaluated by the Premorbid Adjustment Scale. Thirty-three of these of the patients were assessed at two-year follow-up for comorbid personality disorders by the Structured Clinical Interview for DSM-IV Personality Disorders and by the self-report instrument Millon Clinical Multiaxial Inventory-II. Half of the patients met the criteria of two or more personality disorders, while one-third of the patients did not fulfil the criteria for any personality disorder. The schizoid and the avoidant were the most frequent personality disorders and both were associated with social withdrawal during childhood and adolescence. The limitation of the study is the small sample, the retrospective assessment and a 40% attrition rate. The strengths are that it is a clinical epidemiological sample of first-episode psychotic patients and that different but complimentary measures of the personality disorders were used. Copyright © 2008 John Wiley & Sons, Ltd. [source] Personality Disorder Features as Predictors of Symptoms Five Years Post-TreatmentTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 3 2008Irene Jansson MSc Personality disorders are associated with dysfunction in a variety of areas. Recent longitudinal research has shown that personality disorders are also predictive of problems later in life, as well as of poor response to treatment of depression and anxiety. This study assessed whether personality disorder features were associated with psychiatric symptoms in a cohort of women treated for substance abuse in Sweden. Patients were diagnosed with personality disorders using the Structured Clinical Interview for DSM-IV (SCID-II) personality questionnaire and SCID-II interview, and were then administered a self-report questionnaire designed to measure symptoms of psychiatric illness, the Symptoms Checklist-90 (SCL-90), during and five years after treatment. Concurrently, features of all personality disorders, except histrionic, were associated with SCL-90 score. At five-year follow-up, most personality disorders remained associated with SCL-90 score, with the exception of paranoid and schizoid personality disorder. After controlling for baseline score on the SCL-90, conduct disorder, borderline personality disorder, and narcissistic personality disorder remained significantly associated with symptoms at follow-up. After controlling for abstinence and baseline score, only borderline personality disorder features remained associated with SCL-90 score at follow-up. Patients with personality disorders should be monitored after treatment for psychiatric symptoms. [source] Pre-treatment predictors and in-treatment factors associated with change in avoidant and dependent personality disorder traits among patients with social phobiaCLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 2 2010Finn-Magnus Borge Abstract We examined changes in avoidant and dependent personality disorder dimensions, and pre-treatment and in-treatment factors associated with such changes in 77 patients, randomized to medication-free residential cognitive (CT) or residential interpersonal therapy for social phobia. Personality disorders and personality dimensions according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were assessed at pre-treatment and at one-year post-treatment. Both treatments were associated with a decrease in avoidant and dependent personality dimensions; dependent dimension decreased more in CT. Changes in cognitive factors predicted changes in both personality dimensions, whereas changes in symptoms or interpersonal factors did not. Change in the cognitive factor estimated cost was the most powerful predictor in the avoidant dimension, as it was the only predictor that remained significant in the forward regression analyses. Change in the cognitive factor estimated cost, and treatment were the most powerful predictors of change in the dependent dimension. Pre-treatment use of anxiolytics predicted larger changes in both PD dimensions.,Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: , Improvement in symptoms and cognitions related to social phobia is associated with improvement in dependent and avoidant personality disorder traits. [source] Quality of life of male outpatients with personality disorders or psychotic disorders: a comparisonCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 5 2008Yvonne HA Bouman Background,Quality of life (QoL) has become increasingly important as an outcome measure in community-based psychiatry. QoL refers to an individual's sense of well-being and satisfaction with his current life conditions. It is measured both through objective social indicators and life domain-specific subjective indicators. People with a personality disorder (PD) or a major mental disorder (MMD) tend to show poor social adjustment, but their relative subjective QoL is not known. Aim,To compare the QoL of male outpatients in treatment for PD or MMD overall and by means of specific social and subjective indicators. Methods,A sample of 135 men under treatment for PD in Dutch forensic outpatient facilities were compared with 79 men with MMD using the extended Dutch version of the Lancashire Quality of Life Profile (LQoLP). Results,Almost all of the objective indicators of QoL were significantly poorer among men with MMD than those with PD, but the groups did not differ on domain-specific subjective ratings of QoL. Indeed, global subjective QoL was lower in the PD than in the MMD patient group. PD outpatients seemed to have a more complex concept of QoL than the MMD outpatients for whom almost half of the variance in subjective QoL rating was related to their everyday activities and their objective sense of safety. Conclusions and implications for practice,Further study of QoL among PD patients would be warranted to test the extent to which subjective dissatisfaction is intrinsic to PD and to explore the possibility of improving it with targeted treatments. Copyright © 2008 John Wiley & Sons, Ltd. [source] A Delphi survey of the views of adult male patients with personality disorders on psychoeducation and social problem-solving therapyCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 5 2007Mary McMurran Background,Psychoeducation and social problem-solving therapy are treatment components that work well in tandem for offenders with personality disorders, hence it is worthwhile to maintain and improve their effectiveness. Aim,The aim was to seek patients' views of these therapies to contribute to their development. Method,A Delphi survey was conducted with all 12 male inpatients of a personality disorder hospital treatment unit. Results,Round 1 produced 30 statements for psychoeducation and 59 for social problem-solving therapy to be rated in Round 2. There was consensus at a level of 70% for all items. Both psychoeducation and social problem-solving therapies were viewed as useful by these patients. The men also suggested improvements in psychoeducation, including minimizing the delay between assessment and feedback, provision of reference material, preparation for the work and support afterwards. Areas identified for improvement in social problem-solving therapy included more frequent review of progress, greater consistency of delivery, eliciting problems more effectively, providing reference material, supporting patients in group work, and the development of an advanced therapy. Discussion,A Delphi approach to evaluation of therapies with the people receiving them is not only feasible but seems to offer a practical way of making useful clinical adjustments to the work. Further research with larger samples might usefully focus on whether such an approach enhances treatment compliance. Copyright © 2007 John Wiley & Sons, Ltd. [source] Temporal reliability of psychological assessments for patients in a special hospital with severe personality disorder: a preliminary noteCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2005Professor P. Tyrer Background The new programme for assessing those with dangerous and severe personality disorder relies heavily on psychological assessments of personality disorder and risk. Methods The temporal reliability of assessments of psychopathy (PCL-R), risk (HCR-20) and personality was assessed using the International Personality Disorder Examination (IPDE) in 15 randomly selected male prisoners in a high secure hospital carried out at intervals varying between a mean of nine and 19 months after initial assessments by a variety of assessors. Results Using the intra-class correlation coefficient the agreement varied between0.57 (HCR-20), 0.58 (PCL-R) and 0.38-0.70 for IPDE personality disorders, with the best agreement for antisocial personality disorder (0.70). Comment These levels of agreement are consistent with other recent work on temporal reliability of personality instruments but are a little too low for confidence in these measures alone in the assessment process. Copyright © 2005 Whurr Publishers Ltd. [source] Personality disorders improve in patients treated for major depressionACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2010R. T. Mulder Mulder RT, Joyce PR, Frampton CMA. Personality disorders improve in patients treated for major depression. Objective:, To examine the stability of personality disorders and their change in response to the treatment of major depression. Method:, 149 depressed out-patients taking part in a treatment study were systematically assessed for personality disorders at baseline and after 18 months of treatment using the SCID-II. Results:, Personality disorder diagnoses and symptoms demonstrated low-to-moderate stability (overall , = 0.41). In general, personality disorder diagnoses and symptoms significantly reduced over the 18 months of treatment. There was a trend for the patients who had a better response to treatment to lose more personality disorder symptoms, but even those who never recovered from their depression over the 18 months of treatment lost, on average, nearly three personality disorder symptoms. Conclusion:, Personality disorders are neither particularly stable nor treatment resistant. In depressed out-patients, personality disorder symptoms in general improve significantly even in patients whose response to their treatment for depressive symptoms is modest or poor. [source] The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on Alcohol and Related ConditionsDEPRESSION AND ANXIETY, Issue 9 2010Josh Nepon M.D. Abstract Background: Previous work has suggested that anxiety disorders are associated with suicide attempts. However, many studies have been limited by lack of accounting for factors that could influence this relationship, notably personality disorders. This study aims to examine the relationship between anxiety disorders and suicide attempts, accounting for important comorbidities, in a large nationally representative sample. Methods: Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2. Face-to-face interviews were conducted with 34,653 adults between 2004 and 2005 in the United States. The relationship between suicide attempts and anxiety disorders (panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, posttraumatic stress disorder (PTSD)) was explored using multivariate regression models controlling for sociodemographics, Axis I and Axis II disorders. Results: Among individuals reporting a lifetime history of suicide attempt, over 70% had an anxiety disorder. Even after adjusting for sociodemographic factors, Axis I and Axis II disorders, the presence of an anxiety disorder was significantly associated with having made a suicide attempt (AOR=1.70, 95% confidence interval (CI): 1.40,2.08). Panic disorder (AOR=1.31, 95% CI: 1.06,1.61) and PTSD (AOR=1.81, 95% CI: 1.45,2.26) were independently associated with suicide attempts in multivariate models. Comorbidity of personality disorders with panic disorder (AOR=5.76, 95% CI: 4.58,7.25) and with PTSD (AOR=6.90, 95% CI: 5.41,8.79) demonstrated much stronger associations with suicide attempts over either disorder alone. Conclusion: Anxiety disorders, especially panic disorder and PTSD, are independently associated with suicide attempts. Clinicians need to assess suicidal behavior among patients presenting with anxiety problems. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source] Severity of personality disorders and suicide attemptACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009H. Blasco-Fontecilla Objective:, Severity of personality disorders (PDs) may be more useful in estimating suicide risk than the diagnosis of specific PDs. We hypothesized that suicide attempters with severe PD would present more attempts and attempts of greater severity/lethality. Method:, Four hundred and forty-six suicide attempters were assessed. PD diagnosis was made using the International Personality Disorder Questionnaire , Screening Questionnaire. PDs were classified using Tyrer and Johnson's classification of severity (no PD, simple PD, diffuse PD). Severity/lethality of attempts was measured with the Suicide Intent Scale, Risk-Rescue Rating Scale and Lethality Rating Scale. Results:, Attempters with severe (diffuse) PD had more attempts than the other groups. After controlling for age and gender, this difference remained significant only for the younger age group and women. There was no relationship between severity of PDs and severity/lethality of attempts. Conclusion:, Younger female attempters with severe PD are prone to repeated attempts. However, the severity of PD was not related to the severity/lethality of suicide attempts. [source] Preterm birth or foetal growth impairment and psychiatric hospitalization in adolescence and early adulthood in a Swedish population-based birth cohortACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2009W. Monfils Gustafsson Objective:, Preterm birth and restricted foetal growth are related to symptoms of psychiatric disorder. Our aim was therefore to investigate possible relations between being born preterm and/or small for gestational age (SGA) and later psychiatric hospitalization. Method:, A population-based registry study of psychiatric hospitalization of in total 155 994 boys and 148 281 girls born in Sweden in 1973,1975. Results:, The risk of hospitalization for all mental disorders was increased for preterm SGA boys (OR 2.19, 95% CI 1.49,3.21); at-term SGA boys (OR 1.55, 95% CI 1.34,1.79); at-term SGA girls (OR 1.31, 95% CI 1.15,1.50). At-term SGA boys and girls suffered increased risk of anxiety and adjustment disorders (OR 1.70, 95% CI 1.18,2.45 and OR 1.49, 95% CI 1.14,1.94). Preterm SGA boys were at risk of personality disorders (OR 3.30, 95% CI 1.16,9.41) and psychotic disorders (OR 4.36, 95% CI 1.85,10.30). Conclusion:, The results show a relationship between being born SGA and later psychiatric hospitalization, where preterm birth and male gender seem to increase the risk. [source] Context-Oriented Model Development in Psychotherapy Planning (,COMEPP'): a useful adjunct to diagnosis and therapy of severe personality disordersACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2004M. Fischer-Kern Objective:, Pathogenous interpersonal (e.g. interfamilial) relationships and reference styles can compromise treatment efforts in severely disturbed (i.e. psychotic or borderline) patients. The integration of family- and individual-centred starting points may be useful in establishing interdisciplinary treatment concepts in these patients. Context-Oriented Model Development in Psychotherapy Planning (COMEPP) represents a diagnostic and therapy planning process, integrating both systemic and psychoanalytic conceptualizations. Method:, COMEPP is exemplified by the case of a young man with psychotic personality disorder who had previously been unresponsive to pharmacological and psychological treatment. Results:, After psycho-dynamical conflicts (i.e. primitive projective processes from the patient's mother to her son) had been elucidated during the COMEPP process, a sufficient treatment setting could be established. Conclusion:, COMEPP provides a psychotherapeutical approach to treatment planning on case-specific premises and may serve as an adjunct to concomitant pharmacological and psychological treatment strategies in so-called ,therapy refractory' patients. [source] Out-patient behaviour therapy in alcoholism: treatment outcome after 2 yearsACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2002W. Burtscheidt Burtscheidt W, Wölwer W, Schwarz R, Strauss W, Gaebel W. Out-patient behaviour therapy in alcoholism: treatment outcome after 2 years. Acta Psychiatr Scand 2002: 106: 227,232. © Blackwell Munksgaard 2002. Objective:,The main aim of the study was the evaluation of out-patient behavioural approaches in alcohol dependence. Additionally, the persistence of treatment effects and the impact of psychiatric comorbidity in long-term follow-up was examined. Method:,A total of 120 patients were randomly assigned to non-specific supportive therapy or to two different behavioural therapy programmes (coping skills training and cognitive therapy) each comprising 26 weekly sessions; the follow-up period lasted 2 years. Results:,Patients undergoing behavioural therapy showed a consistent trend towards higher abstinence rates; significant differences between the two behavioural strategies could not be established. Moreover, the results indicate a reduced ability of cognitive impaired patients to cope with short-time abstinence violations and at a reduced benefit from behavioural techniques for patients with severe personality disorders. Conclusion:,Behavioural treatment yielded long-lasting effects and met high acceptance; yet, still in need of improvement is the development of specific programmes for high-risk patients. [source] Nidotherapy: a new approach to the treatment of personality disorderACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2002Peter Tyrer Objective:,To develop a treatment, nidotherapy, or nest therapy, so named because it aims to alter the sufferer's personal environment rather than symptoms or behaviour, in the management of personality disorders. Method:,Case studies, in which analysis of the environmental circumstances associated with the problems of personality disorder is followed by planned adjustment to that environment so that it makes a more appropriate fit for the personality. Results:,Sustained improvement was found in two individuals with personality disorder after nidotherapy. Those with persistent and predictable personality attributes are easier in principle to treat than those with episodic or variable problems. Conclusion:,Nidotherapy deserves further consideration in the management of personality disorders. [source] New onsets of substance use disorders in borderline personality disorder over 7 years of follow-ups: findings from the Collaborative Longitudinal Personality Disorders StudyADDICTION, Issue 1 2009Marc Walter ABSTRACT Aims The purpose of this study was to examine whether patients with borderline personality disorder (BPD) have a higher rate of new onsets of substance use disorders (SUD) than do patients with other personality disorders (OPD). Design This study uses data from the Collaborative Longitudinal Personality Disorder Study (CLPS), a prospective naturalistic study with reliable repeated measures over 7 years of follow-up. Setting Multiple clinical sites in four northeastern US cities. Participants A total of 175 patients with BPD and 396 patients with OPD (mean age 32.5 years) were assessed at baseline and at 6, 12, 24, 36, 48, 60, 72 and 84 months. Measurements The Structured Clinical Interview for DSM-IV Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders were used at baseline, the Follow-Along version of the DIPD-IV and the Longitudinal Interval Follow-up Evaluation at the follow-up evaluations. Kaplan,Meier analyses were calculated to generate the time to new onsets. Findings BPD patients showed a shorter time to new onsets of SUD. Thirteen per cent of BPD patients developed a new alcohol use disorder and 11% developed a new drug use disorder, compared to rates of 6% and 4%, respectively, for OPD. Non-remitted BPD and remitted BPD patients did not differ significantly in rates of new onsets of SUD. Conclusions BPD patients have a high vulnerability for new onsets of SUDs even when their psychopathology improves. These findings indicate some shared etiological factors between BPD and SUD and underscore the clinical significance of treating SUD when it co-occurs in BPD patients. [source] | |||||||||||||||||||||||||||||||