Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-25T08:51:50.528Z Has data issue: false hasContentIssue false

A personality disorders prevalence study among inpatients with mood disorders, psychoactive substance use disorders and anxiety disorders

Published online by Cambridge University Press:  11 October 2011

Maria Grazia Marinangeli
Affiliation:
Dipartimento di Medicina Sperimentale, Università degli Studi di L'Aquila, L'Aquila
Giancarlo Butti
Affiliation:
Unità Operativa di Psicologia Clinica, Casa di Cura “Villa Serena”, Città S. Angelo (Pescara)
Antonella Scinto
Affiliation:
Dipartimento di Medicina Sperimentale, Università degli Studi di L'Aquila, L'Aquila
Loredana Di Cicco
Affiliation:
Unità Operativa di Psicologia Clinica, Casa di Cura “Villa Serena”, Città S. Angelo (Pescara)
Artemis Kalyvoka
Affiliation:
Dipartimento di Medicina Sperimentale, Università degli Studi di L'Aquila, L'Aquila
Concetta Petruzzi
Affiliation:
Unità Operativa di Psicologia Clinica, Casa di Cura “Villa Serena”, Città S. Angelo (Pescara)
Alessandro Rossi*
Affiliation:
Dipartimento di Medicina Sperimentale, Università degli Studi di L'Aquila, L'Aquila
*
Indirizzo per la corrispondenza: Professor A. Rossi, Polo Clinico, Unità Operativa di Psicologia Clinica, Villa Serena, Via Leonardo Petruzzi, 19, 65013 Città S. Angelo (Pescara). Fax: +39-085-959.0206 E-mail: [email protected]

Summary

Objective - The aim of this study was to asses type and prevalence of Personality Disorders (PDs) and their patterns of comorbidity with Axis I disorders in a sample of psychiatric inpatients. Setting - The sample consisted of 300 subjects admitted to a psychiatric unit on a voluntary bases for an index episode. The study was conducted over a period of 12 months, from 1.11.1997 to 31.10.1998. Main outcome measures - The Italian version of SCID-II-PQ (Structured Clinical Interview for DSM-III-R personality disorders, with Personality Questionnaire-PQ- a self report questionnaire). Results - More than half the patients had at least one personality disorder. The mean of disorders per patient was 2.83±1.93 (±SD). The most prevalent Axis II disorders were Borderline PD (30.7%), Obsessive-compulsive PD (30.7%) and Avoidant PD (25.3%). Women were significantly more likely than men to meet criteria for Dependent PD and Avoidant PD. Man showed significantly more frequently than women Antisocial PD. Significant associations (p<0.05) were found for comorbidity of Mood Disorders and Avoidant PD, and for Psicoactive Use Disorders and Antisocial PD. Conclusions - Our study confirms the high prevalence of PDs in psychiatric inpatients and showes some interesting associations between Axis I and Axis II disorders. These results can't be generalized to outpatients because our clinical sample involved mainly severely ill inpatients, but they raise questions about the exact nature of PDs and of the relationship with Axis I disorders. Further research involving outpatients and general population is needed to examine factors that could affect development and course of Personality Disorders.

Riassunto

Scopo - Scopo dello studio era la valutazione della prevalenza dei Disturbi di Personalità (DPs) e della loro comorbidità con i Disturbi di Asse I in un campione di pazienti psichiatrici ospedalizzati. Setting - Il campione clinico era costituito da 300 soggetti ricoverati presso un reparto di psichiatria su base volontaria per un episodio “indice”. Lo studio si è svolto in un periodo di 12 mesi, dal 1.11.1997 al 31.10.1998. Principali misure utilizzate - La versione italiana dello strumento SCID-II-PQ (Intervista clinica strutturata per il DSM-III-R, Disturbi di Personalità, associata al Questionario di Personalità - PQ - autocompilato). Risultati - Più della metà dei pazienti aveva almeno un Disturbo di Personalità. La media di disturbi per pazienteera 2.83±1.93 (±ds). I disturbi di Asse II più frequenti erano il Disturbo Borderline (30.7%), il Disturbo Ossessivo compulsivo (30.7%) e il Disturbo Evitante (25.3%). Fra le donne erano significativamente più frequenti i Disturbi di Personalità Dipendente ed Evitante. Gli uomini mostravano con una frequenza significativamente maggiore rispetto alle donne il Disturbo Antisociale di Personalità. Un'associazione statisticamente significativa (p<0.05), è stata riscontrata per la comorbidità tra Disturbi dell'Umore e Disturbo di Personalità Evitante e tra Disturbi da Uso di Sostanze Psicoattivee Disturbo Antisociale di Personalità. Conclusioni - Il nostro studio conferma l'elevata prevalenza dei DPs in pazienti psichiatrici ospedalizzati e mostra interessanti associazioni tra disturbi di Asse I e disturbi di Asse II. Il campione clinico da noi esaminato era costituito prevalentemente da pazienti con disturbi mentali di gravità tale da richiedere l'ospedalizzazione, per cui i nostri risultati non possono essere estesi a popolazioni non cliniche, tuttavia sollevano domande sull'esatta natura dei DPs e della loro relazione con i disturbi di Asse I. Ulteriori studi condotti su pazienti ambulatoriali e sulla popolazione generale sono necessari per esaminare i fattori che possono influenzare lo sviluppo e il decorso dei Disturbi di Personalità.

Type
Articles
Copyright
Copyright © Cambridge University Press 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

BIBLIOGRAFIA

American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). American Psychiatric Association: Washington DC.Google Scholar
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.). American Psychiatric Association: Washington DC.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). American Psychiatric Association: Washington DC.Google Scholar
Baer, L., Jenike, M.A.. Black, D.W., Treece, C., Rosenfeld, R. & Greist, J. (1992). Effect of axis II diagnoses on treatment outcome with clomipramine in 55 patients with obsessive-compulsive disorder. Archives of General Psychiatry 49, 862866.CrossRefGoogle ScholarPubMed
Cavedini, P., Erzegovesi, S., Ronchi, P. & Bellodi, L. (1996).Predictive value of obsessive-compulsive personality disorder in antiobsessional pharmacological treatment. European Neuropsychopharmacology 7, 4549.CrossRefGoogle Scholar
Clark, L.A., Livesley, W.J. & Morey, L. (1997). Personality disorder assessment: the challenge of construct validity. Journal of Personality Disorders 11.205231.CrossRefGoogle ScholarPubMed
Cutting, J., Cowen, P.J.. Mann, A.H. & Jenkins, R. (1986). Personality and psychosis: use of the standardized assessment of personality. Acta Psychiatrica Scandinavica 73, 8792.CrossRefGoogle ScholarPubMed
de Girolamo, G. & Reich, J.H. (1993). Personality disorders. In Epidemiology of Mental Disorders and Psychosocial Problems. WHO: Geneva.Google Scholar
Fava, M., Alpert, J.E., Borus, J.S., Nierenberg, A.A., Pava, J.A. & Rosenbaum, J.F. (1996). Patterns of personality disorder comorbidity in early-onset versus late-onset major depression. American Journal of Psychiatry 153, 13081312.Google ScholarPubMed
Goldman, R.G., Skodol, A.E.. McGrath, P.J. & Oldham, J.M. (1994). Relationship between the tridimensional personality questionnaire and DSM-III-R personality traits. American Journal of Psychiatry 151, 274276.Google ScholarPubMed
Golomb, M., Fava, M., Abraham, M. & Rosenbaum, J.F. (1995). Gender differences in personality disorders. American Journal of Psychiatry 152, 579582.Google ScholarPubMed
Grilo, C.M., Becker, D.F., Fehon, D.C., Walker, M.L., Edell, W.S. & McGlashan, T.H. (1996). Gender differences in personality disorders in psychiatrically hospitalized adolescent. American Journal of Psychiatry 153, 10891091.Google Scholar
Grilo, C.M., McGlashan, T.H., Quinlan, D.M., Walker, M.L., Greenfeld, D. & Edell, W.S. (1998a). Frequency of personality disorders in two age cohorts of psychiatric inpatients. American Journal of Psychiatry 155, 140142.CrossRefGoogle ScholarPubMed
Grilo, C.M., McGlashan, T.H. & Oldham, J.M. (1998b). Course and stability of personality disorders. Journal of Practice Psychiatry and Behaviour Health 4,6175.CrossRefGoogle Scholar
Hyler, S.E., Skodol, A.E., Kellman, H.D., Oldham, J.M. & Rosnick, L. (1990). Validity of the personality diagnostic questionnaire-revised: comparison with two structured interviews. American Journal of Psychiatry 147, 10431048.Google ScholarPubMed
Kendler, K.S., Thacker, L. & Walsh, D. (1996). Self-report measures of schizotypy as indices of familial vulnerability to schizophrenia. Schizophrenia Bulletin 22, 511520.CrossRefGoogle ScholarPubMed
Langs, G., Quehenberger, F., Fabisch, K., Klug, G., Fabisch, H, & Zapotoczky, H.G. (1998). Prevalence, patterns and role of personality disorders in panic disorders patients with and without comorbid (life time) major depression. Acta Psychiatrica Scandinavica 96, 116123.CrossRefGoogle Scholar
Lenzenweger, M.F., & Clarkin, J.F. (1997). I disturbi di personalità: storia, classificazione ricerca. In I Disturbi di Personalità, le Cinque Principali Teorie, pp. 336. Raffaello Cortina: Milano.Google Scholar
Livesley, W.J. (1998). Suggestions for a framework for an empirically based classification of personality disorder. Canadian Journal of Psychiatry 43, 137–47.CrossRefGoogle ScholarPubMed
Livesley, W.J., Jang, K.L. & Vemon, P.A. (1998). Phenotypic and genetic structure of traits delineating personality disorder. Archives of General Psychiatry 55, 941–8.CrossRefGoogle ScholarPubMed
Loranger, A.W. (1995). Dependent personality disorder. Journal of Nervous andMental Desease 184, 1721.CrossRefGoogle Scholar
Loranger, A.W., Susman, V.L. & Oldham, M.M. (1987). The personality disorder examination: a preliminary report. Journal of Personality Disorders 1, 113.CrossRefGoogle Scholar
Marinangeli, M.G., Butti, G., Scinto, A., Di Cicco, L., Petruzzi, C., Daneluzzo, E., & Rossi, A. (in stampa). Patterns of comorbidity among DSM-III-R personality disorders. Psychopatology.Google Scholar
Modestin, J.Oberson, B. & Erni, T. (1997). Possible correlates ofDSMIII-R personality disorders. Acta Psychiatrica Scandinavica 96, 424430.CrossRefGoogle ScholarPubMed
Mors, O. & Sorensen, L.V. (1994). Incidence and comorbidity of personalitydisorders among first ever admitted psychiatric patients. European Psychiatry 9, 175184.CrossRefGoogle Scholar
Mulder, R.T., Joyce, P.R. & Cloninger, C.R. (1994). Temperament and early environment influence comorbidity and personality disorders in major depression. Comprehensive Psychiatry 35, 225233.CrossRefGoogle ScholarPubMed
Norusis, M.S. (1992). SPSS for Windows. User's Guide Release 5.0. SPSS Inc.: Chicago.Google Scholar
Nussbaum, D. & Rogers, R. (1992). Screening psychiatric patients for axis II disorders. Canadian Journal of Psychiatry 37, 658660.CrossRefGoogle ScholarPubMed
Okasha, A., Omar, A.M., Lotaief, F., Ghanem, M., Seif El Dawla, A. & Okasha, T. (1996). Comorbidity of Axis I and Axis II diagnoses in a sample of egyptian patients with neurotic disorders. Comprehensive Psychiatry 37, 95101.CrossRefGoogle Scholar
Oldham, J.M., Skodol, A.E., Kellman, H.D., Hyler, S.E., Doidge, N., Rosnick, L. & Gallaher, P.E. (1995). Comorbidity of axis I and axis II disorders. American Journal of Psychiatry 152, 571578.Google ScholarPubMed
Perry, J.C. (1993). Longitudinal studies of personality disorders. In The NIMH Williamsburg Conference on Personality Disorders. What Have we Learned? Journal of Personality Disorders, Supplementum N.1, vol. 7, pp. 6385.Google Scholar
Perry, J.C., Lavori, P.H. & HSke, L. (1987). A Markov model for predicting levels of psychiatry service use in borderline and antisocial personality disorders and bipolar typeII affective disorder. Journal of Psychiatric Research 21, 215232.CrossRefGoogle Scholar
Reich, J. (1987). Sex distribution of DSM-HI personality disorders in psychiatric outpatients. American Journal of Psychiatry 144, 485488.Google ScholarPubMed
Pilgrim, J. & Mann, A. (1990). Use of ICD-IO version of the standardized assessment of personality to determine the prevalence of personality disorder in psychiatric in-patients.Psychological Medicine 20, 985992.CrossRefGoogle Scholar
Robins, L.N. (1998). The intimate connection between antisocial personality and substance abuse. Social Psychiatry and Psychiatric Epidemiology 33, 393399.CrossRefGoogle ScholarPubMed
Seivewright, H., Tyrer, P., Casey, P. & Seivewright, N. (1991). A three year follow-up of psychiatric morbidity in urban and rural primary care. PsychologicalMedicine 21, 495503.Google Scholar
Siever, L.J. & Davis, K.L. (1991). A psychobiological perspective on the personality disorders. American Journal of Psychiatry 148, 16471658.Google ScholarPubMed
Soloff, P.H. (1998). Symptom-oriented psychopharmacology for personality disorders. Journal of Practice Psychiatry and Behaviour Health 4, 311.CrossRefGoogle Scholar
Spitzer, R.L., Williams, J.B.W. & Gibbon, M. (1993). Intervista Clinica Strutturata per il DSM-III-R Disturbi di Personalità (SCID-II), Versione Italiana. O.S. Organizzazioni Speciali: Firenze.Google Scholar
Thase, M.E. (1996). The role of axis II comorbidity in the managment of patients with treatment-resistant depression. Psychiatric Clinics of North America 19, 287309.CrossRefGoogle ScholarPubMed
Tyrer, P., Merson, S., Onyett, S. & Johnson, T. (1994). The effect of personality disorder on clinical outcome, social networks and adjustment: a controlled clinical trial of psychiatric emergencies. Psychological Medicine 24, 731740.CrossRefGoogle ScholarPubMed
Valgum, P., Friis, S. & Valgum, S. (1989). Comparison between personality disorder diagnoses in DSM-III and DSM-III-R: reliability, diagnostic overlap, predictive validity. Psychopatology 22, 309314.Google Scholar
Wilberg, T., Karterud, S., , Urnes, & Pedersen, G., & Friis, S. (1998). Outcomes of poorly functioning patients with personality disorders in a day treatment program. Psychiatric Services 49, 14621467.CrossRefGoogle Scholar
Zimmerman, M. (1994). Diagnosing personality disorders. Archives of General Psychiatry 51, 225245.CrossRefGoogle ScholarPubMed