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PubMed1998

Pharmacotherapy for personality disorders.

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

Antipsychotic Agents↗
PubMed1983

Briquet and Briquet's syndrome viewed from France.

Briquet's contributions to the description of hysteria have been almost completely forgotten in France. One may wonder how he, as well as contemporary French psychiatrists, would react to the approach to hysteria introduced and officialized by DSM III. In particular, its fragmentation into syndromes without apparent link to each other (psychogenic amnesia, conversion disorders, histrionic personality disorder, etc.) and its psychological causation, unbalanced by the consideration of organic factors in etiology, may raise questions. The correlation of conversion disorders with hysterical personality remains a feature of the WHO classification (ICD 9), as well as a feature of French contemporary texts, although it is no longer viewed as a regular association by American psychiatry. It may be that cultural factors lead, as suggested by Brisset, to a repression of conversion phenomena and of hyperexpressivity of affects replaced by more psychosomatic disorders in many contemporary societies. Finally, one may question whether the choice of the term "Briquet Syndrome" is appropriate, as many of the patients described by him did not have the chronic and malignant course described by Guze: It tends to limit hysteria to one end (the most severe one) of a spectrum of disorders.

Cross-Cultural Comparison↗
PubMedDate not supplied

[Therapeutic community model in short psychiatric hospitalization. Descriptive study on the dynamic psychiatric inpatient unit of the Italian hospital of Buenos Aires].

OBJECTIVE: the aim of this paper is to communicate a project of short term psychiatric hospitalization, based on a therapeutic community model, considering qualitative and quantitative aspects in the present socio - cultural context. INTRODUCTION: this psychiatric hospitalization model that embraces psychodynamic and pharmacological interventions is focused in the intensity of interactions between members of the therapeutic community and integrated to the administrative structure of a general hospital; this will be the key to consider patient's return to the community and to move forward over the prejudices that inpatients suffer. MATERIAL AND METHODS: quantitative, prospective, observational and transversal study on a Dynamic Psychiatric Inpatient Unit. 605 patients were included. RESULTS: mean length of stay was 16.34 days; principal causes of admission were depression (19.4%), suicide ideas (17.7%), suicide attempt (17.6%), substance abuse or dependence (14.3%), psychosis (13.8%), behavioral and psychological symptoms of dementia (6%). There were 75 readmissions. 14.88% patients were physically restrained. Principal Axis I diagnosis were depression (32.1%), substance dependence (13.2%), bipolar disorder (10.2%), dementia (7.6%), schizophrenia (7.5%), and psychotic disorder (5.8). Axis II diagnosis were borderline personality disorder (27.3%), narcissistic personality disorder (8.9%), histrionic personality disorder (5.3%). DISCUSSION: this kind of approach shows a structural model that allows possible and persistent favorable changes for psychiatric inpatients.

Argentina↗
PubMed1995

Comorbidity of axis I and axis II disorders.

OBJECTIVE: In light of continuing controversies concerning the DSM-III-R system for diagnosing personality disorders, their construct validity, and the assignment of disorders to a particular axis, the authors studied patterns of axis I-axis II comorbidity. METHOD: Semistructured interviews were used to assess axis I and axis II disorders in 200 inpatients and outpatients. Odds ratios were calculated to determine significant comorbidity between classes of current axis I disorders and axis II personality disorders diagnosed according to two methods and defined at two diagnostic thresholds. Distributions of personality disorder traits were also compared in patients with and without axis I disorders. RESULTS: Significantly elevated odds ratios were found for co-occurrence of current mood disorders with avoidant and dependent personality disorders; anxiety disorders with borderline, avoidant, and dependent personality disorders; psychotic disorders with schizotypal, borderline, and dependent personality disorders; psychoactive substance use disorders with borderline and histrionic personality disorders; and eating disorders with schizotypal, borderline, and avoidant personality disorders. These results held when conservative and liberal definitions of personality disorders were used. Non-specific axis I and axis II associations were confirmed for distributions of personality disorder traits. CONCLUSIONS: Significant associations occurred between most axis I classes of disorders and axis II disorders and traits in more than one cluster. All axis I classes of disorders except mood disorders co-occurred with borderline personality disorder; however, patients with mood disorders had elevated levels of borderline traits. When any personality disorder was present, there were significant odds that a mood, anxiety, psychotic, or eating disorder would also be present; psychoactive substance use disorders, in contrast, significantly co-occurred with borderline and histrionic personality disorders.

Adolescent↗
PubMedDate not supplied

Neuroticism and personality disorder in depression.

Neuroticism and DSM-III personality disorder were studied in 39 depressed inpatients. Interrelationships between these variables and their relationship to depressive typology were compared. The relationship of neuroticism, DSM-III personality type and adequacy of personality to MAOI treatment are also examined. Neuroticism scores were unaffected by short-term treatment, and no differences in neuroticism were observed between melancholics and nonmelancholics, or between endogenous and nonendogenous depressives. Higher neuroticism scores were associated with DSM-III personality disorder. Personality disorder occurred significantly more often in nonmelancholia; borderline, antisocial and histrionic personality disorders occurred exclusively in nonmelancholia, while passive-aggressive, dependent and avoidant disorders occurred in both kinds of depression. Response to MAO inhibitor treatment was similar in patients with high and low neuroticism, adequate and inadequate personality, DSM-III personality disorder and no DSM-III personality disorder. Ambiguities of Eysenck's neuroticism scale are discussed in relationship to depression.

Antisocial Personality Disorder↗
PubMed1992

Neurocognitive impairment in dramatic personalities: histrionic, narcissistic, borderline, and antisocial disorders.

Thirty-seven patients with personalities in the dramatic cluster (DSM-III-R histrionic, narcissistic, borderline, and antisocial) and 40 controls matched for age and gender were evaluated on 16 neurocognitive variables. The evaluation screened for deficits in functions of attention, memory, language, abstraction, and behavior planning/sequencing. Analysis of variance revealed significant deficits in neurocognitive performance among patients with dramatic personalities, particularly in subtests requiring multi-step, multi-element associative operations.

Adult↗
PubMed2004

Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions.

OBJECTIVE: To present nationally representative data on the prevalence, sociodemographic correlates, and disability of 7 of the 10 DSM-IV personality disorders. METHOD: The data were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Diagnoses were made using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version, and associations between personality disorders and sociodemographic correlates were determined. The relationship between personality disorders and 3 emotional disability scores (Short-Form 12, version 2) was also examined. RESULTS: Overall, 14.79% of adult Americans (95% CI = 14.08 to 15.50), or 30.8 million, had at least 1 personality disorder. The most prevalent personality disorder in the general population was obsessive-compulsive personality disorder, 7.88% (95% CI = 7.43 to 8.33), followed by paranoid personality disorder 4.41% (95% CI = 4.12 to 4.70), antisocial personality disorder 3.63% (95% CI = 3.34 to 3.92), schizoid personality disorder 3.13% (95% CI = 2.89 to 3.37), avoidant personality disorder 2.36% (95% CI = 2.14 to 2.58), histrionic personality disorder 1.84% (95% CI = 1.66 to 2.02), and dependent personality disorder 0.49% (95% CI = 0.40 to 0.58). The risk of avoidant, dependent, and paranoid personality disorders was significantly greater among women than men (p <.05); the risk of antisocial personality disorder was greater among men compared with women (p <.05); and no sex differences were observed in the risk of obsessive-compulsive, schizoid, or histrionic personality disorders. In general, risk factors for personality disorders included being Native American or black, being a young adult, having low socioeconomic status, and being divorced, separated, widowed, or never married. Avoidant, dependent, schizoid, paranoid, and antisocial personality disorders (p <.02 to p <.0001) were each statistically significant predictors of disability. Obsessive-compulsive personality disorder was inconsistently related to disability. In contrast, disability was not significantly different among individuals with histrionic personality disorder compared with those without the disorder. CONCLUSION: Personality disorders are prevalent in the general population and are generally highly associated with disability. This study highlights the need to develop more effective and targeted prevention and intervention initiatives for personality disorders.

Adolescent↗
PubMed1999

Rorschach aggression variables: a study of reliability and validity.

This study investigated the extent to which 6 Rorschach variables of aggression (A1, A2, AG, MOR, AgC, AgPast) are related to one another, to the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) Cluster B personality disorder criteria, and to self-report measures of anger, aggression, and antisocial behavior. Seventy-eight patients were found to meet DSM-IV criteria for an Axis II disorder, Cluster A personality disorder (paranoid, schizoid, schizotypal) = 9, Cluster B (antisocial personality disorder [ANPD] = 16, borderline personality disorder [BPD] = 23, histrionic personality disorder = 5, narcissistic personality disorder = 12) = 56, and Cluster C personality disorder (avoidant, dependent, obsessive-compulsive) = 13. The results of this study indicated that (a) these 6 Rorschach aggression variables can be scored reliably; (b) 2 factors, revealed by factor analysis, accounted for 77% of the total variance; (c) selected variables were found to be empirically related to DSM-IV diagnostic criteria for ANPD and BPD; and (d) selected variables were found to be empirically related to a self-report measure of anger and antisocial practices. The conceptual nature and clinical utility of these Rorschach aggression variables as well as implications for future research are discussed.

Adult↗
PubMed1990

Histrionic disorder among Iranian high school and college students.

This study was designed to explore the sex and group differences in histrionic personalities of high school and university students, and also to explore the results of this study with those of Crown and Crisp from 1966 in England. A sample of 160 high school students (80 girls and 80 boys) were selected randomly from four high schools in Shiraz and Shiraz University. The mean ages for high school girls and boys were 15.3 and 17.3 yr., for university women and men were 20.6 and 23.2 yr., respectively. The hysteria (H) scale of the Middlesex Hospital Questionnaire was used. The questions of this scale refer to histrionic personality according to DSM-III and DSM-III--R. Analysis showed significant effects of group (high school, college) for histrionic personality disorder. It was concluded that more histrionic personality disorders were reported among British college students than among their Iranian peers.

Adolescent↗
PubMed1989

Sex bias in the diagnosis of histrionic and antisocial personality disorders.

The differential prevalence of the histrionic and antisocial personality disorders among men and women has been attributed both to sex biases and to actual variation in disorder base rates. The present study assessed the bias and base rate explanations and examined whether sex biases are minimized by the relatively explicit diagnostic criteria in the DSM-III. Psychologists (N = 354) either diagnosed 9 DSM-III disorders from case histories that varied in the ambiguity of the antisocial and histrionic personality disorder diagnoses or rated the degree to which specific features extracted from the case histories met 10 histrionic and antisocial diagnostic criteria. The sex of the patient was either male, female, or unspecified. Sex biases were evident for the diagnoses but not for the diagnostic criteria. The results are discussed with respect to base rate effects, sex biases, and the construction of diagnostic criteria.

Adult↗
PubMed1992

MCMI-II personality disorders in recent-onset bipolar disorders.

This study investigated the personality disorders of 21 recent-onset Bipolar Disorder patients using the revised Million Clinical Multiaxial Inventory (MCMI-II; Millon, 1987). Personality disorder assessments, conducted after patients' clinical symptoms had settled, indicated that 17 patients received at least one MCMI-II personality disorder diagnosis with a trend toward multiple diagnoses. Narcissistic, Antisocial, and Histrionic personality disorders were diagnosed most frequently and were the scales most elevated. Schizoid and Compulsive personality disorders were the scales least elevated. Diagnostic concordance between the MCMI-II and the Structured Interview for DSM-III Personality (SIDP; Pfohl, Stangl, & Zimmerman, 1983) was poor; the MCMI-II made more multiple diagnoses. Implications of the discrepancies between these instruments and suggestions for future research are discussed.

Adult↗
PubMed1984

WAIS characteristics of non-pathological obsessive and hysteric styles.

Tested traditional clinical hypotheses about the cognitive functioning of individuals (N = 16) with an obsessive or an hysteric style in a non-pathological population using selected subtests of the WAIS. Individuals identified as having an obsessive style displayed the predicted patterns (Information and Vocabulary greater than Comprehension), while their hysteric counterparts displayed only a trend toward certain predicted patterns (Comprehension greater than Information and Vocabulary). Predicted between-group differences were significant. Higher base rates of obsessive features in a college population may account for the weaker trends within the hysteric group. Generally, the results appear to support the likelihood that nonpathological forms of the two styles display patterns of cognitive functioning similar to those of their more pathological counterparts.

Compulsive Personality Disorder↗
PubMed1998

Demographic features of patients seeking cosmetic surgery.

The demographic features of 415 patients seeking cosmetic surgery were investigated from a psychiatric point of view. Of the 415 patients, 198 (47.7%) were found to have mental disorders according to ICD-10 including: 17 with schizophrenia, 20 with other persistent delusional disorders, 33 with depressive episode, 47 with neurotic disorders, 42 with hypochondriacal disorder, five with paranoid personality disorder and 14 with histrionic personality disorder. The rate of subjects with poor social adjustment was 56.0%. It was noteworthy that such a considerable number of patients with mental disorders or with poor social adjustment had sought cosmetic surgery. Distinct gender differences were found: male subjects were characterized to have a greater number of mental disorders, especially dysmorphophobia (other persistent delusional disorders plus hypochondriacal disorder) and showed the narrow age range between teenage and young adult age when they were preoccupied with their 'deformity', and poor social function. A history of frequent operations was not considered to be an indicator for mental abnormality. The diagnostic issue in dysmorphophobia is briefly described.

Adolescent↗
PubMed1985

The MCMI provides a good assessment of DSM-III disorders: the MCMI-II will prove even better.

Although the arguments that Widiger, Williams, Spitzer and Frances muster in their appraisal of MCMI-DSM-III relationships appear compelling, the study employed to furnish empirical support for their thesis may be seriously flawed and the item content approach they propose as a validation model is judged logically and psychometrically deficient. A rejoinder with supportive data are presented to demonstrate both the substantive parallels and the clinical concordance that exist between MCMI and DSM-III criteria. On the basis of theory development and ongoing research, a new MCMI-II assessment instrument will be forthcoming. A brief summary of this updated inventory's rationale and empirical grounding is provided.

Antisocial Personality Disorder↗
PubMedDate not supplied

[The role of the personality in the feeding behavior disorders].

Personality disorders are common in eating disorders and preliminary reports indicate that this type of disorders implicate a poor prognosis in anorexia and bulimia nervosa. Cluster C personality disorders, particularly avoidant and dependent personality disorder are the most frequent in anorexia nervosa. In bulimia nervosa, however, cluster B personality disorders, including borderline and histrionic personality disorders, are more frequent. Furthermore, temperament could differentiate anorectic patients from bulimic patients. Eating disorders seem to be associated with high scores in neuroticism and harm avoidance. However, while anorexia nervosa patients might have higher persistence, bulimia nervosa patients seem to have an impulsive temperament. According to the character model of Cloninger, both anorexia and bulimia present lower scores in the dimension self-directedness.

Adult↗
PubMed2000

[Role of personality in eating behavior disorders].

Personality disorders are common in eating disorders and preliminary reports indicate that this type of disorders implicate a poor prognosis in anorexia and bulimia nervosa. Cluster C personality disorders, particularly avoidant and dependent personality disorder are the most frequent in anorexia nervosa. In bulimia nervosa, however, cluster B personality disorders, including borderline and histrionic personality disorders, are more frequent. Furthermore, temperament could differentiate anorectic patients from bulimic patients. Eating disorders seem to be associated with high scores in neuroticism and harm avoidance. However, while anorexia nervosa patients might have higher persistence, bulimia nervosa patients seem to have an impulsive temperament. According to the character model of Cloninger, both anorexia and bulimia present lower scores in the dimension self-directedness.

Anorexia Nervosa↗