1
|
Coello K, Kuchinke OV, Kjærstad HL, Miskowiak KW, Faurholt-Jepsen M, Vinberg M, Kessing LV. Differences in clinical presentation between newly diagnosed bipolar I and II disorders: A naturalistic study. J Affect Disord 2024; 351:95-102. [PMID: 38244799 DOI: 10.1016/j.jad.2024.01.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/10/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
AIM This naturalistic clinical study aims to investigate differences between newly diagnosed patients with bipolar type I (BDI) and bipolar type II (BDII) disorders in socio-demographic and clinical characteristics, affective symptoms, cognition, functioning and comorbidity with personality disorders. METHODS The BD diagnosis and type were confirmed using the Schedules for Clinical Assessment in Neuropsychiatry. Affective symptoms were assessed with the Young Mania Rating Scale, the Hamilton Depression Rating Scale, the Major Depressive Index, and the Altman Self-Rating Mania Scale. Functional impairment was assessed with the Functional Assessment Short Test. Cognitive impairment was evaluated by the Screen for Cognitive Impairment in Psychiatry and the Cognitive Complaints in Bipolar Disorder Rating Assessment. Finally, comorbid personality disorders were assessed with the Standardized Assessment of Personality-Abbreviated Scale and structured interview Structured Clinical Interview for DSM-disorders. RESULTS 383 newly diagnosed patients were included (BDI: n = 125; BDII: n = 258). Against expectations, we found no more depressive symptoms in BDII compared with BDI nor any differences in cognitive, childhood trauma or overall functional impairment. The only difference was lower occupational impairment in the BDII group. LIMITATIONS The self-reported measures of cognitive difficulties and childhood trauma involved potential bias (recall or other). Despite BD being newly diagnosed a diagnostic delay was observed. CONCLUSION Patients newly diagnosed with BDII and BDI had similar burdens of depressive symptoms and cognitive and overall functional impairment, however patients with BDI had lower occupational functioning. No statistically significant difference was found in prevalence of comorbid personality disorders between patients with BDI and BDII.
Collapse
Affiliation(s)
- Klara Coello
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - Oscar Vittorio Kuchinke
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Hanne Lie Kjærstad
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| |
Collapse
|
2
|
Sletved KSO, Villemoes NHF, Coello K, Stanislaus S, Kjærstad HL, Faurholt-Jepsen M, Miskowiak K, Bukh JD, Vinberg M, Kessing LV. Personality disorders in patients with newly diagnosed bipolar disorder, their unaffected first-degree relatives and healthy control individuals. J Affect Disord 2023; 327:183-189. [PMID: 36754094 DOI: 10.1016/j.jad.2023.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Bipolar disorder (BD) is often a progressive mood disorder with a high prevalence of comorbid personality disorder (PD) ranging from 25 to 73 %. Previous studies have included patients with various illness duration of BD. Longer illness duration may be associated with increased prevalence of comorbid PD. This study investigated the prevalence of comorbid personality disorders in patients with newly diagnosed BD and their unaffected first-degree relatives (UR) compared with healthy control individuals (HC). METHODS We included 204 patients with newly diagnosed BD, 109 of their UR and 188 HC. To assess comorbid PD according to DSM-IV, the SCID-II-interview was performed in full or partial remission. Subthreshold PD was defined as scores above cut-off in the SCID-II self-report questionnaires. Functioning was assessed using the Functioning Assessment Short Test. RESULTS In total 52 (25.5 %) of the patients with newly diagnosed BD fulfilled criteria for a comorbid PD. Regarding UR, 7 (6.4 %) fulfilled the criteria for a PD. Subthreshold PD were more prevalent in BD (82.8 %) and UR (53.0 %) than in HC (35.1 %), p-values < 0.003). Patients with comorbid PD presented with impaired functioning compared with patients without PD. LIMITATIONS Clinical diagnostic distinction between PD and BD is challenged by overlapping symptoms. CONCLUSION A quarter of patients with newly diagnosed BD fulfill criteria for a comorbid PD, already at the time of the diagnosis with BD. A comorbid PD is associated with larger functional impairments. This emphasizes the need for early assessment of comorbid PD at time of BD diagnosis.
Collapse
Affiliation(s)
- Kimie Stefanie Ormstrup Sletved
- Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Niels Henrik Falck Villemoes
- Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Klara Coello
- Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Denmark
| | - Sharleny Stanislaus
- Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Denmark
| | - Hanne Lie Kjærstad
- Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Denmark
| | - Kamilla Miskowiak
- Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | | | - Maj Vinberg
- Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder research Center (CADIC), Psychiatric Center Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
van Dijk DA, Deen ML, van den Boogaard TM, Ruhé HG, Spijker J, Peeters FPML. Prevalence and prediction of dropout during depression treatment in routine outpatient care: an observational study. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01499-1. [PMID: 36253582 PMCID: PMC10359217 DOI: 10.1007/s00406-022-01499-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/27/2022] [Indexed: 11/24/2022]
Abstract
Efficacious treatments are available for major depressive disorder (MDD), but treatment dropout is common and decreases their effectiveness. However, knowledge about prevalence of treatment dropout and its risk factors in routine care is limited. The objective of this study was to determine the prevalence of and risk factors for dropout in a large outpatient sample. In this retrospective cohort analysis, routinely collected data from 2235 outpatients with MDD who had a diagnostic work-up between 2014 and 2016 were examined. Dropout was defined as treatment termination without achieving remission before the fourth session within six months after its start. Total and item scores on the Dutch Measure for Quantification of Treatment Resistance in Depression (DM-TRD) at baseline, and demographic variables were analyzed for their association with dropout using logistic regression and elastic net analyses. Data of 987 subjects who started routine outpatient depression treatment were included in the analyses of which 143 (14.5%) dropped out. Higher DM-TRD-scores were predictive for lower dropout odds [OR = 0.78, 95% CI = (0.70-0.86), p < 0.001]. The elastic net analysis revealed several clinical variables predictive for dropout. Higher SES, higher depression severity, comorbid personality pathology and a comorbid anxiety disorder were significantly associated with less dropout in the sample. In this observational study, treatment dropout was relatively low. The DM-TRD, an easy-to-use clinical instrument, revealed several variables associated with less dropout. When applied in daily practice and combined with demographical information, this instrument may help to reduce dropout and increase treatment effectiveness.
Collapse
Affiliation(s)
- D A van Dijk
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands. .,Department of Mood Disorders, PsyQ Haaglanden, The Hague, The Netherlands. .,Parnassia Psychiatric Institute, Monsterseweg 93, 2553 RJ, The Hague, The Netherlands.
| | - M L Deen
- Parnassia Psychiatric Institute, The Hague, The Netherlands.,Institute of Psychology, Leiden University, Leiden, The Netherlands
| | | | - H G Ruhé
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands.,Donders Institute for Brain and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - J Spijker
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Pro Persona Mental Healthcare, Nijmegen, The Netherlands
| | - F P M L Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
4
|
Sen P, Barnicot K, Podder P, Dasgupta I, Gormley M. Exploring the prevalence of personality disorder and the feasibility of using the SAPAS as a screening tool for personality disorder in an emergency department in India. MEDICINE, SCIENCE, AND THE LAW 2022; 62:8-16. [PMID: 34018857 DOI: 10.1177/00258024211011387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Personality disorders (PD) lead to frequent emergency department (ED) visits. Existing studies have evaluated high-risk ED populations in Western settings. PD screening tools, such as the Standardized Assessment of Personality - Abbreviated Scale (SAPAS), have thus far only been validated in Western populations. AIMS This study aimed to establish the screened prevalence of PD, and to evaluate the performance of the SAPAS as a screening tool within an ED setting in India. METHODS The study took place in the ED of a private multi-speciality hospital in Kolkata, India. All attendees were approached during two days per week over three months, except those who were medically unfit to participate. The SAPAS and the International Personality Disorder Examination (IPDE) were translated into Bengali and then used as screening tools for PD and as the reference standard for PD diagnosis. RESULTS Out of 120 ED attendees approached, 97 participated (48 men and 49 women), of whom 24% met the criteria for a diagnosis of PD. A cut-off score of 4 on the SAPAS provided the best trade-off between sensitivity and specificity for detecting PD. CONCLUSION The prevalence of PD was similar to Western samples, and the SAPAS showed promise for use in a non-Western setting.
Collapse
Affiliation(s)
- Piyal Sen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Elysium Healthcare, UK
| | - Kirsten Barnicot
- Centre for Psychiatry, Imperial College London, UK
- Central and North West London NHS Foundation Trust, UK
| | | | - Indraneel Dasgupta
- Department of Emergency Medicine, Peerless Hospital and B.K. Roy Research Centre, India
- Royal College of Emergency Medicine, UK
| | | |
Collapse
|
5
|
van Bronswijk SC, van Dijk DA, van den Boogaard TM, Deen ML, Ruhé HG, Spijker J, Peeters FPML. Impact of Comorbid Personality Disorders on Depression Treatment in Routine Outpatient Care. Am J Psychother 2021; 74:150-156. [PMID: 34905935 DOI: 10.1176/appi.psychotherapy.202120200046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The impact of personality disorder on treatment effectiveness for depression has been debated, and study results have been inconsistent. However, studies that report a negative impact of personality disorders on depression treatment outcomes are often characterized by uncontrolled treatment designs. Within such contexts, individuals with depression and personality disorders are at risk to receive suboptimal treatment. The aim of this retrospective observational study was to investigate whether and to what extent comorbid personality disorders were associated with the type and amount of depression treatment received in routine outpatient care. METHODS Retrospectively extracted data from electronic records of 1,455 outpatients treated for depression at several sites of a nationwide mental health provider in the Netherlands were included. The type and number of treatment sessions and visits were analyzed by using regression models. RESULTS Individuals with depression and comorbid personality disorders received more psychotherapy sessions than individuals without personality disorders, irrespective of depression severity. The number of pharmacotherapy sessions and supportive and crisis visits did not differ between individuals with and without comorbid personality disorders. CONCLUSIONS Individuals with depression and personality disorders received more intensive treatment than individuals without comorbid personality disorders. These results conflict with treatment guidelines and recommendations from high-quality studies and may be indicative of overtreatment among this large group of patients.
Collapse
Affiliation(s)
- Suzanne C van Bronswijk
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Dyllis A van Dijk
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Th Michael van den Boogaard
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Mathijs L Deen
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Henricus G Ruhé
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Jan Spijker
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Frenk P M L Peeters
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| |
Collapse
|
6
|
Zabihi S, Jones R, Moran P, King M, Osborn D, Pitman A. The Association Between Personality Disorder Traits and Suicidality Following Sudden Bereavement: A National Cross-Sectional Survey. J Pers Disord 2021; 35:917-935. [PMID: 33999654 DOI: 10.1521/pedi_2021_35_520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Personality disorder is associated with increased risk of suicidal behavior. The authors aimed to investigate the association between number of personality disorder traits and suicidality risk following sudden bereavement. A secondary analysis of cross-sectional data on 3,167 young adults in the United Kingdom who had experienced sudden bereavement investigated the association between number of traits (measured using a standardized screening instrument) and postbereavement suicide attempt and suicidal ideation. Using multivariable logistic regression, the authors found a linear relationship between number of traits and suicide attempt (adjusted odds ratio [AOR] = 1.36, 95% CI [1.23, 1.49]) and suicidal ideation (AOR = 1.31, 95% CI [1.25, 1.38]) following bereavement. This represented an increase in odds by 36% and 31%, respectively, for each additional personality trait. The authors suggest that individuals with a greater number of traits suggestive of a personality disorder diagnosis are at increased risk of suicidality after a negative life event.
Collapse
Affiliation(s)
- Sedigheh Zabihi
- Division of Psychiatry, University College London, London, United Kingdom
| | - Rebecca Jones
- Division of Psychiatry, University College London, London, United Kingdom
| | - Paul Moran
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael King
- Division of Psychiatry, University College London, London, United Kingdom
| | - David Osborn
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom
| | - Alexandra Pitman
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom
| |
Collapse
|
7
|
Mahoney AEJ, Haskelberg H, Mason E, Millard M, Newby J. Comorbid personality difficulties are not associated with poorer outcomes for online cognitive behaviour therapy for symptoms of anxiety and depression. Personal Ment Health 2021; 15:173-185. [PMID: 33650772 DOI: 10.1002/pmh.1506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/13/2021] [Accepted: 02/17/2021] [Indexed: 12/11/2022]
Abstract
Little is known about the prevalence and impact on treatment of comorbid personality disorders for adults undertaking online cognitive behaviour therapy (internet-delivered or internet-based cognitive behaviour therapy (iCBT)) for anxiety and depressive disorders. This study explored how common comorbid personality difficulties were in a large sample of consecutive patients (N = 1 132) seeking iCBT for their symptoms of anxiety and depression in routine care settings. Patients completed the Standardized Assessment of Personality-abbreviated Scale Self-Report prior to commencing an iCBT programme, as well as completing assessments of anxiety and depression symptom severity and psychological distress pre-iCBT and post-iCBT. Consistent with previous studies, a high proportion of the sample (62.6%) reported experiencing comorbid personality difficulties. However, comorbid personality difficulties were not significantly associated with poorer treatment adherence or higher post-treatment symptom severity or psychological distress (controlling for baseline symptom severity, demographic characteristics and treatment variables). Current findings support an inclusive approach to iCBT provision where comorbid personality difficulties do not appear to be a contraindication for treatment. © 2021 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Elizabeth Mason
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Jill Newby
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.,Black Dog Institute, Sydney, New South Wales, Australia
| |
Collapse
|
8
|
van Bronswijk SC, van Dijk DA, van den Boogaard TM, Deen ML, Ruhé HG, Spijker J, Peeters FPML. Impact of Comorbid Personality Disorders on Depression Treatment in Routine Outpatient Care. Am J Psychother 2021:appipsychotherapy20200046. [PMID: 34134502 DOI: 10.1176/appi.psychotherapy.20200046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The impact of personality disorder on treatment effectiveness for depression has been debated, and study results have been inconsistent. However, studies that report a negative impact of personality disorders on depression treatment outcomes are often characterized by uncontrolled treatment designs. Within such contexts, individuals with depression and personality disorders are at risk to receive suboptimal treatment. The aim of this retrospective observational study was to investigate whether and to what extent comorbid personality disorders were associated with the type and amount of depression treatment received in routine outpatient care. METHODS Retrospectively extracted data from electronic records of 1,455 outpatients treated for depression at several sites of a nationwide mental health provider in the Netherlands were included. The type and number of treatment sessions and visits were analyzed by using regression models. RESULTS Individuals with depression and comorbid personality disorders received more psychotherapy sessions than individuals without personality disorders, irrespective of depression severity. The number of pharmacotherapy sessions and supportive and crisis visits did not differ between individuals with and without comorbid personality disorders. CONCLUSIONS Individuals with depression and personality disorders received more intensive treatment than individuals without comorbid personality disorders. These results conflict with treatment guidelines and recommendations from high-quality studies and may be indicative of overtreatment among this large group of patients.
Collapse
Affiliation(s)
- Suzanne C van Bronswijk
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Dyllis A van Dijk
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Th Michael van den Boogaard
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Mathijs L Deen
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Henricus G Ruhé
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Jan Spijker
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| | - Frenk P M L Peeters
- Department of Clinical Psychological Science, Maastricht University, Maastrich, the Netherlands (van Bronswijk, van Dijk, Peeters); Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands (van Bronswijk); Department of Mood Disorders, PsyQ Haaglanden, the Hague, the Netherlands (van Dijk, van den Boogaard); Parnassia Psychiatric Institute, the Hague (Deen); Institute of Psychology, Leiden University, Leiden, the Netherlands (Deen); Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands (Ruhé); Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen (Ruhé); Pro Persona Mental Healthcare, and Behavourial Science Institute, Radboud University, Nijmegen (Spijker)
| |
Collapse
|
9
|
Mars B, Gibson J, Dunn BD, Gordon C, Heron J, Kessler D, Wiles N, Moran P. Personality difficulties and response to community-based psychological treatment for anxiety and depression. J Affect Disord 2021; 279:266-273. [PMID: 33074146 DOI: 10.1016/j.jad.2020.09.115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/18/2020] [Accepted: 09/26/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous research suggests that comorbid personality disorder may be associated with a less favourable treatment outcome for individuals with depression and anxiety disorder. However, little is known about whether personality difficulties are associated with treatment outcomes within Improving Access to Psychological Therapies (IAPT) services-the largest platform for treating depression and anxiety in England, UK. Secondary aims were to investigate i) whether individual personality difficulties are associated with treatment outcome and ii) whether findings are moderated by treatment type. METHODS The sample included 3,689 adults who accessed community-based psychological treatment (cognitive behavioural therapy, emotional skills training, or other psychological therapy) for depression and/or anxiety disorder. Associations between personality difficulties (assessed with the Standardised Assessment of Personality-Abbreviated Scale (SAPAS)) and treatment outcomes (recovery and reliable improvement in depression/anxiety symptom scores, assessed using questionnaire-based measures) were investigated using logistic/linear regression. RESULTS Personality difficulties were associated with a reduced likelihood of recovery (adjusted OR per unit increase on SAPAS: depression=0.87, 95%CI 0.84, 0.91; anxiety=0.86, 95%CI 0.82, 0.90) and reliable improvement (adjusted OR per unit increase on SAPAS: depression=0.88, 95%CI 0.84, 0.92; anxiety=0.85, 95%CI 0.82, 0.89). Those with three or more difficulties were over 30% less likely to recover/reliably improve. LIMITATIONS Personality difficulties data were collected via self-report and were not available for all participants. CONCLUSION Patients with personality difficulties have a less favourable response to psychological treatment for depression/anxiety disorder. If replicated, the findings highlight a major challenge to the way community-based psychological therapy services in England (IAPT services) are presently constituted.
Collapse
Affiliation(s)
- Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, University of Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK.
| | - Jo Gibson
- Mental Health & Learning Disabilities Directorate, Somerset Partnership NHS Foundation Trust
| | | | - Christopher Gordon
- Mental Health & Learning Disabilities Directorate, Somerset Partnership NHS Foundation Trust
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, University of Bristol, UK
| | - David Kessler
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, University of Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
| | - Nicola Wiles
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, University of Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, University of Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
| |
Collapse
|
10
|
Bhavsar V, Dorrington S, Morgan C, Hatch SL, McGuire P, Fusar-Poli P, Mills J, MacCabe JH, Hotopf M. Psychotic experiences, psychiatric comorbidity and mental health need in the general population: a cross-sectional and cohort study in Southeast London. Psychol Med 2021; 51:147-157. [PMID: 31713511 PMCID: PMC7116680 DOI: 10.1017/s0033291719003106] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/02/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Co-occurrence of common mental disorders (CMD) with psychotic experiences is well-known. There is little research on the public mental health relevance of concurrent psychotic experiences for service use, suicidality, and poor physical health. We aim to: (1) describe the distribution of psychotic experiences co-occurring with a range of non-psychotic psychiatric disorders [CMD, depressive episode, anxiety disorder, probable post-traumatic stress disorder (PTSD), and personality dysfunction], and (2) examine associations of concurrent psychotic experiences with secondary mental healthcare use, psychological treatment use for CMD, lifetime suicide attempts, and poor self-rated health. METHODS We linked a prospective cross-sectional community health survey with a mental healthcare provider database. For each non-psychotic psychiatric disorder, patients with concurrent psychotic experiences were compared to those without psychotic experiences on use of secondary mental healthcare, psychological treatment for CMD, suicide attempt, physical functioning, and a composite multimorbidity score, using logistic regression and Cox regressions. RESULTS In all disorders except for anxiety disorder, concurrent psychotic experiences were accompanied by a greater odds of all outcomes (odds ratios) for a unit change in composite multimorbidity score ranged between 2.21 [95% confidence interval (CI) 1.49-3.27] and 3.46 (95% CI 1.52-7.85). Hazard ratios for secondary mental health service use for non-psychotic disorders with concurrent psychotic experiences, ranged from 0.53 (95% CI 0.15-1.86) for anxiety disorders with psychotic experiences to 4.99 (95% CI 1.22-20.44) among those with PTSD with psychotic experiences. CONCLUSIONS Co-occurring psychotic experiences indicate greater public mental health burden, suggesting psychotic experiences could be a marker for future preventive strategies improving public mental health.
Collapse
Affiliation(s)
- Vishal Bhavsar
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Dorrington
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Craig Morgan
- Department of Health Services and Population Research, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - John Mills
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - James H. MacCabe
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Matthew Hotopf
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
11
|
van Dijk DA, van den Boogaard TM, Deen ML, Spijker J, Ruhé HG, Peeters FPML. Predicting clinical course in major depressive disorder: The association between DM-TRD score and symptom severity over time in 1115 outpatients. Depress Anxiety 2019; 36:345-352. [PMID: 30474901 DOI: 10.1002/da.22865] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/27/2018] [Accepted: 11/06/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The Dutch Measure for Quantification of Treatment Resistance in Depression (DM-TRD) is a promising prediction tool for major depressive disorder (MDD) based on variables associated with treatment outcome. The objective of our study was to examine the association between the DM-TRD and clinical course in a large cohort of MDD outpatients receiving treatment as usual. Furthermore, we examined whether the addition of an item measuring the presence of childhood adversity improved this association. METHODS We included 1115 subjects with MDD (according to the DSM-IV) who were naturalistically treated at seven outpatient departments of a secondary mental healthcare center in the Netherlands. Data on subjects who had a diagnostic work-up between June 2014 and June 2016 were analyzed. Multilevel analyses were performed to examine the association between the DM-TRD score at baseline and clinical course, defined by symptom severity according to scores on the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) over time. We also investigated whether an extra item measuring childhood adversity improved the model. RESULTS The model including the DM-TRD and its interaction with time was superior to previous models. The addition of childhood adversity and its interaction with time did not improve the model. CONCLUSIONS In depressed outpatients receiving treatment as usual, the solid longer-term association between higher DM-TRD scores and worse clinical course supports its usefulness in clinical practice. Childhood adversity did not improve the model value indicating that-counterintuitively-this parameter offers no additional predictive power to the variables included.
Collapse
Affiliation(s)
- D A van Dijk
- Parnassia Psychiatric Institute, The Hague, the Netherlands.,PsyQ Haaglanden, Department of Mood Disorders, The Hague, the Netherlands
| | - Th M van den Boogaard
- Parnassia Psychiatric Institute, The Hague, the Netherlands.,PsyQ Haaglanden, Department of Mood Disorders, The Hague, the Netherlands
| | - M L Deen
- Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - J Spijker
- Pro Persona Mental Healthcare, Nijmegen, the Netherlands
| | - H G Ruhé
- Department of Psychiatry, Radboudumc, Nijmegen, the Netherlands
| | - F P M L Peeters
- Department of Psychiatry and Psychology, University Hospital Maastricht, Maastricht, the Netherlands.,School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
12
|
Innocent S, Podder P, Ram JR, Barnicot K, Sen P. Using the SAPAS to identify risk for personality disorders among psychiatric outpatients in India: A feasibility study. Personal Ment Health 2018; 12:15-24. [PMID: 29052355 DOI: 10.1002/pmh.1394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/22/2017] [Accepted: 07/30/2017] [Indexed: 11/09/2022]
Abstract
Personality disorders (PDs) are common among psychiatric outpatients and are associated with increased morbidity and worse treatment outcomes. Epidemiological research conducted among this population in Asian countries is limited, reflecting a significant gap in the current literature. One barrier to this research is the lack of appropriate screening tools. The current research assessed the feasibility of using the SAPAS (Standardized Assessment of Personality-Abbreviated Scale) screening tool to identify individuals at high risk of PD in an Indian psychiatric outpatient population and provides an initial estimate of PD prevalence by using a validated diagnostic interview, the ICD-10 International Personality Disorder Examination. The findings suggest that whilst use of the SAPAS was feasible, acceptable to patients and led to clinically useful findings, when using the recommended cut-off score of 4, the SAPAS largely overdiagnoses the risk for PD in psychiatric outpatients in India (positive predictive value = 26.3%). The estimated prevalence of personality disorder in the sample was 11.1%, based on administering the International Personality Disorder Examination diagnostic interview to high-risk patients scoring 4 and above on the SAPAS, which is higher than previous estimates for this population and still likely to be an underestimation. Future studies should translate the measure into Bengali and evaluate its sensitivity and specificity at different cut-off points in order to optimize its use in Indian populations. Copyright © 2017 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
| | - Priyanka Podder
- Mental Health Foundation, University of Calcutta, Kolkata, India
| | | | | | - Piyal Sen
- Elysium Healthcare, King's College London, London, UK
| |
Collapse
|
13
|
Olajide K, Munjiza J, Moran P, O'Connell L, Newton-Howes G, Bassett P, Akintomide G, Ng N, Tyrer P, Mulder R, Crawford MJ. Development and Psychometric Properties of the Standardized Assessment of Severity of Personality Disorder (SASPD). J Pers Disord 2018; 32:44-56. [PMID: 28513349 DOI: 10.1521/pedi_2017_31_285] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Personality disorder (PD) is increasingly categorized according to its severity, but there is no simple way to screen for severity according to ICD-11 criteria. We set out to develop the Standardized Assessment of Severity of Personality Disorder (SASPD). A total of 110 patients completed the SASPD together with a clinical assessment of the severity of personality disorder. We examined the predictive ability of the SASPD using the area under the ROC curve (AUC). Two to four weeks later, 43 patients repeated the SASPD to examine reliability. The SASPD had good predictive ability for determining mild (AUC = 0.86) and moderate (AUC = 0.84) PD at cut points of 8 and 10, respectively. Test-retest reliability of the SASPD was high (intraclass correlation coefficient = 0.93, 95% CI [0.88, 0.96]). The SASPD thus provides a simple, brief, and reliable indicator of the presence of mild or moderate PD according to ICD-11 criteria.
Collapse
Affiliation(s)
- Kike Olajide
- Centre for Mental Health, Imperial College London
| | | | - Paul Moran
- School of Social and Community Medicine, University of Bristol, UK
| | | | - Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | | | | | - Nicola Ng
- Central and North West London NHS Foundation Trust
| | - Peter Tyrer
- Centre for Mental Health, Imperial College London
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | |
Collapse
|
14
|
Ottesen NM, Meluken I, Scheike T, Kessing LV, Miskowiak KW, Vinberg M. Clinical Characteristics, Life Adversities and Personality Traits in Monozygotic Twins With, at Risk of and Without Affective Disorders. Front Psychiatry 2018; 9:401. [PMID: 30233425 PMCID: PMC6127629 DOI: 10.3389/fpsyt.2018.00401] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/09/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Affective disorders have a long-term impact on psychiatric health and are caused by multiple interacting factors including familial risk, childhood adversity, life events and personality traits. Methods: In this study, monozygotic twins (MZ) at familial risk (indexed by affective disorder in their co-twin; high-risk group), affected MZ twins (indexed by a diagnosis with affective disorder) and MZ twins with no family history of affective disorder (low-risk group) were identified through cross-linking of nation-wide Danish registers. In total, 204 MZ twins were included and psychopathology, personality traits and life adversity were evaluated by semi-structured interviews and questionnaires. Results: Affected MZ twins presented with more subclinical affective symptoms and were functionally impaired as evidenced by higher unemployment rates and reduced functional status. The affected and the high-risk groups reported more childhood adversity and had experienced more stressful life events than the low-risk group. A direct comparison within the discordant twin pairs showed that the high-risk twins presented fewer affective symptoms, better functional status, more extraversion and lower neuroticism scores than their affected co-twins although they had equal levels of life adversity as their affected co-twins. Conclusion: These findings add to the evidence indicating that patients experience higher neuroticism, persistent subclinical symptoms and reduced socio-occupational function after affective episodes. Additionally, neuroticism and extraversion seem capable of moderating the sensitivity to exposure from the environment.
Collapse
Affiliation(s)
- Ninja M Ottesen
- Copenhagen Affective Disorder Research Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Iselin Meluken
- Copenhagen Affective Disorder Research Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Scheike
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark.,Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kamilla W Miskowiak
- Copenhagen Affective Disorder Research Centre, Copenhagen University Hospital, Copenhagen, Denmark.,Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorder Research Centre, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
15
|
Kessing LV, Munkholm K, Faurholt-Jepsen M, Miskowiak KW, Nielsen LB, Frikke-Schmidt R, Ekstrøm C, Winther O, Pedersen BK, Poulsen HE, McIntyre RS, Kapczinski F, Gattaz WF, Bardram J, Frost M, Mayora O, Knudsen GM, Phillips M, Vinberg M. The Bipolar Illness Onset study: research protocol for the BIO cohort study. BMJ Open 2017; 7:e015462. [PMID: 28645967 PMCID: PMC5734582 DOI: 10.1136/bmjopen-2016-015462] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Bipolar disorder is an often disabling mental illness with a lifetime prevalence of 1%-2%, a high risk of recurrence of manic and depressive episodes, a lifelong elevated risk of suicide and a substantial heritability. The course of illness is frequently characterised by progressive shortening of interepisode intervals with each recurrence and increasing cognitive dysfunction in a subset of individuals with this condition. Clinically, diagnostic boundaries between bipolar disorder and other psychiatric disorders such as unipolar depression are unclear although pharmacological and psychological treatment strategies differ substantially. Patients with bipolar disorder are often misdiagnosed and the mean delay between onset and diagnosis is 5-10 years. Although the risk of relapse of depression and mania is high it is for most patients impossible to predict and consequently prevent upcoming episodes in an individual tailored way. The identification of objective biomarkers can both inform bipolar disorder diagnosis and provide biological targets for the development of new and personalised treatments. Accurate diagnosis of bipolar disorder in its early stages could help prevent the long-term detrimental effects of the illness.The present Bipolar Illness Onset study aims to identify (1) a composite blood-based biomarker, (2) a composite electronic smartphone-based biomarker and (3) a neurocognitive and neuroimaging-based signature for bipolar disorder. METHODS AND ANALYSIS The study will include 300 patients with newly diagnosed/first-episode bipolar disorder, 200 of their healthy siblings or offspring and 100 healthy individuals without a family history of affective disorder. All participants will be followed longitudinally with repeated blood samples and other biological tissues, self-monitored and automatically generated smartphone data, neuropsychological tests and a subset of the cohort with neuroimaging during a 5 to 10-year study period. ETHICS AND DISSEMINATION The study has been approved by the Local Ethical Committee (H-7-2014-007) and the data agency, Capital Region of Copenhagen (RHP-2015-023), and the findings will be widely disseminated at international conferences and meetings including conferences for the International Society for Bipolar Disorders and the World Federation of Societies for Biological Psychiatry and in scientific peer-reviewed papers. TRIAL REGISTRATION NUMBER NCT02888262.
Collapse
Affiliation(s)
- Lars Vedel Kessing
- Department of Psychiatry, Psychiatric Center Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Munkholm
- Department of Psychiatry, Psychiatric Center Copenhagen, Copenhagen, Denmark
| | | | - Kamilla Woznica Miskowiak
- Department of Psychiatry, Psychiatric Center Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Bo Nielsen
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Claus Ekstrøm
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Ole Winther
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
- Gene Regulation Bioinformatics at the Bioinformatics Centre, Department of Biology/BRIC, University of Copenhagen, Copenhagen, Denmark
| | - Bente Klarlund Pedersen
- The Centre of Inflammation and Metabolism at Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Roger S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada
| | | | - Wagner F Gattaz
- Department and Institute of Psychiatry, and Laboratory of Neuroscience (LIM27), University of São Paulo Medical School, São Paulo, Brazil
| | - Jakob Bardram
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Mads Frost
- IT University Copenhagen, Copenhagen, Denmark
| | - Oscar Mayora
- Create-Net: Center for Research and Telecommunications Experimentation for Networked Communities, Trento, Italy
| | - Gitte Moos Knudsen
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Copenhagen, Denmark
| | - Mary Phillips
- Department of Psychiatry, University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania, USA
| | - Maj Vinberg
- Department of Psychiatry, Psychiatric Center Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
16
|
Differences in clinical presentation between bipolar I and II disorders in the early stages of bipolar disorder: A naturalistic study. J Affect Disord 2017; 208:521-527. [PMID: 27816324 DOI: 10.1016/j.jad.2016.10.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/30/2016] [Accepted: 10/22/2016] [Indexed: 11/23/2022]
Abstract
AIM In a naturalistic clinical study of patients in the early stages of bipolar disorders the aim was to assess differences between patients with bipolar I (BD I) and bipolar II (BD II) disorders on clinical characteristics including affective symptoms, subjective cognitive complaints, functional level, the presence of comorbid personality disorders and coping strategies. METHODS Diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Disorders. Clinical symptoms were rated with the Young Mania Rating Scale and the Hamilton Depression Rating Scale, and functional status using the Functional Assessment Short Test. Cognitive complaints were assessed using the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire, the presence of comorbid personality disorders using the Standardized Assessment of Personality - Abbreviated Scale and coping style using the Coping Inventory for Stressful Situations. RESULTS In total, 344 patients were included (BD I (n=163) and BD II (n=181). Patients with BD II presented with significantly more depressive symptoms, more cognitive complaints, lower overall functioning, and a higher prevalence of comorbid personality disorders. Finally, they exhibited a trend towards using less adaptive coping styles. LIMITATION It cannot be omitted that some patients may have progressed from BD II to BD I. Most measures were based on patient self report. CONCLUSIONS Overall, BD II was associated with a higher disease burden. Clinically, it is important to differentiate BD II from BD I and research wise, there is a need for tailoring and testing specific interventions towards BD II.
Collapse
|
17
|
Family psychoeducation for major depressive disorder - study protocol for a randomized controlled trial. Trials 2016; 17:427. [PMID: 27577267 PMCID: PMC5006499 DOI: 10.1186/s13063-016-1549-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/11/2016] [Indexed: 11/13/2022] Open
Abstract
Background Major depressive disorder has been shown to affect many domains of family life including family functioning. Conversely, the influence of the family on the course of the depression, including the risk of relapse, is one reason for targeting the family in interventions. The few studies conducted within this area indicate that family psychoeducation as a supplement to traditional treatment can effectively reduce the risk of relapse in patients with major depression as well as being beneficial for the relatives involved. However, the evidence is currently limited. This study will investigate the effect of family psychoeducation compared to social support on the course of the illness in patients with major depressive disorder. Method/design The study is designed as a dual center, two-armed, observer-blinded, randomized controlled trial. Relatives are randomized to participate in one of two conditions: either four sessions of manualized family psychoeducation or four sessions in a social support group led by a health care professional. Patients will not participate in the groups and will continue their treatment as usual. A total of 100 patients, each accompanied by one relative, will be recruited primarily from two outpatient clinics in the Capital Region of Denmark. The primary outcome is the occurrence of depressive relapse at 9-month follow-up defined as a score ≥7 on the Hamilton six-item subscale. Secondary outcomes will include time to relapse. Discussion It is hoped that the results from this study will help to clarify the mechanisms behind any beneficial changes due to family psychoeducation and provide information on the long-term effect of this intervention for both patient and relatives. If the results are positive, the family psychoeducation program may be suitable for implementation within a clinical setting. Trial registration ClinicalTrials.gov Identifier: NCT02348827, registered 5 January 2015.
Collapse
|
18
|
Fok MLY, Seegobin S, Frissa S, Hatch SL, Hotopf M, Hayes RD, Moran P. Validation of the standardised assessment of personality--abbreviated scale in a general population sample. Personal Ment Health 2015; 9:250-7. [PMID: 26314385 PMCID: PMC4950006 DOI: 10.1002/pmh.1307] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 07/19/2015] [Accepted: 07/26/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Personality disorder (PD) is associated with important health outcomes in the general population. However, the length of diagnostic interviews poses a significant barrier to obtaining large scale, population-based data on PD. A brief screen for the identification of people at high risk of PD in the general population could be extremely valuable for both clinicians and researchers. AIM We set out to validate the Standardised Assessment of Personality - Abbreviated Scale (SAPAS), in a general population sample, using the Structured Clinical Interviews for DSM-IV Personality Disorders (SCID-II) as a gold standard. METHOD One hundred and ten randomly selected, community-dwelling adults were administered the SAPAS screening interview. The SCID-II was subsequently administered by a clinical interviewer blind to the initial SAPAS score. Receiver operating characteristic analysis was used to assess the discriminatory performance of the SAPAS, relative to the SCID-II. RESULTS Area under the curve for the SAPAS was 0.70 (95% CI = 0.60 to 0.80; p < 0.001), indicating moderate overall discriminatory accuracy. A cut point score of 4 on the SAPAS correctly classified 58% of participants. At this cut point, the sensitivity and specificity were 0.69 and 0.53 respectively. CONCLUSION The SAPAS operates less efficiently as a screen in general population samples and is probably most usefully applied in clinical populations.
Collapse
Affiliation(s)
- Marcella Lei-Yee Fok
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Seth Seegobin
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Souci Frissa
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Richard D Hayes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Moran
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
19
|
Hvenegaard M, Watkins ER, Poulsen S, Rosenberg NK, Gondan M, Grafton B, Austin SF, Howard H, Moeller SB. Rumination-focused cognitive behaviour therapy vs. cognitive behaviour therapy for depression: study protocol for a randomised controlled superiority trial. Trials 2015; 16:344. [PMID: 26260780 PMCID: PMC4532251 DOI: 10.1186/s13063-015-0875-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Cognitive behavioural therapy is an effective treatment for depression. However, one third of the patients do not respond satisfactorily, and relapse rates of around 30 % within the first post-treatment year were reported in a recent meta-analysis. In total, 30–50 % of remitted patients present with residual symptoms by the end of treatment. A common residual symptom is rumination, a process of recurrent negative thinking and dwelling on negative affect. Rumination has been demonstrated as a major factor in vulnerability to depression, predicting the onset, severity, and duration of future depression. Rumination-focused cognitive behavioural therapy is a psychotherapeutic treatment targeting rumination. Because rumination plays a major role in the initiation and maintenance of depression, targeting rumination with rumination-focused cognitive behavioural therapy may be more effective in treating depression and reducing relapse than standard cognitive behavioural therapy. Method/design This study is a two-arm pragmatic randomised controlled superiority trial comparing the effectiveness of group-based rumination-focused cognitive behaviour therapy with the effectiveness of group-based cognitive behavioural therapy for treatment of depression. One hundred twenty-eight patients with depression will be recruited from and given treatment in an outpatient service at a psychiatric hospital in Denmark. Our primary outcome will be severity of depressive symptoms (Hamilton Rating Scale for Depression) at completion of treatment. Secondary outcomes will be level of rumination, worry, anxiety, quality of life, behavioural activation, experimental measures of cognitive flexibility, and emotional attentional bias. A 6-month follow-up is planned and will include the primary outcome measure and assessment of relapse. Discussion The clinical outcome of this trial may guide clinicians to decide on the merits of including rumination-focused cognitive behavioural therapy in the treatment of depression in outpatient services. Trial registration ClinicalTrials.gov Identifier: NCT02278224, registered 28 Oct. 2014.
Collapse
Affiliation(s)
- Morten Hvenegaard
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen K, Denmark.
| | - Ed R Watkins
- School of Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Streatham Campus, Perry Road, Exeter, EX4 4QG, UK.
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen K, Denmark.
| | - Nicole K Rosenberg
- Psychiatric Outpatient Clinic of Copenhagen, Psychiatric Hospital of The Capital Region, Nannasgade 28, 2200, Copenhagen N, Denmark.
| | - Matthias Gondan
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen K, Denmark.
| | - Ben Grafton
- Centre for the Advancement of Research in Emotion, School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Stephen F Austin
- Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University, Dyrehavehavevej 48, 3400, Hillerød, Denmark.
| | - Henriette Howard
- Mental Health Centre for Child and Adolescent Psychiatry, Bispebjerg Bakke 30, 2400, Copenhagen, NV, Denmark.
| | - Stine B Moeller
- Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University, Dyrehavehavevej 48, 3400, Hillerød, Denmark.
| |
Collapse
|
20
|
Goddard E, Wingrove J, Moran P. The impact of comorbid personality difficulties on response to IAPT treatment for depression and anxiety. Behav Res Ther 2015. [PMID: 26226089 DOI: 10.1016/j.brat.2015.07.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
UNLABELLED The UK's Improving Access to Psychological Therapies (IAPT) initiative provides evidence-based psychological interventions for mild to moderate common mental health problems in a primary care setting. Predictors of treatment response are unclear. This study examined the impact of personality disorder status on outcome in a large IAPT service. We hypothesised that the presence of probable personality disorder would adversely affect treatment response. METHOD We used a prospective cohort design to study a consecutive sample of individuals (n = 1249). RESULTS Higher scores on a screening measure for personality disorder were associated with poorer outcome on measures of depression, anxiety and social functioning, and reduced recovery rates at the end of treatment. These associations were not confounded by demographic status, initial symptom severity nor number of treatment sessions. The presence of personality difficulties independently predicted reduced absolute change on all outcome measures. CONCLUSIONS The presence of co-morbid personality difficulties adversely affects treatment outcome among individuals attending for treatment in an IAPT service. There is a need to routinely assess for the presence of personality difficulties on all individuals referred to IAPT services. This information will provide important prognostic data and could lead to the provision of more effective, personalised treatment in IAPT.
Collapse
Affiliation(s)
- Elizabeth Goddard
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Clinical Psychology, Addiction Sciences Building, 4 Windsor Walk, London, SE5 8AF, UK.
| | - Janet Wingrove
- Southwark Psychological Therapies Service, South London and Maudsley NHS Foundation Trust, Eileen Skellern House, Denmark Hill, SE5 8AZ, London, UK.
| | - Paul Moran
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, De Crespigny Park, London, SE5 8AF, UK.
| |
Collapse
|
21
|
Fok M, Hotopf M, Stewart R, Hatch S, Hayes R, Moran P. Personality disorder and self-rated health: a population-based cross-sectional survey. J Pers Disord 2014; 28:319-33. [PMID: 23795755 DOI: 10.1521/pedi_2013_27_119] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Little is known about the impact of personality disorder (PD) on the health of people living in the community. The authors set out to examine the association between PD and general health, using a cross-sectional survey of a representative community sample in London, UK. A total of 1,698 adults aged 16 years or over from 1,075 randomly selected households were recruited and interviewed face-to-face by trained interviewers. Using multivariable logistic regression, the authors examined the cross-sectional association between PD screen status, as assessed by the Standardised Assessment of Personality-Abbreviated Scale (SAPAS), and self-rated health, adjusting for demographic and health covariates. Of the participants, 14.5% screened positively for PD. A greater proportion of those scoring positively for PD reported poor self-rated health, compared to screen negative participants (41.3% versus 15.0%). This association was reduced, but remained significant, after adjustment for potential confounders (unadjusted odds ratio (OR) = 3.99, 95% CI [2.93, 5.42]; fully adjusted OR = 1.53, 95% CI [1.02, 2.29]. Of note, subthreshold symptoms of PD were significantly associated with poor self-rated health (unadjusted OR per unit SAPAS score increment = 1.53, 95% CI [1.40, 1.67]; fully adjusted OR = 1.19, 95% CI [1.07, 1.33]. Furthermore, people screening positive for PD were more likely to report multiple (three or more) long-standing illnesses. The authors conclude that in the general population, individuals who are at high risk for PD are independently at increased risk of poor general health.
Collapse
|
22
|
Kongerslev M, Moran P, Bo S, Simonsen E. Screening for personality disorder in incarcerated adolescent boys: preliminary validation of an adolescent version of the standardised assessment of personality - abbreviated scale (SAPAS-AV). BMC Psychiatry 2012; 12:94. [PMID: 22846474 PMCID: PMC3507652 DOI: 10.1186/1471-244x-12-94] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 07/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Personality disorder (PD) is associated with significant functional impairment and an elevated risk of violent and suicidal behaviour. The prevalence of PD in populations of young offenders is likely to be high. However, because the assessment of PD is time-consuming, it is not routinely assessed in this population. A brief screen for the identification of young people who might warrant further detailed assessment of PD could be particularly valuable for clinicians and researchers working in juvenile justice settings. METHOD We adapted a rapid screen for the identification of PD in adults (Standardised Assessment of Personality - Abbreviated Scale; SAPAS) for use with adolescents and then carried out a study of the reliability and validity of the adapted instrument in a sample of 80 adolescent boys in secure institutions. Participants were administered the screen and shortly after an established diagnostic interview for DSM-IV PDs. Nine days later the screen was readministered. RESULTS A score of 3 or more on the screening interview correctly identified the presence of DSM-IV PD in 86% of participants, yielding a sensitivity and specificity of 0.87 and 0.86 respectively. Internal consistency was modest but comparable to the original instrument. 9-days test-retest reliability for the total score was excellent. Convergent validity correlations with the total number of PD criteria were large. CONCLUSION This study provides preliminary evidence of the validity, reliability, and usefulness of the screen in secure institutions for adolescent male offenders. It can be used in juvenile offender institutions with limited resources, as a brief, acceptable, staff-administered routine screen to identify individuals in need of further assessment of PD or by researchers conducting epidemiological surveys.
Collapse
Affiliation(s)
- Mickey Kongerslev
- Department of Child and Adolescent Psychiatry, Region Zealand, Roskilde, Denmark
- Psychiatric Research Unit, Region Zealand, Toftebakken 9, 4000, Roskilde, Denmark
| | - Paul Moran
- King’s College London, Health Services & Population Research Department, Institute of Psychiatry, London, United Kingdom
| | - Sune Bo
- Psychiatric Research Unit, Region Zealand, Toftebakken 9, 4000, Roskilde, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Toftebakken 9, 4000, Roskilde, Denmark
| |
Collapse
|