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Sarmiento A, Dean OM, Kavanagh BE, Mohebbi M, Berk M, Dodd S, Cotton SM, Malhi GS, Ng CH, Turner A. The Influence of Personality Disorder Symptoms on Treatment Outcomes in Bipolar Disorder: A Secondary Analysis of a Randomised Controlled Trial: L'influence des symptômes du trouble de la personnalité sur les résultats du traitement dans le trouble bipolaire : Une analyse secondaire d'un essai randomisé contrôlé. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:275-287. [PMID: 37964558 PMCID: PMC10924579 DOI: 10.1177/07067437231213558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVES Many people who are diagnosed with bipolar disorder also have comorbid personality disorder. Few studies have explored how personality disorder may influence pharmacological treatment outcomes. The aim of this study was to conduct a secondary analysis of data from a clinical trial of adjunctive nutraceutical treatments for bipolar depression, to determine whether maladaptive personality traits influence treatment outcomes. METHODS Scores on the Standardised Assessment of Personality - Abbreviated Scale screener were used to classify participants as having bipolar disorder with (n = 119) and without (n = 29) above threshold personality disorder symptoms (personality disorder). Outcome measures included: The Montgomery Åsberg Depression Rating Scale, Clinical Global Impressions and Improvement Severity Scales, Patient Global Impressions-Improvement scale, Bipolar Depression Rating Scale, Range of Impaired Functioning Tool, Social and Occupational Functioning Assessment Scale and Quality of Life and Enjoyment Scale (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form). Generalised estimated equations examined the two-way interactions of personality disorder by time or treatment and investigated personality disorder as a non-specified predictor of outcomes. RESULTS Over time, the Patient Global Impressions-Improvement scores were significantly higher in those in the personality disorder group. No other significant differences in the two-way interactions of personality disorder by treatment group or personality disorder by time were found. Personality disorder was a significant but non-specific predictor of poorer outcomes on the Bipolar Depression Rating Scale, Range of Impaired Functioning Tool, and Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form, regardless of time or treatment group. CONCLUSIONS This study highlights the potential impact of maladaptive personality traits on treatment outcomes and suggests that the presence of comorbid personality disorder may confer additional burden and compromise treatment outcomes. This warrants further investigation as does the corroboration of these exploratory findings. This is important because understanding the impact of comorbid personality disorder on bipolar disorder may enable the development of effective psychological and pharmacotherapeutic options for personalised treatments.
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Affiliation(s)
- Alessandra Sarmiento
- IMPACT – The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Olivia M. Dean
- IMPACT – The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Bianca E. Kavanagh
- IMPACT – The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
- Deakin Rural Health, Deakin University, Warrnambool, VIC, Australia
| | - Mohammadreza Mohebbi
- Faculty of Health, Biostatistics Unit, Deakin University, Geelong, VIC, Australia
| | - Michael Berk
- IMPACT – The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Seetal Dodd
- IMPACT – The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Sue M. Cotton
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Gin S. Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, NSW, Australia
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Chee H. Ng
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Richmond, VIC, Australia
| | - Alyna Turner
- IMPACT – The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
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2
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Ruchensky JR, Kelley SE, Massey C, Richardson LA, Blais MA, Stein MB. Using the Personality Assessment Inventory to Assess the Alternative Model for Personality Disorders: Criterion Validity in a Clinical Sample. J Pers Assess 2024; 106:72-82. [PMID: 37220386 DOI: 10.1080/00223891.2023.2203240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/06/2023] [Accepted: 03/31/2023] [Indexed: 05/25/2023]
Abstract
The Personality Assessment Inventory (PAI) is a broadband measure of psychopathology that is widely used in applied settings. Researchers developed regression-based estimates that use the PAI to measure constructs of the Alternative Model for Personality Disorders (AMPD) - a hybrid dimensional and categorical approach to conceptualizing personality disorders. Although prior work has linked these estimates to formal measures of the AMPD, there is little work investigating the clinical correlates of this scoring approach of the PAI. The current study examines associations between these PAI-based AMPD estimates and life data in a large, archival dataset of psychiatric outpatients and inpatients. We found general support for the criterion validity of AMPD estimate scores, such that a theoretically consistent pattern of associations emerged with indicators such as prior academic achievement, antisocial behavior, psychiatric history, and substance abuse. These results provide preliminary support to this scoring approach for use in clinical samples.
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Affiliation(s)
- Jared R Ruchensky
- Department of Psychology & Philosophy, Sam Houston State University, Huntsville, Texas
| | - Shannon E Kelley
- Clinical Psychology Department, William James College, Newton, Massachusetts
| | - Christina Massey
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laura A Richardson
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark A Blais
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michelle B Stein
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Hasty MK, Macneil CA, Cotton SM, Berk M, Kader L, Ratheesh A, Ramain J, Chanen AM, Conus P. Personality disorder among youth with first episode psychotic mania: An important target for specific treatment? Early Interv Psychiatry 2022; 16:256-263. [PMID: 33768702 DOI: 10.1111/eip.13150] [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: 11/05/2020] [Revised: 02/16/2021] [Accepted: 03/12/2021] [Indexed: 12/01/2022]
Abstract
AIM Personality disorder is a common co-occurrence ('comorbidity') among patients with bipolar disorder and appears to affect outcome negatively. However, there is little knowledge about the impact of this comorbidity in the early phases of bipolar disorder. We examined the prevalence and effect of personality disorder co-occurrence on outcome in a cohort of youth with first episode mania with psychotic features. METHODS Seventy-one first episode mania patients, aged 15-29, were assessed at baseline, 6, 12, and 18 months as part of a randomized controlled trial of olanzapine and chlorpromazine as add-on to lithium in first episode mania with psychotic features. The current study involved secondary analysis of trial data. RESULTS A co-occurring clinical personality disorder diagnosis was present in 16.9% of patients. Antisocial and narcissistic personality disorders were the most common diagnoses. Patients with co-occurring personality disorder had higher rates of readmission to hospital, lower rates of symptomatic recovery and poorer functional levels at 6 months, but these differences disappeared after 12 and 18 months. CONCLUSIONS In the early phase of bipolar disorder, patients with personality disorder comorbidity display delayed symptomatic and functional recovery and increased likelihood to need hospital readmissions. These observations suggest that routine assessment for personality disorder and specific interventions are important in order to improve short-term treatment efficacy in this subgroup.
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Affiliation(s)
| | | | - Sue M Cotton
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Berk
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Aswin Ratheesh
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julie Ramain
- Department of Psychiatry CHUV, Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Lausanne University, Lausanne, Switzerland
| | - Andrew M Chanen
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Philippe Conus
- Orygen, Melbourne, Victoria, Australia.,Department of Psychiatry CHUV, Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Lausanne University, Lausanne, Switzerland
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Henriques-Calado J, Gonçalves B, Marques C, Paulino M, Gama Marques J, Grácio J, Pires R. In light of the DSM-5 dimensional model of personality: Borderline personality disorder at the crossroads with the bipolar spectrum. J Affect Disord 2021; 294:897-907. [PMID: 34375218 DOI: 10.1016/j.jad.2021.07.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/22/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND State-of-the-art research highlights that borderline personality disorder (PD) and bipolar spectrum disorders have clinical characteristics in common, which imply uncertainty in differential diagnoses. Although there is a growing body of literature on the DSM-5 dimensional model of personality disorder, its discriminative features between these clinical samples are still understudied. In this study, we seek to identify the best set of predictors that differentiate between borderline PD and bipolar spectrum, based on pathological and normative personality traits and symptoms. METHODS A cross-sectional study of three clinical samples: 1) Borderline PD group of 63 participants; 2) Major depressive disorder group of 89 participants; 3) Bipolar disorder group of 65 participants. Self-reported assessment: Personality Inventory for DSM-5; Brief Symptom Inventory; FFM Inventory. A series of one-way ANOVAs and logistic regression analyses were computed. RESULTS The major set of data emerging as common discriminants of borderline PD across the bipolar spectrum are unusual beliefs & experiences, paranoid ideation, obsession-compulsion and extraversion. Depressivity (OR: 34.95) and impulsivity (OR: 22.35) pathological traits displayed the greatest predictive values in the differential diagnosis. LIMITATIONS The small size of the samples; a lack of data from participants' previous clinical history. CONCLUSIONS Findings support the DSM-5 pathological traits as differentiating borderline PD through bipolar spectrum, and reinforcing the joint use of symptom-related pathological functioning and normal-range personality traits. Alongside the bipolar spectrum, borderline pathology sheds light upon a hypothetical overlap along the depressive and schizoaffective/schizophrenia spectra, representing a borderland space at a crossroads with the psychopathology of a meta-spectrum.
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Affiliation(s)
- Joana Henriques-Calado
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal; CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal.
| | - Bruno Gonçalves
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal; CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal
| | - Catarina Marques
- Instituto Universitário de Lisboa (ISCTE-IUL), Business Research Unit, Av. das Forças Armadas, 1649-026 Lisboa, Portugal
| | - Marco Paulino
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal; Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - João Gama Marques
- Clínica de Psiquiatria Geral e Transcultural, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil, 53, 1749-002 Lisboa, Portugal; Clínica Universitária de Psiquiatra e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Jaime Grácio
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal; Champalimaud Research, Champalimaud Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal; NOVA Medical School/ Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Rute Pires
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal; CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal
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Riemann G, Chrispijn M, Weisscher N, Regeer E, Kupka RW. A Feasibility Study of the Addition of STEPPS in Outpatients With Bipolar Disorder and Comorbid Borderline Personality Features: Promises and Pitfalls. Front Psychiatry 2021; 12:725381. [PMID: 34858221 PMCID: PMC8631960 DOI: 10.3389/fpsyt.2021.725381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Pharmacotherapy is a cornerstone in bipolar disorder (BD) treatment whereas borderline personality disorder (BPD) is treated primarily with psychotherapy. Given the overlap in symptomatology, patients with BD may benefit from psychotherapy designed for BPD. Aims: This paper reports the findings of a non-controlled open feasibility study of STEPPS training in patients with BD and borderline personality features (BPF). Methods: Outpatients with BD were screened for BPD, and if positive interviewed with SCID-II. Patients with at least three BPF, always including impulsivity and anger burst, were included in the intervention study. Severity of BD and BPD and quality of life were assessed. Descriptive statistics were performed. Results: Of 111 patients with BD 49.5% also screened positive on BPD according to PDQ-4+, and 52.3% of these had BPD according to SCID-II. Very few participants entered the intervention study, and only nine patients completed STEPPS. Descriptive statistics showed improvement on all outcome variables post treatment, but no longer at 6-month follow up. We reflect on the potential reasons for the failed inclusion. Conclusion: Features of BPD were highly prevalent in patients with BD. Still, recruiting patients for a psychological treatment originally designed for BPD proved to be difficult. Feedback of participants suggests that the association of STEPPS with "borderline" had an aversive effect, which may have caused limited inclusion for screening and subsequent drop-out for the treatment. Therefore, STEPPS should be adapted for BD to be an acceptable treatment option. Clinical Trial Registration: www.ClinicalTrials.gov/3856, identifier: NTR4016.
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Affiliation(s)
- Georg Riemann
- Department of Applied Psychology, Saxion University of Applied Sciences, Deventer, Netherlands.,Dimence Mental Health, Center for Bipolar Disorders, Deventer, Netherlands
| | - Melissa Chrispijn
- Dimence Mental Health, Center for Bipolar Disorders, Deventer, Netherlands
| | - Nadine Weisscher
- Geestelijke Gezondheids Zorg (GGZ) Heuvelrug, Center for Mental Health, Driebergen, Netherlands
| | - Eline Regeer
- Center for Bipolar Disorders, Altrecht Institute for Mental Health Care, Utrecht, Netherlands
| | - Ralph W Kupka
- Center for Bipolar Disorders, Altrecht Institute for Mental Health Care, Utrecht, Netherlands.,Amsterdam University Medical Center (UMC), Department of Psychiatry, VU University, Amsterdam, Netherlands.,Geestelijke Gezondheids Zorg (GGZ) InGeest, Center for Mental Health Care, Amsterdam, Netherlands
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Kamali M, Saunders EFH, Assari S, Ryan KA, Marshall DF, McInnis MG. Mood, Dimensional Personality, and Suicidality in a Longitudinal Sample of Patients with Bipolar Disorder and Controls. Suicide Life Threat Behav 2019; 49:1360-1378. [PMID: 30450613 DOI: 10.1111/sltb.12529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/09/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the effects of mood and anxiety symptoms in relation to personality dimensions and clinical features such as trauma and substance use on suicidal behaviors in a longitudinal sample of individuals with bipolar illness (BP) and healthy controls (HC). METHODS Mood, personality, and clinical features were assessed in 151 individuals with BP I and 119 HC. Clinical data were collected at baseline and at 2-year follow-up. Personality traits were measured using the NEO PI-R. RESULTS In bivariate analyses, personality measures were significantly different between BP and HC, and between BP based on suicide attempt history. However, in regression analyses, baseline measures of depression, mania, anxiety, trauma, education, and age of BP onset correlated with personality domains, while a history of suicide attempts did not. Logistic regressions showed that prospective depression or mania, and a pattern of mixed mood features and chronicity of illness, along with two Neuroticism facet scores (N4-Self-Consciousness and N6-Vulnerability) were predictive of suicide ideation (SI) in the 2-year follow-up period. CONCLUSIONS While dimensions of personality, trauma, and substance use clearly correlated with suicidal behaviors in BP, in multivariate models emerging mood symptoms were the most robust predictors of suicidality. These results reinforce the importance and attributable role of mood and anxiety symptoms in evaluating suicidal risk.
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Affiliation(s)
- Masoud Kamali
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Erika F H Saunders
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Kelly A Ryan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - David F Marshall
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Tyrer P, Mulder R, Kim YR, Crawford MJ. The Development of the ICD-11 Classification of Personality Disorders: An Amalgam of Science, Pragmatism, and Politics. Annu Rev Clin Psychol 2019; 15:481-502. [PMID: 30601688 DOI: 10.1146/annurev-clinpsy-050718-095736] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The nomenclature of personality disorders in the 11th revision of the International Classification of Diseases and Related Health Problems represents the most radical change in the classification history of personality disorders. A dimensional structure now replaces categorical description. It was argued by the Working Group that only a dimensional system was consistent with the empirical evidence and, in the spirit of clinical utility, the new system is based on two steps. The first step is to assign one of five levels of severity, and the second step is to assign up to five prominent domain traits. There was resistance to this structure from those who feel that categorical diagnosis, particularly of borderline personality disorder, should be retained. After lengthy discussion, described in detail here, there is now an option for a borderline pattern descriptor to be selected as a diagnostic option after severity has been determined.
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Affiliation(s)
- Peter Tyrer
- Centre for Psychiatry, Department of Medicine, Imperial College London, London W12 0NN, United Kingdom; ,
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch 8140, New Zealand;
| | - Youl-Ri Kim
- Department of Psychiatry, Seoul Paik Hospital, Inje University, Seoul 100-032, South Korea;
| | - Mike J Crawford
- Centre for Psychiatry, Department of Medicine, Imperial College London, London W12 0NN, United Kingdom; ,
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Abstract
PURPOSE OF REVIEW To provide an update of the recent studies, which have evaluated the radical changes in personality disorder classification in DSM-5 and ICD-11. RECENT FINDINGS Although the DSM-5 Committee rejected the personality disorders Work Group proposal for personality disorder classification, the model was published in DSM-5 Section III. This Alternative Model of Personality Disorders (AMPD) has been widely adopted by the research community resulting in multiple studies evaluating its reliability and clinical utility. The ICD-11 Personality Classification has recently been accepted by the WHO and is also receiving increasing study. Both models emphasize personality disorder severity, which most studies report is consistently linked to impairment and outcome. Both models propose five descriptive domains, which appear to capture most of the current personality disorder diagnoses, and can also be linked to disease extremes of normal personality such as the Five Factor Model. SUMMARY The changes in DSM-5 AMPD and ICD-11 represent a significant paradigm shift in the diagnosis of personality disorders. Early research suggests that the changes may be beneficial for clinicians and researchers. The models more closely align with the large body of literature supporting dimensional models of normal personality. The severity dimensions are consistent with the large body of evidence that personality disorder severity is a strong determinant of impairment and outcome. It remains to be seen if clinicians will use the classification to plan and predict treatment for a wide range of mental disorders.
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Argolo L, Batista F, Bezerra-Filho S, Kapczinski F, Miranda-Scippa Â. Case series of diagnostic shift from bipolar disorder to schizoaffective disorder. Nord J Psychiatry 2018; 72:232-235. [PMID: 29189086 DOI: 10.1080/08039488.2017.1411524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe three cases of diagnostic shift from bipolar I disorder (BD) to schizoaffective disorder (SAD). METHODS BD patients were clinically assessed and followed up in a mood disorder program. A questionnaire was applied to assess clinical and socio-demographic characteristics, and a Structured Clinical Interview (SCID-I) was conducted. RESULTS We identified three patients with diagnosis conversion to SAD from 2005 to 2016. The mean time between BD diagnosis and the diagnostic shift to SAD was 9 years. CONCLUSIONS Psychotic symptoms may become persistent, chronic and unrelated to the presence of mood episodes many years after the beginning of BD. Psychiatrists should be aware of this and reassess the diagnosis during the longitudinal course of BD, especially in those patients who present psychotic symptoms.
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Affiliation(s)
- Lucas Argolo
- a Medicine and Health Postgraduate Program , Federal University of Bahia , Salvador , BA , Brazil.,b Mood and Anxiety Disorders Program (CETHA) , Federal University of Bahia , Salvador , BA , Brazil.,c Department of Life Sciences , State University of Bahia , Salvador , BA , Brazil
| | - Fabrício Batista
- b Mood and Anxiety Disorders Program (CETHA) , Federal University of Bahia , Salvador , BA , Brazil
| | - Severino Bezerra-Filho
- a Medicine and Health Postgraduate Program , Federal University of Bahia , Salvador , BA , Brazil.,b Mood and Anxiety Disorders Program (CETHA) , Federal University of Bahia , Salvador , BA , Brazil
| | - Flávio Kapczinski
- d Department of Psychiatry and Behavioral Neurosciences , McMaster University , Hamilton , ON , Canada
| | - Ângela Miranda-Scippa
- a Medicine and Health Postgraduate Program , Federal University of Bahia , Salvador , BA , Brazil.,b Mood and Anxiety Disorders Program (CETHA) , Federal University of Bahia , Salvador , BA , Brazil.,e Department of Neurosciences and Mental Health , Medical School, Federal University of Bahia , Salvador , BA , Brazil
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