Coexistence between personality disorders and substance use disorder. Madrid study about prevalence of dual pathology

INTRODUCTION

Personality disorders (PD) and substance use disorders (SUD) have a high prevalence and an important health and socioeconomic impact so, it is interesting to study the relationship between them. The objectives of the study are: to compare the prevalence of SUD between patients with and without diagnosis of PD, to analyze if any PD is related to the SUD, and if a specific PD is associated with a specific SUD.

MATERIAL AND METHODS

Cross-sectional study in 837 patients from centers of attention to drug addiction and mental health in Madrid, Spain. The Mini International Neuropsychiatric Interview (MINI) and the Personality Diagnostic Questionnaire-4+ (PDQ4+) are used to detect mental disorder and PD, respectively.

RESULTS

SUD is significantly higher in antisocial PD (p<0.01); sedative (p<0.01) and alcohol (p<0.05) use disorder in borderline PD; cocaine (p<0.05) and alcohol (p<0.01) use disorder in paranoid PD; and alcohol use disorder in histrionic PD (p<0.01). The SUD for cocaine is lower in obsessive- compulsive PD (p<0.05) and depressive PD (p<0.01). There is a positive correlation between the number of PD of a subject and the number of SUD that it presents. The risk of an alcohol [OR of 1,08 CI (1,01-1,16)] or sedatives [OR of 1,08 CI (1,001-1,17)] use disorders increases if an individual presents more than one type of PD.

CONCLUSIONS

There is not differences of SUD prevalence between PD and not PD groups. We found an association between SUD and PD of cluster B (antisocial, borderline and histrionic) and also with paranoid PD. The SUD are more common among man with the exception of sedatives.

Gender differences in the prevalence and impact factors of hysterical tendencies in adolescents from three eastern Chinese provinces

BACKGROUND

Few studies have attempted to compare the differences in the prevalence and impact factors of hysterical tendencies (HTs) in adolescents. Thus, the aim of this study was to examine gender differences in the prevalence and impact factors of adolescents' HTs across three eastern Chinese provinces (Anhui, Jiangsu, and Zhejiang).

METHODS

A multicenter, school-based, cross-sectional study was conducted in three provinces (Anhui, Jiangsu, and Zhejiang) in China in 2014. The sample included 10,131 middle-school students aged 13-18 years who were randomly selected using a multiphase, stratified, cluster sampling technique. A two-stage appraisal procedure was used to determine the adolescents' HTs. We also designed a multicenter, school-based, case control (1329 cases with 2661 control individuals) study to collect data on the common factors affecting this population using a common protocol and questionnaire.

RESULTS

An overall positive rate of HTs among adolescents across the three eastern Chinese provinces studied was found at 13.1% (95% confidence interval (CI) 12.5-13.8%), at 14.5% (95% CI 13.3-15.7%) for females, and at 12.2% (95% CI 11.1-13.4%) for males. Gender-stratified, multiple conditional regression analyses revealed that superstitious beliefs pertaining to life, somatotype, teacher-student satisfaction, and family achievement orientation were significantly linked to HTs only in males, while left-behind adolescents, emotional and social adaptation, teacher-student support, family cohesion, and the Hospital Anxiety and Depression Scale - depression scores were significantly associated with female HTs only. The models indicated that of all the independent variables studied, family medical history was the strongest impact factor for both male HTs (adjusted matched odds ratio (amOR) = 2.92, 95% CI = 1.84-4.86) and female HTs (amOR = 2.74, 95% CI = 1.59-4.98).

CONCLUSIONS

HTs are prevalent among adolescents in the three eastern Chinese provinces studied. Gender differences in the prevalence and impact factors of HTs are significant in adolescents, and HTs seem to affect more females than males. Therefore, sex-specific intervention programs against HTs in adolescents should be considered to reduce HT prevalence in adolescents by modifying influential social, school, and family factors.

Paternal malparenting and offspring personality disorders: Mediating effect of early maladaptive schemas

OBJECTIVE

To examine the mediating role of maladaptive schemas between permissive/authoritarian parenting by fathers and personality disorders, including histrionic, antisocial, narcissistic and depressive attitudes among adults.

METHODS

This cross-sectional study was conducted at the University of Sargodha, Sargodha, Pakistan, and comprised university students. Data was collected by administering the parental authority questionnaire, the young schema questionnaire and the personality diagnostic questionnaire. SPSS 23 was used for data analysis. The study was completed in one year. It was started from June 2014 and ended in June 2015.

RESULTS

Of the 200 participants who were handed the questionnaires, 100(50%) returned it fully filled up. Of them, 87(87%) were women and 13(13%) were men. All scales had greater than 0.70 alpha reliability coefficients. The values of skewness for all scales ranged from 0.10 to 0.86.Permissive parenting style had positive correlation with histrionic (p<0.05), narcissistic (p<0.05) and antisocial personality disorders (p<0.01). Authoritarian parenting had positive correlation with early maladaptive schemas (p<0.01) and depressive personality disorder (p<0.05).

CONCLUSIONS

Both permissive and authoritarian parenting styles led to personality disorders among offspring in the adult phase of their lives.

Measuring IPDE-SQ personality disorder prevalence in pre-sentence and early-stage prison populations, with sub-type estimates

Understanding the prevalence and type of personality disorder within prison systems allows for the effective targeting of resources to implement strategies to alleviate symptoms, manage behaviour and attempt to reduce re-offending. This study aimed to determine the prevalence of personality disorder (PD) traits within a local urban high-turnover adult male prison with a remand/recently sentenced population in London, UK. The International Personality Disorder Examination - Screening Questionnaire (IPDE-SQ) self-administered questionnaire (ICD-10 version) was completed by 283 prisoners (42% completion rate). 77% of respondents reached the threshold for one or more PDs. The most common PD types were Paranoid PD (44.5%), Anankastic PD (40.3%), Schizoid PD (35%) and Dissocial PD (25.8%). These results confirm and extend existing knowledge regarding the prevalence of PD in prison populations into a high-turnover, urban, remand population. The stark comparison with community samples indicates that a more equitable standard of service delivery within the criminal justice system, focussing on preventive and early intervention services, is now required.

Cluster B maladaptive personality traits in Spanish adolescents

INTRODUCCTION

The prevalence and expression of Cluster B personality disorders during adolescence have been poorly analyzed. The main aim of this research was to analyze the rate of Cluster B maladaptive personality traits in Spanish adolescents. We also examined dimensional structure underlying the influence of sex and age in its phenotypic expression, was also examined.

METHOD

The sample consisted of a total of 1440 participants (Mean=15.9 years, SD=1.2). The self-reporting questionnaire used was the Personality Diagnostic Questionnaire-4 + (PDQ-4 +).

RESULTS

Maladaptative «dramatic» or «erratic» personality traits are common among adolescents, particularly antisocial and borderline facets. Using the PDQ-4+ cut-off points, 20.3% of the sample submitted had a Cluster B personality disorder. The analysis of the internal structure of the Cluster B items of the PDQ-4 + yielded a factorial solution centred on three interrelated factors, including: Antisocial, Borderline and Histrionic/Narcissistic. There were differences by gender in the subscales of Cluster B, but not in function of age.

CONCLUSIONS

These data yield new insights that improve the understanding of the Cluster B personality disorders and traits in this sector of the population. Future studies should use measurement tools that take into account the concern, conviction and distress associated with such experiences.

Borderline personality and substance use in women

The association between borderline personality disorder (BPD) and substance use disorder (SUD) was examined in a predominantly psychiatric (77.6%) sample of 232 women. BPD proved to be a significant predictor of a lifetime diagnosis of SUD across four different categories: any SUD (including alcohol); alcohol use; drug use; and heroin, cocaine, or poly-substance use. BPD continued to be a predictor of SUD even when the effects of other cluster B and all cluster C PDs were controlled statistically. Antisocial personality disorder generally yielded larger odds ratios than BPD and emerged as a partial mediator of the relation between BPD and SUD. Histrionic PD was the only other PD that showed meaningful relations with SUD.

What dimensions underlie cluster B personality disorders?

This report presents a conceptual model of the relationships between personality dimensions and the four personality disorders listed in the B cluster on axis II. The hypothesis will be developed that while impulsivity is the common dimension underlying all four disorders, differences between the categories reflect the severity of impulsive traits, interactions with other personality dimensions, the effects of gender, and the influence of culture. Clinical and research implications of the model are then described.

DSM-III-R axis II comorbidity in dysthymia and major depression

OBJECTIVE

Dysthymia is generally believed to be associated with a high rate of DSM-III-R axis II comorbidity. However, it is unclear whether this rate is higher than that for other axis I disorders, how many dysthymic patients have personality disorders, and what the most common co-occurring axis II conditions are.

METHOD

Ninety-seven outpatients with early-on-set dysthymia and 45 with episodic major depression were administered structured diagnostic interviews for axis I and II disorders. In addition, knowledgeable informants were independently interviewed about axis II conditions in the patients.

RESULTS

A significantly greater proportion of dysthymic patients (60%) than patients with episodic major depression (18%) met criteria for a personality disorder. The most common axis II conditions among dysthymic patients were borderline, histrionic, and avoidant personality disorder. Informants' reports yielded similar results.

CONCLUSIONS

These data indicate that early-onset dysthymia is associated with significantly greater axis II comorbidity than episodic major depression. Further work is necessary to elucidate the processes underlying this association.

Ganser syndrome: a review of 15 cases

Using the diagnostic criteria found in the literature, 15 new cases of Ganser syndrome were examined. A relationship was found between specific premorbid personality traits and severity of the syndrome; a high percentage of the sample belonged to an ethnic minority and was suspected of having symptoms of premorbid neurological pathology.

[Histrionic personality disorder in a psychiatry department at a general hospital]

The personality disturbances imply problem within the psychiatric assistance, both for its difficult delimitation and classification and for the limited results and bad use obtained from therapeutic resources. We studied 402 patients psychiatric service of a general hospital over a period approximately 2 years, 70 (17.5%) were diagnosed DSM-III with Personality disturbances: 44 females (62.9%) and 26 males (37.1%), of an age group between 18 and 67 years old. The most frequent diagnosis was of histrionic of the personality followed by unspecific and border-line. Within the histrionic disturbance of the personality there was a clear predominance of women, whereas in the others types, no significant differences were observed.

An epidemiological study of histrionic personality disorder

In conjunction with the Epidemiological Catchment Area (ECA) survey conducted in Baltimore, MD, a two-stage probability sample of community subjects was developed with a full psychiatric examination employing DSM-III criteria. This report details the observations on those subjects diagnosed with the DSM-III diagnosis Histrionic Personality Disorder. The results indicate that this condition can be diagnosed reliably and that it is a valid construct. It has a prevalence of 2.1% in a general population. Males and females are equally affected, suggesting that prior reports of an increased prevalence in females was an expression of ascertainment bias found in hospital-based studies. The diagnosis is associated with clear evidence of disturbance in the emotional, behavioural, and social realms. Individuals with this disorder tend to use health care facilities more frequently than others.

[Hysterical manifestations in Black Africa. Pilot study conducted at the Neuro-Psycho-Pathology Center, Kinshasa]

In a retrospective study on twenty Zairese patients, presenting a hysterical personality structure, the different forms of decompensation have been described and classified according to the DSM III criteria. Even taking into account the inconstancy of hysterical manifestations and the use of criteria not adapted to the local context, some of the described syndromes seem rather atypical. Such findings should stimulate the African psychiatry to develop its own nosographical criteria.

[Epidemiological factors and personality structure]

The relation between sociodemographic characteristics and structure of personality (MMPI) was analyzed using the results of the "Basle Adolescence Study". Type of housing, family structure, employment of the mother and number of working hours of the father produced statistically significant differences, which, however, were small in respect to the general variability of the structure of personality.