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Psychological Medicine Oct 2020Investigation of personality traits and pathology in large, generalizable clinical cohorts has been hindered by inconsistent assessment and failure to consider a range...
BACKGROUND
Investigation of personality traits and pathology in large, generalizable clinical cohorts has been hindered by inconsistent assessment and failure to consider a range of personality disorders (PDs) simultaneously.
METHODS
We applied natural language processing (NLP) of electronic health record notes to characterize a psychiatric inpatient cohort. A set of terms reflecting personality trait domains were derived, expanded, and then refined based on expert consensus. Latent Dirichlet allocation was used to score notes to estimate the extent to which any given note reflected PD topics. Regression models were used to examine the relationship of these estimates with sociodemographic features and length of stay.
RESULTS
Among 3623 patients with 4702 admissions, being male, non-white, having a low burden of medical comorbidity, being admitted through the emergency department, and having public insurance were independently associated with greater levels of disinhibition, detachment, and psychoticism. Being female, white, and having private insurance were independently associated with greater levels of negative affectivity. The presence of disinhibition, psychoticism, and negative affectivity were each significantly associated with a longer stay, while detachment was associated with a shorter stay.
CONCLUSIONS
Personality features can be systematically and scalably measured using NLP in the inpatient setting, and some of these features associate with length of stay. Developing treatment strategies for patients scoring high in certain personality dimensions may facilitate more efficient, targeted interventions, and may help reduce the impact of personality features on mental health service utilization.
Topics: Adult; Cohort Studies; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Electronic Health Records; Female; Humans; Inpatients; International Classification of Diseases; Length of Stay; Machine Learning; Male; Middle Aged; Natural Language Processing; Personality Disorders
PubMed: 31544723
DOI: 10.1017/S0033291719002320 -
Psychiatry and Clinical Neurosciences Feb 1998Double-blind, placebo-controlled trials of pharmacotherapy for personality disorders (PD) were reviewed, and the indications concluded were as follows: (1) Severe cases... (Review)
Review
Double-blind, placebo-controlled trials of pharmacotherapy for personality disorders (PD) were reviewed, and the indications concluded were as follows: (1) Severe cases of both Borderline Personality Disorder (BDP) and Schizotypal Personality Disorder (SPD) respond to low dose antipsychotic drugs resulting in improvement of a broad spectrum of symptoms. They also respond to monoamine oxidase inhibitor (MAOI). Amitriptyline causes a paradoxical effect. (2) Borderline personality disorder with behavioral dyscontrol responds to carbamazepine which reduces actual episodes of dyscontrol, to an antipsychotic drug and to MAOI. Alprazolam is associated with an increase in suicidality and dyscontrol. Borderline personal disorder or Histrionic Personality Disorder with a tendency to suicide, responds to a depot antipsychotic drug. Personality disorders with aggressive behavior respond to lithium. Moderately severe PD with explosive behavior respond to oxazepam, but at a dose where the side effect is sedation. (3) Borderline personality disorder and SPD with psychotic symptoms respond to an antipsychotic drug which improves psychotic symptoms as well as neurotic symptoms. Emotionally Unstable Character Disorder with a disturbance of mood swings, responds to lithium. Adolescent PD respond to an antipsychotic drug. (4) Comorbid atypical depression of histrionic personality and BPD respond to MAOI or imipramine. Comorbid neurotic disorder of PD responds to dothiepin. Comorbid social phobia of avoidant and dependent PD responds to MAOI.
Topics: Antipsychotic Agents; Clinical Trials as Topic; Double-Blind Method; Humans; Personality Disorders; Psychotropic Drugs
PubMed: 9682928
DOI: 10.1111/j.1440-1819.1998.tb00967.x -
Lakartidningen Dec 2016Compliance and patience is needed when meeting patients with personality disorder To encounter patients with personality disorders in health care settings is often... (Review)
Review
Compliance and patience is needed when meeting patients with personality disorder To encounter patients with personality disorders in health care settings is often challenging. Most treatment studies published have included only patients with borderline personality disorder. Of evaluated psychological treatments in borderline personality disorder, dialectical behaviour therapy (DBT) has the strongest research support, followed by mentalization based therapy (MBT). Pharmacological treatment in personality disorders should focus on time-limited crisis intervention and treatment of comorbidity. There are few studies on inpatient care of persons with personality disorder. However, there are some interesting projects on brief self-directed inpatient stays as crisis intervention. There is a consensus to avoid long inpatient stays and coercive measures as far as possible.
Topics: Behavior Therapy; Borderline Personality Disorder; Crisis Intervention; Humans; Patient-Centered Care; Personality Disorders; Professional-Patient Relations; Psychotherapy
PubMed: 27959459
DOI: No ID Found -
Addiction (Abingdon, England) Aug 2018Individual differences in DSM-IV personality disorders (PDs) are associated with increased prevalence of substance use disorders. Our aims were to determine which...
BACKGROUND AND AIMS
Individual differences in DSM-IV personality disorders (PDs) are associated with increased prevalence of substance use disorders. Our aims were to determine which combination of PDs trait scores best predict cannabis use (CU) and cannabis use disorder (CUD), and to estimate the size and significance of genetic and environmental risks in PD traits shared with CU and CUD.
DESIGN
Linear mixed-effects models were used to identify PD traits for inclusion in twin analyses to explore the genetic and environmental associations between the traits and cannabis use.
SETTING
Cross-sectional data were obtained from Norwegian adult twins in a face-to-face interview in 1999-2004 as part of a population-based study of mental health.
PARTICIPANTS
Subjects were 1419 twins (μ = 28.2 years, range = 19-36) from the Norwegian Institute of Public Health Twin Panel with complete PD and cannabis data.
MEASUREMENTS
PD traits were assessed using DSM-IV criteria. Life-time CU and CUD were based on DSM-IV abuse and dependence criteria, including withdrawal and craving.
FINDINGS
After adjusting for age and sex, antisocial [β = 0.23, 95% confidence interval (CI) = 0.19-0.28] and borderline PDs (β = 0.20, 95% CI = 0.14-0.26) were associated strongly with CU. Antisocial (β = 0.26, 95% CI = 0.21-0.31) and borderline PDs (β = 0.12, 95% CI = 0.06-0.18) were also linked strongly to CUD. Genetic risks in antisocial and borderline PD traits explained 32-60% of the total variance in CU and CUD. Dependent and avoidant PDs explained 11 and 16% of the total variance in CU and CUD, respectively.
CONCLUSIONS
Individual differences in the liability to cannabis use and cannabis use disorder appear to be linked to genetic risks correlated with antisocial and borderline personality disorder traits.
Topics: Adult; Antisocial Personality Disorder; Borderline Personality Disorder; Dependent Personality Disorder; Female; Humans; Male; Marijuana Abuse; Marijuana Use; Norway; Personality Disorders; Young Adult
PubMed: 29500852
DOI: 10.1111/add.14209 -
Psychological Bulletin Jul 2017Personality disorders are defined in the current psychiatric diagnostic system as pervasive, inflexible, and stable patterns of thinking, feeling, behaving, and... (Meta-Analysis)
Meta-Analysis Review
Personality disorders are defined in the current psychiatric diagnostic system as pervasive, inflexible, and stable patterns of thinking, feeling, behaving, and interacting with others. Questions regarding the validity and reliability of the current personality disorder diagnoses prompted a reconceptualization of personality pathology in the most recent edition of the psychiatric diagnostic manual, in an appendix of emerging models for future study. To evaluate the construct and discriminant validity of the current personality disorder diagnoses, we conducted a quantitative synthesis of the existing empirical research on associations between personality disorders and interpersonal functioning, defined using the interpersonal circumplex model (comprising orthogonal dimensions of agency and communion), as well as functioning in specific relationship domains (parent-child, family, peer, romantic). A comprehensive literature search yielded 127 published and unpublished studies, comprising 2,579 effect sizes. Average effect sizes from 120 separate meta-analyses, corrected for sampling error and measurement unreliability, and aggregated using a random-effects model, indicated that each personality disorder showed a distinct profile of interpersonal style consistent with its characteristic pattern of symptomatic dysfunction; specific relationship domains affected and strength of associations varied for each personality disorder. Overall, results support the construct and discriminant validity of the personality disorders in the current diagnostic manual, as well as the proposed conceptualization that disturbances in self and interpersonal functioning constitute the core of personality pathology. Importantly, however, contradicting both the current and proposed conceptualizations, there was not evidence for pervasive dysfunction across interpersonal situations and relationships. (PsycINFO Database Record
Topics: Humans; Interpersonal Relations; Personality Disorders
PubMed: 28447827
DOI: 10.1037/bul0000101 -
BMC Psychiatry Mar 2024Personality disorders (PDs) are associated with an inferior quality of life, poor health, and premature mortality, leading to heavy clinical, familial, and societal... (Review)
Review
Personality disorders (PDs) are associated with an inferior quality of life, poor health, and premature mortality, leading to heavy clinical, familial, and societal burdens. The International Classification of Diseases-11 (ICD-11) makes a thorough, dramatic paradigm shift from the categorical to dimensional diagnosis of PD and expands the application into adolescence. We have reviewed the recent literature on practical implications, and severity and trait measures of ICD-11 defined PDs, by comparing with the alternative model of personality disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), by mentioning the relevance in forensic and social concerns, and by referencing the developmental implication of life span, especially in adolescence. Study results strongly support the dimensional utility of ICD-11 PD diagnosis and application in adolescence which warrants early detection and intervention. More evidence-based research is needed along the ICD-11 PD application, such as its social relevance, measurement simplification, and longitudinal design of lifespan observation and treatment.
Topics: Adolescent; Humans; International Classification of Diseases; Quality of Life; Personality Disorders; Diagnostic and Statistical Manual of Mental Disorders; Mortality, Premature; Personality
PubMed: 38454364
DOI: 10.1186/s12888-024-05640-3 -
Medicine, Science, and the Law Jul 2012The Response to Offender Personality Disorder Consultation was released in October 2011. For some this is a welcome step in the right direction due to its therapeutic... (Review)
Review
The Response to Offender Personality Disorder Consultation was released in October 2011. For some this is a welcome step in the right direction due to its therapeutic optimism, however for practitioners operating in the secure estate there are significant challenges ahead. This aim of this article is to discuss the increasing convergence of health and criminal justice and their inherent ideological and practical difficulties. It does so with reference to the consultation on offender personality disorder pathways and in particular the implications regarding multi-disciplinary and cross agency approaches to risk, public protection and personality disorder respectfully. It concludes that before embarking on a new wave of determining and responding to those with personality disorder, offender or otherwise, a more in-depth and empirically informed critical reflection is warranted.
Topics: Commitment of Mentally Ill; Dangerous Behavior; Hospitals, Psychiatric; Humans; Mental Health Services; Personality Disorders; State Medicine; United Kingdom
PubMed: 22833481
DOI: 10.1258/msl.2011.011112 -
Psychiatria Danubina Jun 2010After 30 years of clinical work and research based on categorical criteria for personality disorders (Diagnostic and Statistical manual of Mental Disorders - DSM IV TR)... (Review)
Review
After 30 years of clinical work and research based on categorical criteria for personality disorders (Diagnostic and Statistical manual of Mental Disorders - DSM IV TR) and (International Classification of Diseases - ICD 10th revision), a solid conceptual understanding and treatment of these disorders have not been established. For the field to move forward, it is imperative that future classifications introduce major revisions of the concept, diagnosis, and classification of personality disorders. This paper proposes one such revision. Based on recent advances in molecular biology and epigenetics, we define personality disorders as maladaptive syndromes developed trough person-environment interaction. We conceptualize maladaptation as a failure of integrative functions of personality (i.e., those that carry out adaptive processes) caused by strong biogenetic dispositions or by pathological environmental effects, or both. Hence, accurate diagnosis of personality disorder depends upon neurobiological (innate) and adaptive (interactive) etiological factors. We propose a 2-step diagnostic algorithm for personality disorders: adaptive processes (i.e., character) are used to diagnose maladaptation, whereas biological aspects (i.e., temperament) are used to specify dominant clinical presentation and for differential diagnosis. We suggest that the term "Personality Disorder" be replaced by a more appropriate term "Adaptation Disorder" as the latter reflects more accurately the real nature of the disorder and distributes the causality of maladaptive syndromes more evenly, between the person and the environment. Diagnostic, research, and treatment advantages of the proposed solution are discussed in some detail.
Topics: Adaptation, Psychological; Algorithms; Character; Diagnostic and Statistical Manual of Mental Disorders; Epigenesis, Genetic; Gene Expression Regulation; Genetic Predisposition to Disease; Humans; Personality Assessment; Personality Development; Personality Disorders; Social Environment; Temperament
PubMed: 20562740
DOI: No ID Found -
Psychopathology 2020This paper reviews maladaptive trait development (DSM-5 Section III Criterion B), the development of DSM-5 Section II borderline personality disorder, and research on... (Review)
Review
This paper reviews maladaptive trait development (DSM-5 Section III Criterion B), the development of DSM-5 Section II borderline personality disorder, and research on the development of identity, self-direction, empathy/mentalizing, and intimacy (DSM-5 Section III Criterion A). Combined, these previously disparate literatures begin to point to an integrated developmental theory of personality pathology, which suggests that Criterion A concepts (identity, self-direction, empathy, and intimacy) coalesce around the development of self, marking a discontinuous (qualitative) developmental shift. This developmental shift is a function of the demands placed on individuals to take on independent adult role function, combined with biologically-based maturational cognitive and emotional advances during adolescence. Section II personality disorder ensues when an integrated and coherent sense of self fails to develop, resulting in nonfulfilment of adult role function. In this sense, Criterion A self function can account for the onset of Section II personality disorder in adolescence, while Criterion B provides a useful descriptive account of continuous aspects of personality function over time.
Topics: Adolescent; Female; Humans; Male; Personality Disorders; Personality Inventory
PubMed: 32464626
DOI: 10.1159/000507588 -
Personality Disorders Oct 2017Existing categorical models of personality disorder diagnoses capture heterogeneous populations in terms of symptom presentation and etiological influences on... (Review)
Review
Existing categorical models of personality disorder diagnoses capture heterogeneous populations in terms of symptom presentation and etiological influences on personality pathology. Though several well-validated alternative dimensional trait models (i.e., variable-centered approaches) of personality disorders have been developed, person-centered approaches can provide important additional information on both the phenotypic expression and etiology of personality pathology. We discuss the utility and necessary attributes of person-centered or subtype models of personality disorders and briefly review statistical approaches and other methodological considerations, drawing specific examples from the psychopathy literature. We conclude by advocating a utilitarian approach whereby person-centered and variable-centered methods complement each other to better understand personality disorders. (PsycINFO Database Record
Topics: Humans; Male; Models, Psychological; Personality; Personality Disorders; Research Design
PubMed: 29022733
DOI: 10.1037/per0000212