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Personality and Mental Health Feb 2021Current UK evidence on the prevalence of personality disorder in homicide is lacking. The aims were to estimate the prevalence of personality disorder in homicide...
BACKGROUND
Current UK evidence on the prevalence of personality disorder in homicide is lacking. The aims were to estimate the prevalence of personality disorder in homicide perpetrators from court reports and carry out a dimensional assessment in keeping with the new ICD-11 classification of the prevalence of severe personality disorder. Associations between severe personality disorder and sociodemographic, historical and offence-related characteristics were then explored.
METHODS
Six hundred court reports from a national case series of homicide perpetrators in England and Wales were analysed using a document-derived version of the Personality Assessment Schedule (PAS-DOC), providing categorical and dimensional personality assessments. The prevalence of personality disorder and severe personality disorder was estimated. Factors associated with the diagnosis of severe personality disorder were examined.
RESULTS
The prevalence of personality disorder using the PAS-DOC was 56.3% (95% confidence interval 52.3%, 60.3%), compared with 16% as diagnosed in reports. Severe personality disorder was present in 62% (n = 338) of all those with a personality disorder and was significantly associated with homicides of strangers and previous violence.
CONCLUSIONS
Severe personality disorder is highly prevalent among perpetrators of homicide, and the finding that it is more prevalent when strangers are the victims stresses both the need for early identification of those at risk of developing severe personality disorder and the development of appropriate early preventive interventions. There is also a need for the development of effective treatment and interventions for those with established severe personality disorder and better identification of this level of disorder by psychiatrists. The forthcoming ICD-11 classification should help in this endeavour. © 2021 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd.
Topics: England; Homicide; Humans; Personality Disorders; Prevalence; Violence
PubMed: 33569927
DOI: 10.1002/pmh.1503 -
Journal of Psychopharmacology (Oxford,... Nov 2022Quetiapine is frequently prescribed to people with personality disorder diagnoses, but this is not supported by evidence or treatment guidelines.
BACKGROUND
Quetiapine is frequently prescribed to people with personality disorder diagnoses, but this is not supported by evidence or treatment guidelines.
AIMS
To examine associations between periods of quetiapine prescribing and self-harm events in people with personality disorder.
METHOD
Self-controlled case series using linked primary care and hospital records covering the period 2007-2017. We calculated incidence rates and incidence rate ratios (IRRs) for self-harm events during periods when people were prescribed (exposed to) quetiapine, as well as periods when they were unexposed or pre-exposed to quetiapine.
RESULTS
We analysed data from 1,082 individuals with established personality disorder diagnoses, all of whom had at least one period of quetiapine prescribing and at least one self-harm episode. Their baseline rate of self-harm (greater than 12 months before quetiapine treatment) was 0.52 episodes per year. Self-harm rates were elevated compared to the baseline rate in the month after quetiapine treatment was commenced (IRR 1.85; 95% confidence interval (CI) 1.46-2.34) and remained raised throughout the year after quetiapine treatment was started. However, self-harm rates were highest in the month prior to quetiapine initiation (IRR 3.59; 95% CI 2.83-4.55) and were elevated from 4 months before quetiapine initiation, compared to baseline.
CONCLUSION
Self-harm rates were elevated throughout the first year of quetiapine prescribing, compared to the baseline rate. However, rates of self-harm reduced in the month after patients commenced quetiapine, compared to the month before quetiapine was initiated. Self-harm rates gradually dropped over a year of quetiapine treatment. Quetiapine may acutely reduce self-harm. Longer-term use and any potential benefits need to be balanced with the risk of adverse events.
Topics: Humans; Quetiapine Fumarate; Self-Injurious Behavior; Personality Disorders; Primary Health Care; United Kingdom
PubMed: 36317651
DOI: 10.1177/02698811221131990 -
Journal of Psychiatric Research Aug 2006Neuroimaging has become one of the most important methods in the investigation of the neurobiological underpinnings of borderline personality disorder. Structural and... (Review)
Review
Neuroimaging has become one of the most important methods in the investigation of the neurobiological underpinnings of borderline personality disorder. Structural and functional imaging studies have revealed dysfunction in different brain regions which seem to contribute to borderline symptomatology. This review presents relevant studies using different methodologies: volumetry of limbic and prefrontal regions, investigations of brain metabolism under resting conditions, studies of serotonergic neurotransmission, and challenge studies using emotional, stressful, and sensory stimuli. Dysfunction in a frontolimbic network is suggested to mediate much, if not all of the borderline symptomatology.
Topics: Borderline Personality Disorder; Brain; Brain Mapping; Humans; Personality Disorders; Serotonin; Tomography, X-Ray Computed
PubMed: 16239012
DOI: 10.1016/j.jpsychires.2005.08.011 -
Cells Jan 2023Brain-derived neurotrophic factor () has previously been associated with the pathogenesis of both emotionally unstable personality disorder (EUPD) and suicidal behavior....
Brain-derived neurotrophic factor () has previously been associated with the pathogenesis of both emotionally unstable personality disorder (EUPD) and suicidal behavior. No study has yet investigated -associated epigenetic alterations in a group of severely impaired EUPD and suicidal patients. The discovery cohort consisted of 97 women with emotionally unstable personality disorder (EUPD) with at least two serious suicide attempts (SAs) and 32 healthy female controls. The genome-wide methylation pattern was measured by the Illumina EPIC BeadChip and analyzed by robust linear regression models to investigate mean methylation levels in a targeted analysis conditioned upon severity of suicide attempt. The validation cohort encompassed 60 female suicide attempters, stratified into low- (n = 45) and high-risk groups (n = 15) based on degree of intent-to-die and lethality of SA method, and occurrence of death-by-suicide at follow-up. Mean methylation levels exhibited increased methylation in relation to EUPD ( = 0.0159, percentage mean group difference ~3.8%). Similarly, this locus was confirmed as higher-methylated in an independent cohort of females with severe suicidal behavior ( = 0.0300). Results were independent of age and BMI. This is the first study to reveal emerging evidence of epigenetic dysregulation of with dependence on features known to confer increased risk of suicide deaths (lethality of suicide-attempt method and presence of EUPD diagnosis with history of recent SAs). Further studies investigating epigenetic and genetic effects of on severe suicidal behavior and EUPD are needed to further elucidate the role of epigenetic regulatory mechanisms and neurotrophic factors in relation to suicide and EUPD, and hold potential to result in novel treatment methods.
Topics: Female; Humans; Brain-Derived Neurotrophic Factor; Methylation; Personality Disorders; Suicidal Ideation; Suicide, Attempted
PubMed: 36766691
DOI: 10.3390/cells12030350 -
Journal of Personality Disorders Oct 2014This study provides estimates of the prevalence and demographic features of borderline personality disorder (BPD) in a community sample as well as BPD comorbidity rates...
This study provides estimates of the prevalence and demographic features of borderline personality disorder (BPD) in a community sample as well as BPD comorbidity rates with Axis I and II disorders. In addition, the authors provide data on general functioning and treatment seeking among individuals with BPD. Data from 34,481 participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analyzed. Results suggest that 2.7% of adults in the United States meet diagnostic criteria for BPD, with slightly higher rates of the disorder in females, people in lower income brackets, people younger than 30, and individuals who are separated or divorced. Racial/ethnic differences were evident, with Native Americans (5.0%) and Blacks (3.5%) having significantly higher rates of the disorder, on average, and Asians having significantly lower rates (1.2%). Individuals with a BPD diagnosis were likely to have co-occurring lifetime mood disorders, anxiety disorders, substance use disorders, and other personality disorders. Specifically, 84.8% of individuals with BPD also had a lifetime anxiety disorder, 82.7% had a lifetime mood disorder/episode, and 78.2% were diagnosed with a lifetime substance use disorder. Individuals with BPD showed significant impairment in functioning and were highly likely to seek therapy or receive medication for mental health concerns.
Topics: Adult; Age Distribution; Anxiety Disorders; Borderline Personality Disorder; Comorbidity; Female; Humans; Male; Mood Disorders; Patient Acceptance of Health Care; Personality Disorders; Prevalence; Risk Factors; Sex Distribution; Socioeconomic Factors; Substance-Related Disorders; United States; Young Adult
PubMed: 25248122
DOI: 10.1521/pedi_2012_26_093 -
Personality Disorders Sep 2022A debate has emerged regarding the nature of Level of Personality Functioning (LPF; Criterion A) of the alternative model of personality disorder. The aim of the...
A debate has emerged regarding the nature of Level of Personality Functioning (LPF; Criterion A) of the alternative model of personality disorder. The aim of the current study was to evaluate the distinctiveness of an aspect of LPF, namely, maladaptive self and identity function, from general psychosocial disability by evaluating its incremental utility over that of general psychosocial disability for personality disorder in adolescents. To this end, a measure of maladaptive self and identity function was administered alongside measures of general psychiatric impairment, peer problems, life satisfaction, and academic functioning in 2 samples of adolescents: a community-dwelling sample ( = 379; = 14.70, = 1.74) and a sample of clinically-referred adolescents ( = 74; = 15.05, = 1.47). Using hierarchical regression analyses to test our hypotheses, and consistent with the results from studies in adults, our findings showed that maladaptive self and identity function incremented general psychosocial disability in the association with borderline features with similar magnitude for clinical and community samples when considered together and separately. Results are discussed in the context of current views on the nature and meaning of LPF. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Topics: Adolescent; Adult; Borderline Personality Disorder; Diagnostic and Statistical Manual of Mental Disorders; Humans; Personality; Personality Disorders; Personality Inventory
PubMed: 35201822
DOI: 10.1037/per0000547 -
Journal of Applied Research in... Nov 2022People with intellectual disability often receive diagnoses which may complicate their clinical care. Among these, personality disorder diagnoses are still considered...
'It's working together with what you've got': Healthcare professionals' experiences of working with people with combined intellectual disability and personality disorder diagnoses.
BACKGROUND
People with intellectual disability often receive diagnoses which may complicate their clinical care. Among these, personality disorder diagnoses are still considered contentious. Little is also known on the perspectives of staff caring for people with intellectual disability who have received a personality disorder diagnosis.
METHODS
Three focus groups were carried out to explore 15 healthcare professionals' subjective experiences of working with people with intellectual disability who also have a recorded additional diagnosis of personality disorder. Data were analysed through thematic analysis.
FINDINGS
Four overarching themes were identified: (a) diagnostic issues and the need for person-centred approaches; (b) challenges and adjustments to working with combined intellectual disability and PD diagnoses; (c) the importance of multidisciplinary team training, support, and cohesion; (d) provision issues and barriers to service access.
CONCLUSIONS
The themes are outlined in depth and a number of implications for clinical management and service improvement are discussed.
Topics: Attitude of Health Personnel; Health Personnel; Humans; Intellectual Disability; Personality Disorders; Qualitative Research
PubMed: 35725900
DOI: 10.1111/jar.13020 -
The Australian and New Zealand Journal... Mar 2022Persistence is said to be a feature of personality disorder, but there are few long-term prospective studies of the condition. A total of 200 patients with anxiety and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Persistence is said to be a feature of personality disorder, but there are few long-term prospective studies of the condition. A total of 200 patients with anxiety and depressive disorders involved in a randomised controlled trial initiated in 1983 had full personality status assessed at baseline. We repeated assessment of personality status on three subsequent occasions over 30 years.
METHODS
Personality status was recorded using methods derived from the Personality Assessment Schedule, which has algorithms for allocating Diagnostic and Statistical Manual of Mental Disorders (DSM) and the 11th International Classification of Diseases (ICD-11) categories. The category and severity of personality diagnosis were recorded at baseline in the randomised patients with DSM-III anxiety and depressive diagnoses. The same methods of assessing personality status was repeated at 2, 12 and 30 years after baseline.
RESULTS
Using the ICD-11 system, 47% of patients, mainly those with no personality disturbance at baseline, retained their personality status; of the others 16.8% improved and 20.4% worsened to more severe disorder. In DSM-III diagnosed patients, those diagnosed as Cluster A and Cluster C increased in frequency (from 14% to 40%, p < 0.001, and 21.5% to 36%, p < 0.001, respectively) over follow-up, while those with Cluster B showed little change in frequency (22% to 18%, p = 0.197).
CONCLUSION
In this population of patients with common mental disorders, personality status showed many changes over time, inconsistent with the view that personality disorder is a persistent or stable condition. The increase in diagnoses within the Cluster A and C groups suggests personality disorder generally increases in frequency as people age.
Topics: Cohort Studies; Diagnostic and Statistical Manual of Mental Disorders; Humans; Neurotic Disorders; Personality; Personality Disorders; Prospective Studies
PubMed: 34250845
DOI: 10.1177/00048674211025624 -
Comprehensive Psychiatry 2007This study examined the construct validity of narcissistic personality disorder (NPD) by examining the relations between NPD and measures of psychologic distress and...
This study examined the construct validity of narcissistic personality disorder (NPD) by examining the relations between NPD and measures of psychologic distress and functional impairment both concurrently and prospectively across 2 samples. In particular, the goal was to address whether NPD typically "meets" criterion C of the DSM-IV definition of Personality Disorder, which requires that the symptoms lead to clinically significant distress or impairment in functioning. Sample 1 (n = 152) was composed of individuals receiving psychiatric treatment, whereas sample 2 (n = 151) was composed of both psychiatric patients (46%) and individuals from the community. Narcissistic personality disorder was linked to ratings of depression, anxiety, and several measures of impairment both concurrently and at 6-month follow-up. However, the relations between NPD and psychologic distress were (a) small, especially in concurrent measurements, and (b) largely mediated by impaired functioning. Narcissistic personality disorder was most strongly related to causing pain and suffering to others, and this relationship was significant even when other Cluster B personality disorders were controlled. These findings suggest that NPD is a maladaptive personality style which primarily causes dysfunction and distress in interpersonal domains. The behavior of narcissistic individuals ultimately leads to problems and distress for the narcissistic individuals and for those with whom they interact.
Topics: Activities of Daily Living; Adaptation, Psychological; Adult; Anxiety Disorders; Depressive Disorder; Diagnostic and Statistical Manual of Mental Disorders; Female; Follow-Up Studies; Humans; Interpersonal Relations; Male; Middle Aged; Personality Disorders; Personality Inventory; Sex Factors
PubMed: 17292708
DOI: 10.1016/j.comppsych.2006.10.003 -
BMC Psychiatry Mar 2022Although personality disorders are common and consequential, they are largely ignored in geriatric mental healthcare. We examined the relative contributions of different... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Although personality disorders are common and consequential, they are largely ignored in geriatric mental healthcare. We examined the relative contributions of different aspects of personality disorders and comorbid mental disorders to the impairment of mental wellbeing in older adults.
METHODS
Baseline data were used of 138 patients who participated in a randomized controlled trial on schema therapy for geriatric mental health outpatients with a full or subthreshold cluster B or C personality disorder. Personality was assessed according to both the categorical and dimensional model of DSM-5. Aspects of mental wellbeing assessed were; psychological distress, positive mental health, subjective health, and life satisfaction. The current study uses baseline data of the RCT to examine the associations between different aspects of personality pathology and mental wellbeing by multivariate regression analysis, controlling for age, sex, level of education, and number of chronic somatic illnesses.
RESULTS
The vast majority of patients (79.0%) had one or more mental disorders in addition to personality disorder. Personality pathology was responsible for the core of the mental health burden experienced by patients, and negated the influence of co-occurring mental disorders when entered subsequently in multivariate analysis. Personality dimensions proved to be highly predictive of mental wellbeing, and this contrasted with absence of influence of personality disorder diagnosis. Although the personality functioning dimensions - and in particular Identity integration (large effect size with partial eta-squared = 0.36) - were the primary predictors of mental wellbeing, personality trait dimensions added significant predictive value to that (Disinhibition 0.25 and Negative affect 0.24).
CONCLUSIONS
Personality disorders seriously affect the mental wellbeing of patients, and this overshadows the impact of comorbid mental disorders. In particular personality functioning and pathological traits of the Alternative Model of Personality Disorders (AMPD) of DSM-5 contribute to this impact on mental wellbeing. Alertness for and treatment of personality disorders in geriatric mental healthcare seems warranted.
Topics: Aged; Diagnostic and Statistical Manual of Mental Disorders; Humans; Personality; Personality Disorders; Personality Inventory; Regression Analysis
PubMed: 35331179
DOI: 10.1186/s12888-022-03857-8