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A cross-sectional testing of The Iowa Personality Disorder Screen in a psychiatric outpatient setting
Ingrid Olss?n, ?ystein S?reb?, Alv A Dahl
BMC Psychiatry , 2011, DOI: 10.1186/1471-244x-11-105
Abstract: In a cross-sectional design 145 patients filled in the IPDS and were examined with the SCID-II interview as reference. Various case-findings properties were tested, interference of socio-demographic and other psychopathology were investigated by logistic regression and relationships of the IPDS and the concept of PDs were studied by a latent variable path analysis.We found that socio-demographic and psychopathological factors hardly disturbed the IPDS as screening instrument. With a cut-off ≥4 the 11 items IPDS version had sensitivity 0.77 and specificity 0.71. A brief 5 items version showed sensitivity 0.82 and specificity 0.74 with cut-off ≥ 2. With exception for one item, the IPDS variables loaded adequately on their respective first order variables, and the five first order variables loaded in general adequately on their second order variable.Our results support the IPDS as a useful screening instrument for PDs present or absent in the POC setting.Several studies have indicated that the prevalence of personality disorders (PDs) is high in the setting of psychiatric outpatient clinics (POCs). From the United States Zimmerman reported a prevalence of 50% [1], while 80% was found by Aln?s & Torgersen [2] in Norway. The variation in prevalence rate depends in part on practical matters like the referral practice of the general practitioners (GPs), and in part on research matters like the instruments used to assess PDs. Frequent co-morbidity of Axis I disorders and PDs regularly demands extensive diagnostic assessments [3,4], and PD as an influential but unacknowledged factor impedes the referral process [5]. The GPs want a qualified diagnostic assessment and advice for further treatment as feedback of their referrals. A correct diagnosis of PDs is of clinical importance since their presence is associated with longer duration, poorer treatment outcome and recurrence of Axis I disorders [6-8]. Identification of such co-morbidity is therefore also important for the choi
Quality of life in patients with personality disorders seen at an ordinary psychiatric outpatient clinic
Kjersti Narud, Arnstein Mykletun, Alv A Dahl
BMC Psychiatry , 2005, DOI: 10.1186/1471-244x-5-10
Abstract: 72 patients with PDs at a POC filled in the MOS Short Form 36 (SF-36), and two established psychiatric self-rating measures. A national norm sample was compared on the SF-36. An independent psychiatrist diagnosed PDs and Axis-I disorders by structured interviews and rated the Global Assessment of Functioning (GAF). All measurements were repeated in the 39 PD patients that attended the 2 years follow-up examination.PD patients showed high co-morbidity with other PDs and Axis I mental disorders, and they scored significantly lower on all the SF-36 dimensions than age- and gender-adjusted norms. Adjustment for co-morbid Axis I disorders had some influence, however. The SF-36 mental health, vitality, and social functioning were significantly associated with the GAF and the self-rated psychiatric measures. Significant changes at follow-up were found in the psychiatric measures, but only on the mental health and role-physical of the SF-36.Patients with PDs seen for treatment at a POC have globally poor QoL. Both physical and mental dimensions of the SF-36 are correlated with established psychiatric measures in such patients, but significant changes in these measures are only partly associated with changes in the SF-36 dimensions.According to the DSM-IV [1] personality disorders (PDs) are characterized by enduringly deviating patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts. Such patterns lead to "clinically significant distress or impairment in social, occupational, or other important areas of functioning". The DSM-IV does not indicate how "clinically significant distress or impairment" (page 633) should be evaluated, however, and a recent study showed that various formulations of this criterion hardly increased diagnostic validity [2].Since the DSM-IV included the Global Assessment of Functioning Scale (GAF) as Axis V, it is reasonable to consider if the GAF should be us
Implementation of outpatient schema therapy for borderline personality disorder: study design
Marjon Nadort, Arnoud Arntz, Johannes H Smit, Josephine Giesen-Bloo, Merijn Eikelenboom, Philip Spinhoven, Thea van Asselt, Michel Wensing, Richard van Dyck
BMC Psychiatry , 2009, DOI: 10.1186/1471-244x-9-64
Abstract: Patient outcome measures will be assessed with a semi-structured interview and self-report measures on BPD, therapeutic alliance, quality of life, costs and general psychopathology at baseline, 6, 12, 18 and 36 months. Intention-to-treat analyses will be executed with survival analysis for dichotomous variables, and one-sample t-tests and ANCOVAs for continuous variables with baseline as covariate and condition as between group factor. All tests will be two-tailed with a significance level of 5%.The study will provide an answer to the question whether ST can be effectively implemented and whether phone support by the therapist has an additional value.The Dutch Cochrane Center, NTR (TC = 1781).Borderline Personality Disorder (BPD) is a disabling psychiatric disorder, which is characterized by substantial distress and disruptions in functioning. It has for long been viewed as a severe and difficult to treat psychiatric condition. However, during recent years several promising treatment possibilities have been developed. Among them, Schema Therapy (ST) was found to be effective regarding all aspects of BPD [1,2]. How well ST can be delivered in regular mental healthcare practice is unknown, but it is expected that its implementation poses challenges.BPD is marked by chronic instability in multiple areas (emotional dysregulation, self-harm, impulsivity and identity disturbance). The lifetime prevalence of BPD in the general population is 1-2%. In psychiatric outpatient settings 10% of the patients suffer from BPD, in psychiatric inpatients settings 20% [3]. The medical and societal costs for BPD are substantial [2,4,5]. About 10% of the BPD patients die because of suicide [6,7].However, recent years showed progress in the development of treatment options [8-14] that are supported by randomized controlled trials [1,7,15-19]. These treatments demonstrated effectiveness on symptom level, as manifested by reduced suicide attempts, fewer acts of self-harm or hospitalizations
Personality Disorders in Brazilian Homeless Compared with Non-Psychiatric and Psychiatric Patients  [PDF]
Daniel Bartholomeu, José M. Montiel, Geraldo A. Fiamenghi Jr., Lucas F. Carvalho, Mara Rubia C. A. Orsini, Cecilia R. Ribeiro
Psychology (PSYCH) , 2015, DOI: 10.4236/psych.2015.68099
Abstract: Personality disorders are regarded as conditions that involve a maladaptive personality functioning. Homelessness is a worldly debated phenomenon. The present study aimed to understand the situation of homelessness related to the health sector, instead of considering it only as a social or economic problem. Research was conducted with three different groups, male and female, living in a Metropolitan area of Southeast Brazil, the first composed of 71 homeless people; the second, 74 psychiatric patients; and the third, 250 college students that completed the Personality Disorders Dimensional Inventory (IDTP). A logit regression model and ROC curve were used to analyse data. Results showed that homeless people scored higher in all dimensions, especially Antisocial and Schizotypal, compared with the other groups. Although the number of participants was reduced to only one part of the country, as well as the correlational design preventing clearer causal inferences, the results of this research call the attention for the need of new investigations to homeless people’s mental health, aiming to focus on public health policies that could deal with the problem.
The psychiatric outpatient's family as a support system
Emmerentia du Plessis,M Greeff,M P Koen
Health SA Gesondheid , 2004, DOI: 10.4102/hsag.v9i2.160
Abstract: During 1998 the discharge of as many as possible psychiatric patients from long-term psychiatric hospitals in the North-West Province, in other words deinstitutionalisation, were planned (Roos, 1998). Opsomming Gedurende 1998 is die ontslag van so veel moontlik psigiatriese pasi nte van langtermyn-psigiatriese hospitale in die Noordwes-Provinsie, met ander woorde de nstitusionalisering, beplan (Roos, 1998). *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.
Affective Spectrum Disorders in an Urban Swedish Adult Psychiatric Unit: A Descriptive Study  [PDF]
M. Scharin,T. Archer,P. Hellstr?m
Depression Research and Treatment , 2012, DOI: 10.1155/2012/527827
Abstract: Background. Several studies have found that patients with affective-/anxiety-/stress-related syndromes present overlapping features such as cooccurrence within families and individuals and response to the same type of pharmacological treatment, suggesting that these syndromes share pathogenetic mechanisms. The term affective spectrum disorder (AfSD) has been suggested, emphasizing these commonalities. The expectancy rate, sociodemographic characteristics, and global level of functioning in AfSD has hitherto not been studied neglected. Material and Method. Out of 180 consecutive patients 94 were included after clinical investigations and ICD-10 diagnostics. Further investigations included well-known self-evaluation instruments assessing psychiatric symptoms, personality disorders, psychosocial stress, adaptation, quality of life, and global level of functioning. A neuropsychological screening was also included. Results. The patients were young, had many young children, were well educated, and had about expected (normal distribution of) intelligence. Sixty-one percent were identified as belonging to the group of AfSD. Conclusion. The study identifies a large group of patients that presents much suffering and failure of functioning. This group is shared between the levels of medical care, between primary care and psychiatry. The term AfSD facilitates identification of patient groups that share common traits and identifies individuals clinically, besides the referred patients, in need of psychiatric interventions. 1. Introduction The organization of psychiatric treatment, following diagnosis, follows an ordering of treatment (1°-2° care) within specialization, child psychiatry, forensic psychiatry, and general psychiatry, subspecialization, psychoses, and affective disorders, all of which facilitates general observations of the patient population. Nevertheless, a consideration of those presenting depression, anxiety disorders, personality disorders (most commonly Clusters B and C, DSM-IV [1]), and stress-related conditions shows minimal analysis beyond diagnosis and treatment cost, thereby precluding realistic goals, treatment designs, and evaluation. Although investigations of pure diagnostic groups reduce confounding variables, constraints on ecological validity, this is the clinical setting of specialized outpatient units (SOUs), imply requirements for neuroscientific assessment of patients under these conditions in combination with epidemiological data unfettered by admittance selection based on symptom severity and complexity, incidence, and prevalence
The association between Type D personality and the metabolic syndrome: a cross-sectional study in a University-based outpatient lipid clinic
Dimitrios Tziallas, Michael S Kostapanos, Petros Skapinakis, Haralampos J Milionis, Thanos Athanasiou, Moses S Elisaf, Venetsanos Mavreas
BMC Research Notes , 2011, DOI: 10.1186/1756-0500-4-105
Abstract: New consecutive patients referred to an outpatient lipid clinic for evaluation of possible metabolic syndrome were eligible for inclusion in the study. The metabolic syndrome was defined according to the International Diabetes Federation (IDF) diagnostic criteria. Type D personality was assessed with the DS-14 scale. Multivariate regression techniques were used to investigate the association between personality and metabolic syndromes adjusting for a number of medical and psychiatric confounders. Three hundred and fifty-nine persons were screened of whom 206 met the diagnostic criteria for the metabolic syndrome ("cases") and 153 did not ("control group"). The prevalence of type D personality was significantly higher in the cases as compared to the control group (44% versus 15% respectively, p < 0.001). In multivariate logistic regression analysis the presence of Type D personality was significantly associated with metabolic syndrome independently of other clinical factors, anxiety and depressive symptoms (odds ratio 3.47; 95% Confidence Interval: 1.90 - 6.33).Type D personality was independently associated with the metabolic syndrome in this cross-sectional study. The potential implications of this finding, especially from a clinical or preventive perspective, should be examined in future research.Over the recent years, there is a growing interest of the impact of various psychosocial factors in cardiovascular morbidity and mortality [1]. Several prospective studies suggested that common mental disorders, such as depression and anxiety, may be associated with an increased risk of cardiovascular events in either healthy persons or patients with coronary heart disease (CHD) [1]. Similarly psychosocial factors, such as enhanced 'job strain' as well as the lack of social support, have been proposed as risk factors for CHD. In this context, it is also noted that specific patterns of personality characteristics have been found to independently predict CHD morbidity and m
Role of behavioral and personality instruments in the improvement of team effectiveness in the organization
Elena Suman
Perspectives of Innovations, Economics and Business , 2009,
Abstract: The objective of the paper is to consider the applicability of the behavioral and personality assessment instruments in recruitment, appraisal and development of organization’s teams’ effectiveness. It discusses the application of several widely accepted instruments: extended DiSC, MBTI and Belbin on the basis of the function to build the effective team. Each of the instruments provides insight into the team from the unique perspective and thus helps identifying team’s strong and weak points. This constitutes important learning points for the improvement of the team effectiveness. The paper’s major conclusion is that the combined use of the these instruments improves the quality of the managerial decision making concerning setting up and the developing of the effective organizational teams.
Exploring Registered Psychiatric Nurses' Responses towards Service Users with a Diagnosis of Borderline Personality Disorder  [PDF]
Bridget McGrath,Maura Dowling
Nursing Research and Practice , 2012, DOI: 10.1155/2012/601918
Abstract: This study explored registered psychiatric nurses' (RPNs') interactions and level of empathy towards service users with a diagnosis of borderline personality disorder (BPD). A qualitative approach was used, and 17 RPNs were interviewed using a semistructured interview schedule incorporating the “staff-patient interaction response scale” (SPIRS). Four themes emerged following data analysis: “challenging and difficult,” “manipulative, destructive and threatening behaviour,” “preying on the vulnerable resulting in splitting staff and other service users,” and “boundaries and structure.” Additionally, low levels of empathy were evident in the majority of participants' responses to the SPIRS. The findings provide further insight on nurses' empathy responses and views on caring for service users with BPD and further evidence for the need for training and education for nurses in the care of service users diagnosed with BPD. 1. Introduction Mental health nurses frequently care for service users with a diagnosis of borderline personality disorder (BPD) in both hospital and community settings. The literature suggests that BPD is the most prevalent of all personality disorders [1] with an estimated 2-3% of the population meeting the diagnostic criteria [2]. International research indicates that BPD has a higher incidence of occurrence than schizophrenia or bipolar disorder. It is estimated that between 10 percent of service users in outpatient clinical settings and 15 to 20 percent of those in inpatient psychiatric settings meet the diagnostic criteria for BPD [3]. Suicidal or self-harming behaviour is one of the core diagnostic criteria in DSM IV-TR for BPD, and management of and recovery from this personality disorder can be complex and challenging [4]. Suicide rates among those diagnosed with BPD are approximately 8 to 10 percent [5, 6]. BPD is also characterized by service users having a pattern of unstable and intense interpersonal relationships, affective instability, poor impulse control, and self-mutilating behaviour. Many professionals find these service users difficult to interact with, treat and show empathy towards, perhaps because BPD behaviours may aversely effect interpersonal relationships, including relationships with nursing staff [2]. Derogatory terms to describe persons with BPD such as “difficult,” “dangerous,” “treatment resistant,” “manipulative,” “demanding,” and “attention seeking" are often used [7]. A number of studies have examined attitudes of nurses towards service users with BPD [8–15]. These studies report nurses’ perceptions of
Prevalence of ADHD in Adult Psychiatric Outpatient Clinic and Comorbid Psychiatric Disorders in ADHD Research Article
Filiz ?zdemiro?lu Alyanak,?lhan Yarg??,Serap Oflaz
N?ropsikiyatri Ar?ivi , 2011,
Abstract: Objective: The objective of our study was to investigate the prevalence of attention-deficit/hyperactivity disorder (ADHD) and comorbid psychiatric disorders in adults who presented to the psychiatric outpatient clinic, and the prevalence of ADHD-related clinical features described in the previous literature.Methods: The study was composed of two parts. We aimed to determine the prevalence in the first part. All patients who had presented to the Istanbul University Department of Psychiatry outpatient clinic during the period February-May 2005 had filled in the Adult ADD/ADHD DSM IV-Based Diagnostic Screening and Rating Scale. The patients scored above the cutoff value were evaluated with the Semi-structured Interview Form for ADHD and were diagnosed as having ADHD according to the DSM criteria by psychiatrist. The patients diagnosed with ADHD were reevaluated by consultant lecturer. In the second part of the study, comorbid diagnoses were investigated using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) in the ADHD patients identified in the first part and the patients diagnosed with ADHD in the ADHD outpatient clinic, Department of Psychiatry, Istanbul Medical Faculty.Results: The patients diagnosed as having ADHD were mostly young men. Alcohol and substance abuse were very common problems inADHD patients. The prevalence of ADHD in adult psychiatric outpatient clinic was found to be at least 1.6 %. Conclusion: ADHD is represented less than the expected rate in the general population. ADHD symptoms should be inquired in adult patients who present to psychiatry departments with alcohol or drug problems. (Archives of Neuropsychiatry 2011; 48: 119-24)
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