Incidence of axis I and axis II dual diagnosis in hospitalised patients with somatization disorder

IntroductionSomatization disorder is frequently associated in epidemiologic trials with depressive, anxiety, other somatoform or substance related disorders, as well as with personality disorders. An examination of psychiatric comorbidity in patients diagnosed with somatization disorder is strongly advised due to the impact of these associated conditions over the prognosis and treatment.ObjectiveTo establish the incidence of psychiatric dual diagnosis in hospitalized patients with somatization disorder.MethodsA group of 37 patients, 22 female and 15 male, mean age 45.9, were evaluated using Structured Clinical Interview for DSM Axis I (SCID-I) and Axis II (SCID-II) disorders at the admission in our department for a diagnosis of somatization disorder. All patients included in this trial were known with somatization disorder for at least one year prior to this admission.ResultsPatients diagnosed with somatization disorder presented mostly depressive disorders (46%, n = 17), anxiety disorders (37.8%, n = 14), substance related disorders (16.2%, n = 6) and personality disorders (67.5%, n = 25). A more detailed analysis on axis I established major depressive disorder as the most frequent diagnosis (37.8%, n = 14), followed by panic disorder (27%, n = 10) and alcohol dependence (13.5%, n = 5), while on axis II the histrionic (21.6%, n = 8) and obsessive-compulsive (19%, n = 7) personality disorders were the most frequently associated conditions. A number of 21 patients presented at least three axis I and/or II simultaneous diagnosis (64.8%).ConclusionThe most frequently comorbidities in somatization disorder are major depressive disorder and panic disorder on axis I, as well as histrionic and obsessive-compulsive personality disorder on axis II.

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Personality disorders and depression

Psychological Medicine ◽

10.1017/s0033291702005780 ◽

2002 ◽

Vol 32 (6) ◽

pp. 1049-1057 ◽

Cited By ~ 61

Author(s):

M. FAVA ◽

A. H. FARABAUGH ◽

A. H. SICKINGER ◽

E. WRIGHT ◽

J. E. ALPERT ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Symptoms ◽

Personality Disorder ◽

Depressive Disorder ◽

Personality Disorders ◽

Antidepressant Treatment ◽

Significant Proportion ◽

Obsessive Compulsive ◽

Major Depressive ◽

Before And After

Background. Personality disorders (PDs) were assessed among depressed out-patients by clinical interview before and after antidepressant treatment with fluoxetine to assess the degree of stability of PD diagnoses and determine whether changes in PD diagnoses across treatment are related to the degree of improvement in depressive symptoms.Method. Three hundred and eighty-four out-patients (55% women; mean age = 39.9±10.5) with major depressive disorder (MDD) diagnosed with the SCID-P were enrolled into an 8 week trial of open treatment with fluoxetine 20 mg/day. The SCID-II was administered to diagnose PDs at baseline and endpoint.Results. A significant proportion (64%) of our depressed out-patients met criteria for at least one co-morbid personality disorder. Following 8 weeks of fluoxetine treatment, there was a significant reduction in the proportion of patients meeting criteria for avoidant, dependent, passive-aggressive, paranoid and narcissistic PDs. From baseline to endpoint, there was also a significant reduction in the mean number of criteria met for paranoid, schizotypal, narcissistic, borderline, avoidant, dependent, obsessive–compulsive, passive aggressive and self-defeating personality disorders. While changes in cluster diagnoses were not significantly related to improvement in depressive symptoms, there were significant relationships between degree of reduction in depressive symptoms (percentage change in HAM-D-17 scores) and degree of change in the number of criteria met for paranoid, narcissistic, borderline and dependent personality disorders.Conclusions. Personality disorder diagnoses were found to be common among untreated out-patients with major depressive disorder. A significant proportion of these patients no longer met criteria for personality disorders following antidepressant treatment, and changes in personality disorder traits were significantly related to degree of improvement in depressive symptoms in some but not all personality disorders. These findings suggest that the lack of stability of PD diagnoses among patients with current MDD may be attributable in part to a direct effect of antidepressant treatment on behaviours and attitudes that comprise PDs.

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A personality disorders prevalence study among inpatients with mood disorders, psychoactive substance use disorders and anxiety disorders

Epidemiologia e Psichiatria Sociale ◽

10.1017/s1121189x00007739 ◽

2000 ◽

Vol 9 (1) ◽

pp. 36-44 ◽

Cited By ~ 4

Author(s):

Maria Grazia Marinangeli ◽

Giancarlo Butti ◽

Antonella Scinto ◽

Loredana Di Cicco ◽

Artemis Kalyvoka ◽

...

Keyword(s):

Personality Disorders ◽

Mood Disorders ◽

Clinical Sample ◽

Psychiatric Inpatients ◽

Self Report ◽

Exact Nature ◽

Obsessive Compulsive ◽

Axis Ii ◽

Axis I Disorders ◽

Axis I

SummaryObjective- The aim of this study was to asses type and prevalence of Personality Disorders (PDs) and their patterns of comorbidity with Axis I disorders in a sample of psychiatric inpatients.Setting- The sample consisted of 300 subjects admitted to a psychiatric unit on a voluntary bases for an index episode. The study was conducted over a period of 12 months, from 1.11.1997 to 31.10.1998.Main outcome measures- The Italian version of SCID-II-PQ (Structured Clinical Interview for DSM-III-R personality disorders, with Personality Questionnaire-PQ- a self report questionnaire).Results- More than half the patients had at least one personality disorder. The mean of disorders per patient was 2.83±1.93 (±SD). The most prevalent Axis II disorders were Borderline PD (30.7%), Obsessive-compulsive PD (30.7%) and Avoidant PD (25.3%). Women were significantly more likely than men to meet criteria for Dependent PD and Avoidant PD. Man showed significantly more frequently than women Antisocial PD. Significant associations (p<0.05) were found for comorbidity of Mood Disorders and Avoidant PD, and for Psicoactive Use Disorders and Antisocial PD.Conclusions- Our study confirms the high prevalence of PDs in psychiatric inpatients and showes some interesting associations between Axis I and Axis II disorders. These results can't be generalized to outpatients because our clinical sample involved mainly severely ill inpatients, but they raise questions about the exact nature of PDs and of the relationship with Axis I disorders. Further research involving outpatients and general population is needed to examine factors that could affect development and course of Personality Disorders.

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Faculty Opinions recommendation of Relationship of personality disorders to the course of major depressive disorder in a nationally representative sample.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.9695958.10375057 ◽

2011 ◽

Author(s):

Sabine Herpertz ◽

Alexander Lischke

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Personality Disorders ◽

Representative Sample ◽

Major Depressive ◽

Nationally Representative ◽

Relationship Of

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Personality Disorders and the Trimensional Personality Questionnaire Factors in Major Depressive Disorder

The Journal of Nervous and Mental Disease ◽

10.1097/01.nmd.0000185873.36662.76 ◽

2005 ◽

Vol 193 (11) ◽

pp. 747-750 ◽

Cited By ~ 8

Author(s):

Amy Farabaugh ◽

Dost Ongur ◽

Maurizio Fava ◽

Sarah K. Hamill ◽

Alana M. Burns ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Personality Disorders ◽

Personality Questionnaire ◽

Major Depressive

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The dexamethasone suppression test and DSM-III-R diagnoses in suicide attempters

European Psychiatry ◽

10.1016/j.eurpsy.2003.07.004 ◽

2003 ◽

Vol 18 (7) ◽

pp. 350-355 ◽

Cited By ~ 12

Author(s):

Åsa Westrin ◽

Karin Frii ◽

Lil Träskman-Bendz

Keyword(s):

Personality Disorders ◽

Stressful Events ◽

Suicide Attempter ◽

Axis Ii ◽

Suppression Test ◽

Axis I ◽

Cortisol Levels ◽

Low Cortisol ◽

Hpa Axis Activity ◽

Dexamethasone Suppression

AbstractPrevious research on hypothalamic-pituitary adrenal (HPA) axis-activity in suicide attempter research has shown conflicting outcomes. The design of the present study was to test the influence of personality disorders and concominant axis I diagnoses on the dexamethasone suppression diagnostic test by use of multiple regression analyses. The sample consisted of 184 patients with a recent suicide attempt and 42 healthy controls. As expected, the lowest pre- and postdexamethasone cortisol levels were found in patients with personality disorders axis II, cluster B as compared to the other patients. The results remained significant when analysed for covariance with DSM-III-R axis I diagnoses, age or sex. Whether these low cortisol levels are due to previous experience of extreme stressful events or long-lasting burden, or whether they may be a consequence of biogenetic or psychological predisposal of interest, remains to be elucidated. Axis I comorbidity needs to be further examined.

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Dspect in obsessive compulsive disorder and major depressive disorder

Biological Psychiatry ◽

10.1016/0006-3223(91)91001-8 ◽

1991 ◽

Vol 29 (9) ◽

pp. 58

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Obsessive Compulsive Disorder ◽

Obsessive Compulsive ◽

Major Depressive ◽

Compulsive Disorder

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Discriminating between Substance Abusers with Single and Dual Diagnoses Using MMPI Profiles and the MAC Andrews Alcoholism Scale: Axis I and Axis II Subtypes

Psychological Reports ◽

10.2466/pr0.1988.63.3.985 ◽

1988 ◽

Vol 63 (3) ◽

pp. 985-986 ◽

Cited By ~ 3

Author(s):

Ronald H. Rozensky ◽

Barbara Neirick ◽

Gary M. Slotnick ◽

Debra Morse

Keyword(s):

Substance Abuse ◽

Dual Diagnosis ◽

Substance Abusers ◽

Substance Abusing ◽

Psychiatric Diagnoses ◽

Axis Ii ◽

Heterogeneous Nature ◽

Dual Diagnoses ◽

Axis I

The MacAndrews Scale of the MMPI differentiated 21 dual-diagnosis substance abusers with a DSM-III—R, Axis I diagnosis from a group of 21 single-diagnosis substance abusers and 18 dual-diagnosis substance abusers with an Axis II diagnosis. Subjects were 50 substance-abuse only and 39 dual-diagnosis, hospitalized men. Research must take into account the heterogeneous nature of psychiatric diagnoses within the substance-abusing population.

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The genetic epidemiology of personality disorders

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2010.12.1/trkjennerud ◽

2010 ◽

Vol 12 (1) ◽

pp. 103-114 ◽

Cited By ~ 2

Keyword(s):

Personality Disorders ◽

Genetic Factors ◽

Association Studies ◽

Molecular Genetic ◽

Cluster Structure ◽

Epidemiologic Studies ◽

Axis Ii ◽

Candidate Gene Association ◽

Axis I ◽

Dsm Iv

Genetic epidemiologic studies indicate that all ten personality disorders (PDs) classified on the DSM-IV axis II are modestly to moderately heritable. Shared environmental and nonadditive genetic factors are of minor or no importance. No sex differences have been identified, Multivariate studies suggest that the extensive comorbidity between the PDs can be explained by three common genetic and environmental risk factors. The genetic factors do not reflect the DSM-IV cluster structure, but rather: i) broad vulnerability to PD pathology or negative emotionality; ii) high impulsivity/low agreeableness; and iii) introversion. Common genetic and environmental liability factors contribute to comorbidity between pairs or clusters of axis I and axis II disorders. Molecular genetic studies of PDs, mostly candidate gene association studies, indicate that genes linked to neurotransmitter pathways, especially in the serotonergic and dopaminergic systems, are involved. Future studies, using newer methods like genome-wide association, might take advantage of the use of endophenotypes.

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