The prevalence and 1-year outcome of cluster B personality disorders in primary care

Abstract Personality disorders are enduring patterns of inner experience and behavior that deviate markedly from those expected by the individual's culture; these inflexible and pervasive patterns reflect issues with cognition, affectivity, interpersonal functioning and impulse control, and lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning. The AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition, defines two specific personality disorders, in addition to an eleventh condition, Personality Disorder Not Otherwise Specified. Cluster A personality disorders include paranoid, schizoid, and schizotypal personalities; of these, Paranoid Personality Disorder probably is most common in the legal arena. Cluster B personality disorders include antisocial, borderline, histrionic, and narcissistic personality. Such people may suffer from frantic efforts to avoid perceived abandonment, patterns of unstable and intense interpersonal relationships, an identity disturbance, and impulsivity. Legal issues that involve individuals with cluster B personality disorders often involve determination of causation of the person's problems, assessment of claims of harassment, and assessment of the person's fitness for employment. Cluster C personality disorders include avoidant, dependent, and obsessive-compulsive personality. Two case histories illustrate some of the complexities of assessing impairment in workers with personality disorders, including drug abuse, hospitalizations, and inpatient and outpatient psychotherapy.

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Factors of Impulsivity and Cluster B Personality Dimensions

Journal of Individual Differences ◽

10.1027/1614-0001/a000237 ◽

2017 ◽

Vol 38 (4) ◽

pp. 203-210 ◽

Cited By ~ 1

Author(s):

Christopher M. Lootens ◽

Christopher D. Robertson ◽

John T. Mitchell ◽

Nathan A. Kimbrel ◽

Natalie E. Hundt ◽

...

Keyword(s):

Personality Disorders ◽

The Other ◽

Diagnostic Classification ◽

Personality Dimensions ◽

Cluster B Personality Disorders ◽

Classification And Treatment

Abstract. The goal of the present investigation was to expand the literature on impulsivity and Cluster B personality disorders (PDs) by conceptualizing impulsivity in a multidimensional manner. Two separate undergraduate samples (n = 223; n = 204) completed measures of impulsivity and Cluster B dimensions. Impulsivity was indeed predictive of Cluster B dimensions and, importantly, each PD scale exhibited a unique impulsivity profile. Findings for borderline PD scores were highly consistent across samples and strongly and positively associated with urgency and lack of perseverance, as expected. Findings for the other PD dimensions also exhibited a fair amount of consistency. Implications of these findings for diagnostic classification and treatment are discussed.

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Cost-effectiveness of psychotherapy for cluster B personality disorders

The British Journal of Psychiatry ◽

10.1192/bjp.bp.109.070482 ◽

2010 ◽

Vol 196 (5) ◽

pp. 396-403 ◽

Cited By ~ 33

Author(s):

Djøra I. Soeteman ◽

Roel Verheul ◽

Jos Delimon ◽

Anke M. M. A. Meerman ◽

Ellen van den Eijnden ◽

...

Keyword(s):

Cost Effectiveness ◽

Personality Disorders ◽

Cost Effective ◽

Quality Adjusted Life Year ◽

Decision Analytic Model ◽

Day Hospital ◽

Payer Perspective ◽

Cluster B Personality Disorders ◽

Effective Choice ◽

The Cost

BackgroundRecommendations on current clinical guidelines are informed by limited economic evidence.AimsA formal economic evaluation of three modalities of psychotherapy for patients with cluster B personality disorders.MethodA probabilistic decision-analytic model to assess the cost-effectiveness of out-patient, day hospital and in-patient psychotherapy over 5 years in terms of cost per recovered patient-year and cost per quality-adjusted life-year (QALY). Analyses were conducted from both societal and payer perspectives.ResultsFrom the societal perspective, the most cost-effective choice switched from out-patient to day hospital psychotherapy at a threshold of €12 274 per recovered patient-year; and from day hospital to in-patient psychotherapy at €113 298. In terms of cost per QALY, the optimal strategy changed at €56 325 and €286 493 per QALY respectively. From the payer perspective, the switch points were at €9895 and €155 797 per recovered patient-year, and €43 427 and €561 188 per QALY.ConclusionsOut-patient psychotherapy and day hospital psychotherapy are the optimal treatments for patients with cluster B personality disorders in terms of cost per recovered patient-year and cost per QALY.

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A Psychiatric Clinic in General Practice

Bulletin of the Royal College of Psychiatrists ◽

10.1192/pb.11.4.114 ◽

1987 ◽

Vol 11 (4) ◽

pp. 114-117 ◽

Cited By ~ 9

Author(s):

Sally M. Browning ◽

Michael F. Ford ◽

Cait A. Goddard ◽

Alexander C. Brown

Keyword(s):

Primary Care ◽

Mental Illness ◽

General Practice ◽

Psychiatric Disorder ◽

Personality Disorders ◽

Psychiatric Service ◽

Significant Degree ◽

Care Team ◽

Primary Care Team ◽

Psychiatric Clinic

Only a minority suffering from mental illness are treated by the specialist psychiatric service. The majority of psychiatrically ill patients seen in general practice suffer from minor neuroses, personality disorders and situational reactions and can be appropriately treated by the primary care team. However, a significant degree of morbidity, some of it severe, fails to be identified in general practice and the identification and treatment of psychiatric disorder varies according to the GP's interest and attitudes.

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A-85 Differences in Cerebral Blood Perfusion with Individuals Diagnosed with Cluster B Personality Disorders

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acab062.103 ◽

2021 ◽

Vol 36 (6) ◽

pp. 1132-1132

Author(s):

D'anna Sydow ◽

Daniel Amen ◽

Kristen Willeumier ◽

Brittny Arias ◽

Charles J Golden ◽

...

Keyword(s):

Blood Flow ◽

Basal Ganglia ◽

Personality Disorders ◽

Limbic System ◽

Negative Emotion ◽

Blood Perfusion ◽

Healthy Controls ◽

Self Recognition ◽

Cluster B Personality Disorders ◽

And Gender

Abstract Objective To identify regional cerebral blood flow (rCBF) differences between individuals with DSM-IV diagnosis of Cluster B Personality Disorders (PDB) and healthy controls. Method Healthy controls (n = 81, Mage = 41.9, 53.0% female, 42.0% Caucasian) and persons diagnosed by psychiatric examination with PDB (n=, Mage = 34.12, 71.5% female, 69.8% Caucasian) were selected from a deidentified adult clinical outpatient database. Those with comorbid diagnoses were included. Significant differences (alpha = 0.005) were found for age [t(195) = −3.62], gender [χ2(2) = 7.1], and race [χ2(12) = 23.82] between groups. Mean age [t(523) = 2.09, p = 0.037) and gender [t(532) = −2.653, p = 0.008] different significantly between groups. No significant mean difference was found for education [t(523) = 0.832, p = 0.406]. Results Significant rCBF differences were noted in the cerebellum [left:F(1,192) = 10.5; right:F(1,192) = 4.6], limbic system [left:F(1,192) = 7.8; right:F(1,192) = 5.0], and basal ganglia [left:F(1,192) = 12.3; right:F(1,192) = 6.7]. Group means comparisons indicated higher perfusion in the cerebellum for the PDB group. Lower perfusion was found in the limbic system and basal ganglia in the PDB group. Conclusion Results observed in this study are concurrent with previous literature. PDB demonstrates higher activity in the cerebellum which contains inhibitory neurotransmitters, like Purkinje cells. The increased blood flow to cerebellar circuits may be related to the explicit self-recognition of negative emotion reported in PDB. Hypoperfusion found in the limbic system could be linked to impaired emotional responses. Apathy experienced in PDB may be accounted for by the low perfusion in the highly dopaminergic pathway in the basal ganglia. Further research should assess how different comorbidities with PDB affect perfusion.

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Epidemiology of personality disorders

New Oxford Textbook of Psychiatry ◽

10.1093/med/9780199696758.003.0111 ◽

2012 ◽

pp. 881-886

Author(s):

Francesca Guzzetta ◽

Giovanni de Girolamo

Keyword(s):

Primary Care ◽

Mental Disorders ◽

Personality Disorders ◽

Diagnostic System ◽

Affected Individual ◽

Response To Treatment ◽

Epidemiological Investigation ◽

Prevalence Studies ◽

Epidemiological Surveys ◽

Axis I

tbegun to be scientifically investigated. This development has taken place because a number of standardized instruments to assess personality and PD in an empirical fashion have been developed, in parallel with the refinement of a valid and reliable diagnostic system based on a categorical approach. The need for the epidemiological investigation of PDs seems justified for several reasons. 1 As seen in recent epidemiological surveys, PDs are frequent and have been found in different countries and sociocultural settings. 2 PDs can seriously impair the life of the affected individual and can be highly disruptive to societies, communities, and families. 3 Personality status is often a major predictive variable in determining the outcome of Axis I mental disorders and the response to treatment. In this chapter, we review the epidemiological literature on PDs up to October 2007, focusing on studies carried out since the development of the DSM-III. First, community prevalence studies of PDs are reviewed. We then look at the prevalence of individual PDs in the community. Finally, we consider the prevalence of PDs in clinical populations, and in special settings (e.g. primary care, prisons, etc.).

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