scholarly journals Personality change in the Nottingham Study of Neurotic Disorder: 30-Year cohort study

2021 ◽  
pp. 000486742110256
Author(s):  
Min Yang ◽  
Helen Tyrer ◽  
Tony Johnson ◽  
Peter Tyrer
Keyword(s):  
Personality Disorder ◽  
Mental Disorders ◽  
Personality Assessment ◽  
Depressive Disorders ◽  
Common Mental Disorders ◽  
Controlled Trial ◽  
Stable Condition ◽  
Personality Change ◽  
Neurotic Disorder ◽  
Cluster A

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.

Diagnostic prevalence and comorbidity

2015 ◽  
Author(s):  
Stuart D. M. Thomas
Keyword(s):  
Personality Disorder ◽  
Mental Disorders ◽  
Depressive Disorders ◽  
Common Mental Disorders ◽  
Common Mental Disorder ◽  
Female Prisoners ◽  
Inmate Population ◽  
Correctional Settings ◽  
Major Depressive Disorders ◽  
Almost All

Prisons and jails remain a growth industry, with many countries increasing correctional services to cope with the ever-burgeoning inmate population. One longstanding issue is the perceived increase in prevalence of mental disorders that are found in correctional settings compared to the community. Definitions of mental illness and methods of assessment vary substantially. That said, emerging data reflect some consistency in the range of estimated prevalence. Personality disorder (predominantly antisocial personality disorder) is the most common mental disorder among prisoners, accounting for 65% of male and 42% of female prisoners. Estimated rates of psychosis in some settings are as high as 3.7% for males and 4.0% for females, while major depressive disorders are found in up to 10% of male and 12% of female prisoners. Estimated point prevalence rates for alcohol abuse and dependence varied between 18 and 30% for male prisoners and between 10 and 24% for female prisoners; these estimates were between 10 and 48% for males and 30 to 60% for female prisoners with respect to drug dependence and abuse. The rates of almost all disorders are several times higher than those found in the general community, and the rates of comorbidity are exceptionally high. This chapter outlines the best available correctional prevalence of common mental disorders and considers the key assumptions and methodological challenges around ascertaining rates of these different diagnoses.

scholarly journals Optimising implementation strategies of the first scaleup of a primary care psychological intervention for common mental disorders in Sub-Saharan Africa: a mixed methods study protocol for the optimised Friendship Bench (OptFB)

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e045481
Author(s):  
Ruth Verhey ◽  
Charmaine Chitiyo ◽  
Sandra Ngonidzashe Mboweni ◽  
Ephraim Chiriseri ◽  
Dixon Chibanda ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
Psychological Intervention ◽  
Controlled Trial ◽  
Implementation Strategies ◽  
Evaluation Framework ◽  
Sub Saharan Africa ◽  
Clinical Trial Registry ◽  
Randomised Controlled

IntroductionCommon mental disorders (CMDs) are a leading cause of disability globally. CMDs are highly prevalent in Zimbabwe and have been addressed by an evidence-based, task-shifting psychological intervention called the Friendship Bench (FB). The task-shifted FB programme guides clients through problem-solving therapy. It was scaled up across 36 implementation sites in Zimbabwe in 2016.Methods and analysisThis study will employ a mixed-method framework. It aims to: (1) use quantitative survey methodologies organised around the Reach, Effectiveness, Adoption and Implementation and Maintenance evaluation framework to assess the current scaleup of the FB intervention and classify 36 clinics according to levels of performance; (2) use qualitative focus group discussions and semistructured interviews organised around the Consolidated Framework for Implementation Research to analyse determinants of implementation success, as well as elucidate heterogeneity in implementation strategies through comparing high-performing and low-performing clinics; and (3) use the results from aims 1 and 2 to develop strategies to optimise the Friendship Bench intervention and apply this model in a cluster randomised controlled trial to evaluate potential improvements among low-performing clinics. The trial will be registered with the Pan African Clinical Trial Registry (www.pactr.org). The planned randomised controlled trial for the third research aim will be registered after completing aims one and two because the intervention is dependent on knowledge generated during these phases.Ethics and disseminationThe research protocol received full authorisation from the Medical Research Council of Zimbabwe (MRCZ A/242). It is anticipated that changes in data collection tools and consent forms will take place at all three phases of the study and approval from MRCZ will be sought. All interview partners will be asked for informed consent. The research team will prioritise open-access publications to disseminate research results.

scholarly journals Suicide attempt following sickness absence and disability pension due to common mental disorders: a prospective Swedish twin study

2019 ◽  
Vol 55 (8) ◽  
pp. 1053-1060 ◽  
Author(s):  
M. Wang ◽  
L. Mather ◽  
P. Svedberg ◽  
E. Mittendorfer-Rutz
Keyword(s):  
Mental Disorders ◽  
Suicide Attempt ◽  
Sickness Absence ◽  
Disability Pension ◽  
Depressive Disorders ◽  
Proportional Hazards ◽  
Common Mental Disorders ◽  
Cox Proportional Hazards ◽  
Shared Environment ◽  
Familial Factors

Abstract Purpose The aim of this study was to investigate if sickness absence and disability pension (SA/DP) in general and due to specific common mental disorders (CMDs) are associated with subsequent suicide attempt among women and men by taking familial factors (genetics and shared environment) into consideration. Methods This register-based cohort study includes 4871 twin pairs 18–65 years of age discordant for SA/DP due to CMDs 2005–2010. Twins were followed up for suicide attempt from inpatient and specialised outpatient care until December 2012. Conditional Cox proportional hazards regression models, adjusting for familial factors, were used to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results SA/DP due to CMDs was associated with a higher risk of suicide attempt (HR 3.14, CI 2.51–3.93). The risk of suicide attempt was five times higher among men and three times higher among women, compared to the SA/DP unaffected co-twins. In the diagnosis-specific analysis, SA/DP due to anxiety disorders resulted in the highest HR (4.09, CI 2.37–7.06) for suicide attempt, followed by depressive disorders (HR 3.70, CI 2.66–5.14) and stress-related disorders (HR 1.96, CI 1.35–2.84). The stratified analysis on zygosity indicates that there seems to be a genetic influence on the associations between SA/DP due to CMDs and suicide attempt, particularly among women and among those with SA/DP due to depressive disorders. Conclusions SA/DP due to CMDs was a risk factor for suicide attempt among women and men. Genetic factors might explain part of the associations for women and for those with SA/DP due to depressive disorders.

scholarly journals Stress and psychiatric disorder in urban Rawalpindi

2000 ◽  
Vol 177 (6) ◽  
pp. 557-562 ◽  
Author(s):  
David B. Mumford ◽  
Fareed A. Minhas ◽  
Imtiaz Akhtar ◽  
Saeed Akhter ◽  
Malik H. Mubbashar
Keyword(s):  
Mental Disorders ◽  
Emotional Distress ◽  
Rural Areas ◽  
Depressive Disorders ◽  
Common Mental Disorders ◽  
Psychiatric Morbidity ◽  
Survey Method ◽  
Urban District ◽  
Younger Women ◽  
Socio Economic Variables

BackgroundRecent studies in rural areas of Pakistan have yielded high prevalence rates of common mental disorders, especially among women.AimsTo investigate emotional distress and common mental disorders in a poor urban district using the same survey method.MethodFirst-stage screening of a slum district of Rawalpindi used the Bradford Somatic Inventory. Psychiatric interviews were conducted with stratified samples using the ICD–10 research diagnostic criteria.ResultsOn a conservative estimate, 25% of women and 10% of men suffered from anxiety and depressive disorders. Levels of emotional distress increased with age in both men and women. Women living in joint households reported more distress than those living in unitary families. Higher levels of education were associated with lower risk of common mental disorders, especially in younger women. Emotional distress was negatively correlated with socio-economic variables among women.ConclusionsThis study found levels of emotional distress and psychiatric morbidity in a poor district of Rawalpindi to be less than half those in a nearby rural village in the Punjab, although rates in women were still double those in men. Possible explanations are that more healthy people migrate to the cities or that urban living is more conducive to good mental health in Pakistan.

Work-directed rehabilitation or physical activity to support work ability and mental health in common mental disorders: a pilot randomized controlled trial

2019 ◽  
Vol 34 (2) ◽  
pp. 170-181 ◽  
Author(s):  
Louise Danielsson ◽  
Margda Waern ◽  
Gunnel Hensing ◽  
Kristina Holmgren
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Mental Disorders ◽  
Work Ability ◽  
Common Mental Disorders ◽  
Controlled Trial ◽  
Work Ability Index ◽  
Randomized Controlled ◽  
Ability Index ◽  
Pilot Randomized Controlled Trial

Objective: To evaluate feasibility and potential effectiveness of work-directed rehabilitation in people with common mental disorders. Design: Pilot randomized controlled trial. Setting: Primary healthcare, Sweden. Subjects: Working adults ( n = 42) of mean age 46.2 ± 11.1 years with depression or anxiety disorder. Interventions: Eight weeks of work-directed rehabilitation ( n = 21) or physical activity ( n = 21). Work-directed rehabilitation included sessions with a physiotherapist and/or an occupational therapist, to develop strategies to cope better at work. Physical activity included a planning session and access to a local gym. Main measures: Feasibility: attendance, discontinuation and adverse events. Measurements were the Work Ability Index, the Global Assessment of Functioning, the Montgomery–Asberg Depression Rating Scale, the Beck Anxiety Inventory and the World Health Organization—Five Well-Being Index. Results: Attendance to rehabilitation sessions was 88% ( n = 147/167) and discontinuation rate was 14% ( n = 3/21). No serious adverse events were reported. Within both groups, there was a significant improvement in Work Ability Index score (mean change: 3.6 (95% confidence interval (CI): 0.45, 6.7) in work-directed rehabilitation and 3.9 (95% CI: 0.9, 7.0) in physical activity) with no significant difference between groups. For the other outcomes, significant improvements were found within but not between groups. Per-protocol analysis showed a trend toward the antidepressant effect of work-directed rehabilitation compared to physical activity (mean difference in depression score −3.1 (95% CI: −6.8, 0.4), P = 0.075). Conclusion: Work-directed rehabilitation was feasible to persons with common mental disorders and improved their work ability and mental health. Comparable improvements were seen in the physical activity group. Suggested modifications for a larger trial include adding a treatment-as-usual control.

Pattern of Comorbidity Among Anxious and Odd Personality Disorders: The Case of Obsessive-Compulsive Personality Disorder

CNS Spectrums ◽  
2000 ◽  
Vol 5 (9) ◽  
pp. 23-26 ◽  
Author(s):  
Alessandro Rossi ◽  
Maria Grazia Marinangeli ◽  
Giancarlo Butti ◽  
Artemis Kalyvoka ◽  
Concetta Petruzzi
Keyword(s):  
Personality Disorder ◽  
Mental Disorders ◽  
Personality Disorders ◽  
Odds Ratios ◽  
Obsessive Compulsive ◽  
Statistical Manual ◽  
Axis Ii ◽  
Diagnostic And Statistical Manual ◽  
Cluster A ◽  
Obsessive Compulsive Personality Disorder

AbstractThe aim of this study was to examine the pattern of comorbidity among obsessive-compulsive personality disorder (OCPD) and other personality disorders (PDs) in a sample of 400 psychiatric inpatients. PDs were assessed using the Semistructured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Odds ratios (ORs) were calculated to determine significant comorbidity among OCPD and other axis II disorders. The most elevated odds ratios were found for the cooccurrence of OCPD with cluster A PDs (the “odd” PDs, or paranoid and schizoid PDs). These results are consistent with those of previous studies showing a higher cooccurrence of OCPD with cluster A than with cluster C (“anxious”) PDs. In light of these observations, issues associated with the nosologic status of OCPD within the Diagnostic and Statistical Manual of Mental Disorders clustering system remain unsettled.

Problems in developing an instrument for the rapid assessment of personality status

2000 ◽  
Vol 15 (S1) ◽  
pp. 29-33 ◽  
Author(s):  
E. Van Horn ◽  
C. Manley ◽  
D. Leddy ◽  
D. Cicchetti ◽  
P. Tyrer
Keyword(s):  
Personality Disorder ◽  
Case Management ◽  
Personality Assessment ◽  
Controlled Trial ◽  
Rapid Assessment ◽  
Kappa Statistic ◽  
Weighted Kappa ◽  
Assessment Instrument ◽  
Standard Case ◽  
Weighted Kappa Statistic

SummaryPurposeTo assess the validity of a quick assessment instrument (10 minutes) for assessing personality status, the Rapid Personality Assessment Schedule (PAS-R).Subjects and methodsThe PAS-R was evaluated in psychotic patients recruited in one of the centres involved in a multicentre randomised controlled trial of intensive vs standard case management (the UK700 case management trial). Patients were assessed using both a full version of the PAS (PAS-I – ICD version) and the PAS-R. The weighted kappa statistic was used to gauge the (criterion-related) validity of the PAS-R using the PAS-I as the gold standard. Both measure code personality status using a four-point rating of severity in addition to recording individual categories of personality disorder.ResultsOne hundred fifty-five (77%) of 201 patients recruited were assessed with both instruments. The weighted kappa statistic was 0.31, suggesting only moderate agreement between the PAS-I and PAS-R instruments under the four-point rating format, and 0.39 for the dichotomous personality disorder/no disorder separation. The sensitivity (64%) and specificity (82%) of the PAS-R in predicting PAS-I personality disorder were as satisfactory as for other screening instruments but still somewhat disappointing, and the PAS-R had an overall diagnostic accuracy of 78%.ConclusionThe PAS-R is a quick and rough method of detecting personality abnormality but is not a substitute for a fuller assessment.

scholarly journals Management of depressive disorder in adolescents

1996 ◽  
Vol 2 (6) ◽  
pp. 271-277 ◽  
Author(s):  
Richard Harrington
Keyword(s):  
Mental Disorders ◽  
Depressive Disorder ◽  
Clinical Management ◽  
Depressive Disorders ◽  
Research Evidence ◽  
Age Group ◽  
Neurotic Disorder ◽  
The Past

Historically, depressive disorders in adolescents have been conceptualised as variants of the nonspecific class of childhood emotional or neurotic disorder, which encompassed depressive, anxiety, hysterical and obsessional disorders. Over the past decade, however, the field has shifted towards greater diagnostic refinement. Research evidence has shown that severe depressive disorders differ from other mental disorders in this age group in their epidemiology, outcome and correlates (Harrington & Wood, 1995). Treatment therefore includes not only general techniques of clinical management, but also a variety of treatments targeted at the symptoms of depressive disorder.

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