Neurobiology of Personality Disorders

2017 ◽  
Author(s):  
Theresa Costales ◽  
Marianne Goodman ◽  
Kalpana Kapil-Pair ◽  
Lea Marin ◽  
Katherine Pier ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Functional Neuroimaging ◽  
Significant Risk ◽  
Sufficient Evidence ◽  
Obsessive Compulsive ◽  
Schizotypal Personality ◽  
Normal Personality ◽  
Risk Of Death ◽  
Pharmacologic Treatments

Personality disorders affect an estimated 9.1% of the general population, including 25 to 50% of psychiatric outpatients and up to 80% of inpatients. They constitute heterogeneous clinical presentations characterized by interpersonal deficits owing to disturbances in self and interpersonal functioning. Personality disorders frequently co-occur with other psychiatric conditions and tend to be refractory to traditional pharmacologic treatments, and patients with these disorders have a reduced quality of life and carry significant risk of death by suicide. Research over the last 25 years has advanced our understanding of the neurobiology, neurochemistry, physiology, genetics, and epigenetics that contribute to these complex presentations. A review of the neurobiological basis of personality disorders demonstrates that, in most cases, personality pathology represents a confluence of traits that are on a spectrum with normal personality functioning and other mental disorders. Schizotypal personality disorder, borderline personality disorder, antisocial personality disorder, avoidant personality disorder, and obsessive-compulsive personality disorder are among the disorders with sufficient evidence to support their conceptualization as discrete nosologic entities. Functional neuroimaging and connectivity studies, as well as genetic and epigenetic research, have highlighted structural, neurochemical, environmental, and behavioral targets that hold promise for treatment. This review contains 6 figures, 6 tables, and 116 references. Key words: antisocial, avoidant, borderline, connectivity, functional magnetic resonance imaging, heritability, obsessive-compulsive, personality, personality disorder, schizotypal 

Specific types of personality disorder

2012 ◽  
pp. 861-881 ◽  
Author(s):  
José Luis Carrasco ◽  
Dusica Lecic-Tosevski
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Personality Change ◽  
Obsessive Compulsive ◽  
Schizotypal Personality ◽  
General Medical Condition ◽  
Personality Changes ◽  
Paranoid Personality Disorder ◽  
Paranoid Personality ◽  
Cluster B Personality Disorders

This chapter begins by discussing the epidemiology, aetiology, clinical picture, course, differential diagnosis, and treatment of various Cluster A personality disorders (Paranoid personality disorder, paranoid personality disorder, schizotypal personality disorder), Cluster B personality disorders (antisocial personality disorder, borderline personality disorder (BPD), histrionic personality disorder, narcissistic personality disorder) and Cluster C personality disorders (avoidant personality disorder, dependent personality disorder (JLC), and obsessive–compulsive (anankastic) personality disorder). Other personality disorders (not included in DSM-IV) are also covered, including passive–aggressive (negativistic) personality disorder, self-defeating (masochistic) personality disorder, sadistic personality disorder, depressive personality disorder, and personality changes, including enduring personality changes after traumatic experiences and personality change due to a general medical condition (JLC).

scholarly journals PARANOID SCHIZOPHRENIA -BETWEEN HYPERSEXUALITY AND SADOMASOCHISM

2021 ◽  
Vol 9 (3) ◽  
pp. 195-203
Author(s):  
Simona Trifu ◽  
Beligeanu Mihaela ◽  
Iacob Beatrice Ștefana ◽  
Larimian Ștefania Parisa
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Defense Mechanisms ◽  
Paranoid Schizophrenia ◽  
Point Of View ◽  
Obsessive Compulsive ◽  
Schizotypal Personality ◽  
Paternal Line ◽  
Axis I ◽  
Obsessive Compulsive Personality Disorder

Motivation/Background: In this paper we aimed at clinically analyzing a patient diagnosed with paranoid schizophrenia, who also displays features specific to multiple personality disorders, in the context of a presentation whose key topic is sexuality. Given the global prevalence and the severity of schizophrenia, it is increasingly important to appropriately adapt and identify the patients' clinical and non-clinical personality profile. This paper also aims at making the profile of a patient diagnosed with axis I disorder ever since the age of 19, who also has got traits specific to certain personality disorders. At the same time, the work provides an interpretation of the behaviour from the psycho-dynamic point of view. Method: The following instruments were used for performing the analysis: a clinical interview, heteroanamnesis, psychological tests, clinical course monitoring, psychodynamic interpretations, defence mechanisms identification, psychiatric observation and treatment. Results: Based on the materials aforementioned, it has been established a possible diagnosis which includes multiple disorders: Antisocial Personality Disorder, Histrionic Personality Disorder, Schizotypal Personality Disorder, Obsessive Compulsive Personality Disorder, Cotard Syndrome, Kandinsky-Clérambault Syndrome. and there were identified defense mechanisms and coping strategies, under the influence of sexuality and sadomasochistic impulses. Conclusions: It is highlighted the clinical picture of a patient with paranoid schizophrenia, who presents symptoms for differential diagnoses, with disorganized discourse focused on sexuality, with delusional ideation, psychotic manifestation, but also with high suggestibility, especially on the paternal line

Tools & Resources: Impairment and Disability Web Sites

1999 ◽  
Vol 4 (6) ◽  
pp. 5-6
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Interpersonal Relationships ◽  
Web Sites ◽  
Outpatient Psychotherapy ◽  
Obsessive Compulsive ◽  
Not Otherwise Specified ◽  
Cluster B Personality Disorders ◽  
Clinically Significant ◽  
And Behavior

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.

Treatment of Personality

2018 ◽  
pp. 281-286
Author(s):  
S. Nassir Ghaemi
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Empirical Support ◽  
Symptomatic Treatment ◽  
Borderline Personality ◽  
Antisocial Personality ◽  
Schizotypal Personality ◽  
Narcissistic Personality ◽  
Personality Changes ◽  
The Common

The diagnosis and treatment of personality are probed. Some DSM definitions are viewed as either invalid (narcissistic personality disorder) or related to other conditions (schizotypal personality). Instead, DSM-based personality “disorders” are seen as psychoanalytic speculations, with weak empirical support, except for borderline personality and antisocial personality. Other aspects of personality are best understood as traits, rather than “disorders,” or as symptomatic changes that are acute and occur lower in the hierarchy of diagnosis than mood or psychotic states, and are caused by the latter. The common report of purported comorbidity is seen as an overestimation, with personality changes often being part of other conditions. Symptomatic treatment is seen to be questionable in benefit over risk, both for dopamine blockers and for SRIs.

scholarly journals S9. NEUROIMAGING AND NEUROPHYSIOLOGY BIOMARKERS OF SCHIZOTYPAL PERSONALITY DISORDER: A SYSTEMATIC REVIEW

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S33-S33
Author(s):  
Luigi Attademo ◽  
Francesco Bernardini ◽  
Norma Verdolini
Keyword(s):  
Systematic Review ◽  
Personality Disorder ◽  
Systematic Reviews ◽  
Visual Processing ◽  
Functional Neuroimaging ◽  
Schizotypal Personality Disorder ◽  
Present Review ◽  
Psychiatric Research ◽  
Schizotypal Personality ◽  
Perceptual Evaluation

Abstract Background Schizotypal personality disorder (SPD) is a cluster A personality disorder affecting 1.0% of general population, characterised by disturbances in cognition and reality testing dimensions, affect regulation, and interpersonal function. SPD shares similar but attenuated phenomenological, genetic, and neurobiological abnormalities with schizophrenia (SCZ) and is described as part of the continuum of schizophrenia spectrum disorders. Neuroimaging and neurophysiology are the main non-invasive techniques for the investigation of brain structure and function, so they play a crucial role in psychiatric research and for their applications into clinical practice. The present review aims to systematically identify the major neuroimaging and neurophysiology biomarkers of SPD. Methods The present review has been conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The protocol was prospectively registered in PROSPERO - International prospective register of systematic reviews. The systematic review was performed to summarise the most comprehensive and updated evidence on functional neuroimaging and neurophysiology findings obtained through different techniques (DW-MRI, DTI, PET, SPECT, fMRI, MRS, EEG) in subjects with SPD. Results The search initially yielded 218 records. After study selection and reference screening, the final set comprised 52 studies. Of the 52 studies included in this review, 9 were on DW-MRI and DTI, 11 were on PET and SPECT, 11 were on fMRI and MRS, and 21 were on EEG. Although it was complex to synthesise all the functional abnormalities found in the included studies into a single, unified, pathogenetic pathway, a common theme that emerged was the dysfunction of brain circuits including striatal, frontal, temporal, limbic regions, and their networks. This dysfunction may be the result of a dysregulation along the dopaminergic pathways and lead to deficits or defects in processes that organise a person’s cognitive-perceptual evaluation of the environment and the relatedness to him/herself. As for the limitations, a quantitative data synthesis was not planned for this work, therefore no meta-analytical integrations are presented in this review. The results of individual neuroimaging studies, in fact, are not comparable due to small and heterogeneous samples, analytical flexibility, or differences in imaging modalities and behavioral tasks. Discussion Brain abnormalities in SPD are similar, but less marked, than those found in SCZ, and they do not mirror each other. In fact, different patterns of functional abnormalities in SPD and SCZ have been found in this systematic review, suggesting the ‘presence’ of possible compensatory factors, protecting subjects with SPD from frank psychosis and providing diagnostic specificity. Specifically, SPD differentiates from SCZ by showing: (a) milder frontal-striatal-temporal white matter dysconnectivity in DTI studies, (b) lesser frontal and striatal dysfunction and a decreased striatal dopaminergic activity in PET and SPECT studies, respectively, (c) different patterns of dysfunctional activation of frontal-striatal-thalamic circuitry during attentional processing in fMRI studies, and (d) milder alterations in EEG sensory gating and no evidence of alterations in EEG auditory or visual processing.

Schizo-obsessive spectrum disorders: an update

CNS Spectrums ◽  
2016 ◽  
Vol 22 (3) ◽  
pp. 258-272 ◽  
Author(s):  
Estêvão Scotti-Muzzi ◽  
Osvaldo Luis Saide
Keyword(s):  
Dual Diagnosis ◽  
Pharmacological Treatment ◽  
Schizotypal Personality Disorder ◽  
Sufficient Evidence ◽  
Obsessive Compulsive ◽  
Obsessive Compulsive Symptoms ◽  
Schizotypal Personality ◽  
Spectrum Disorders ◽  
Obsessive Compulsive Disorders ◽  
Compulsive Disorders

The presence of obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorders (OCD) in schizophrenia is frequent, and a new clinical entity has been proposed for those who show the dual diagnosis: the schizo-obsessive disorder. This review scrutinizes the literature across the main academic databases, and provides an update on different aspects of schizo-obsessive spectrum disorders, which include schizophrenia, schizotypal personality disorder (SPD) with OCD, OCD with poor insight, schizophrenia with OCS, and schizophrenia with OCD (schizo-obsessive disorder). An epidemiological discussion on the discrepancies observed in the prevalence of OCS and OCD in schizophrenia across time is provided, followed by an overview of the main clinical and phenomenological features of the disorder in comparison to the primary conditions under a spectral perspective. An updated and comparative analysis of the main genetic, neurobiological, neurocognitive, and pharmacological treatment aspects for the schizo-obsessive spectrum is provided, and a discussion on endophenotypic markers is introduced in order to better understand its substrate. There is sufficient evidence in the literature to demonstrate the clinical relevance of the schizo-obsessive spectrum, although little is known about the neurobiology, genetics, and neurocognitive aspects of these groups. The pharmacological treatment of these patients is still challenging, and efforts to search for possible specific endophenotypic markers would open new avenues in the knowledge of schizo-obsessive spectrum.

scholarly journals Psychiatric, demographic and personality characteristics of elderly sex offenders

2002 ◽  
Vol 32 (2) ◽  
pp. 219-226 ◽  
Author(s):  
S. FAZEL ◽  
T. HOPE ◽  
I. O’DONNELL ◽  
R. JACOBY
Keyword(s):  
Mental Illness ◽  
Personality Disorder ◽  
Sex Offenders ◽  
Personality Traits ◽  
Personality Disorders ◽  
Psychiatric Morbidity ◽  
The Elderly ◽  
Personality Factors ◽  
Obsessive Compulsive ◽  
Dsm Iv

Background. Psychiatric disorders are purported to play a role in the aetiology of violent crime, but evidence for their role in sexual offending is less clear. The authors investigated the prevalence of psychiatric morbidity and personality disorders in elderly incarcerated sex offenders compared with elderly non-sex offenders.Method. One hundred and one sex offenders and 102 non-sex offenders aged over 59 years were interviewed using standardized semi-structured interviews for psychiatric illness (the Geriatric Mental State) and the personality disorder (Structured Clinical Interview for DSM-IV personality disorders). Data on demographic, offence and victim characteristics were collected.Results. Six per cent of the elderly sex offenders had a psychotic illness, 7% a DSM-IV major depressive episode and 33% a personality disorder; and 1% had dementia. These prevalence figures were not different from the elderly non-sex offenders interviewed in this study. Differences emerged at the level of personality traits with sex offenders having more schizoid, obsessive–compulsive, and avoidant traits, and fewer antisocial traits compared with non-sex offenders.Conclusions. Elderly sex offenders and non-sex-offenders have similar prevalence rates of mental illness. However, elderly sex offenders have increased schizoid, obsessive–compulsive, and avoidant personality traits, supporting the view that sex offending in the elderly is associated more with personality factors than mental illness or organic brain disease.

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