Discrepancias diagnósticas entre la CIE-10 y el DSM-IV en los trastornos de personalidad / Diagnostics discrepancies between ICD-10 and DSM-IV in personality disorders

Introducción. Un 50 % de los pacientes atendidos en salud mental presentan trastornos de la personalidad; su diagnóstico es fundamental para el pronóstico y tratamiento de los pacientes. Habitualmente el clínico utiliza una de las nosologías, o la CIE-10 o la DSM-IV; es consciente de las diferencias entre ambas, pero da por buenos los resultados obtenidos con su nosología preferida. Material y método. Se incluyeron en el estudio 248 pacientes atendidos en un centro de salud mental con trastornos de ansiedad (n = 121) y trastornos depresivos (n = 127), con una media de edad de 32,3 años para los trastornos de ansiedad y de 32,4 años para los pacientes depresivos. Se les administró el Cuestionario de Screening IPDE en sus dos versiones (DSM-IV y CIE-10) para observar el grado de concordancia entre ambas nosologías. Resultados y discusión. En la muestra obtenida fue predominante la población femenina en tratornos de ansiedad (35,5 % hombres y 65,5 % mujeres) y en tratornos depresivos (29,10 hombres y 70,9 mujeres). Se realizó un estudio observacional en el que se valoró el porcentaje con tres o más ítems positivos y también el porcentaje con seis o más ítems positivos; es destacable que se obtiene mayor número de diagnósticos positivos y de comorbilidad con la versión DSM-IV del cuestionario de detección International Personality Disorders Examination (IPDE), por lo que se presenta la duda sobre si la CIE-10 subdiagnostica trastornos de la personalidad o el DSM-IV da falsos positivos. Además, hay diferencias cualitativas; que la CIE-10 subdivida en dos el trastorno límite de la personalidad, no incluya el trastorno narcisista de la personalidad y considere el trastorno esquizotípico de la personalidad una psicosis, hace que un paciente pueda recibir diferentes diagnósticos según se empleen criterios DSM-IV o CIE-10. Conclusiones. En la muestra estudiada de pacientes las discrepancias diagnósticas entre los trastornos de la personalidad con el DSM-IV y la CIE-10 son tan importantes que la Organización Mundial de la Salud y la Asociación Americana de Psiquiatría deberían considerar en las próximas nosologías la unificación de las categorías diagnósticas y los criterios diagnósticos en los trastornos de la personalidad

Introduction. 50 % of the patients seen in the mental health clinics have personality disorders and their diagnosis is very important to establish the patient’s prognosis and treatment. The clinician usually only uses one nosology, the ICD-10 or the DSM-IV and is aware of the differences between them. However, he/she gives preference to his/her favorite nosology. Material and method. A total of 248 patients seen in a mental health clinic were included in the study. They were diagnosed of anxiety (n = 121) and depressive (n = 127) disorders, with a mean age of 32.3 years for anxiety disorders and 32.4 years depressive disorders. The International Personality Disorders Examination (IPDE) Screening Questionnaire in its DSM-IV and ICD-10 versions was administered to observe the degree of concordance between the two nosologies. Results and discussion. The female population predominated in our sample, these being 35.5 % men with anxiety disorders and 65,5 % women, and 29.10 % men and 70.9 % women with depressive disorders. An observational study was performed by studying the percentage with 3 or more positive items and also percentage with 6 or more positive items. It was observed that the DSM-IV version produced more positive diagnoses and more comorbidity. Thus, it is necessary to consider whether the ICD-10 version subdiagnoses personality disorders or the DSM-IV version gives false positives. The qualitative differences between the ICD-10 and the DSM-IV must also be considered. The ICD-10 does not include narcissistic and schizotypal personality disorders and subdivides the borderline personality disorder into two subcategories, so that a given patient can receive different diagnoses according to the nosology used. Conclusions. In the patient sample studied, diagnostic discrepancies in personality disorders between DSM-IV and ICD-10 are so important that the World Health Organization and the American Psychiatry Association should consider unifying categories and diagnostic criteria of personality disorders in the next nosologies

Diagnostics discrepancies between ICD-10 and DSM-IV in personality disorders.

INTRODUCTION: 50 % of the patients seen in the mental health clinics have personality disorders and their diagnosis is very important to establish the patient's prognosis and treatment. The clinician usually only uses one nosology, the ICD-10 or the DSM-IV and is aware of the differences between them. However, he/she gives preference to his/her favorite nosology. MATERIAL AND METHOD: A total of 248 patients seen in a mental health clinic were included in the study. They were diagnosed of anxiety (n = 121) and depressive (n = 127) disorders, with a mean age of 32.3 years for anxiety disorders and 32.4 years depressive disorders. The International Personality Disorders Examination (IPDE) Screening Questionnaire in its DSM-IV and ICD-10 versions was administered to observe the degree of concordance between the two nosologies. RESULTS AND DISCUSSION: The female population predominated in our sample, these being 35.5 % men with anxiety disorders and 65,5 % women, and 29.10 % men and 70.9 % women with depressive disorders. An observational study was performed by studying the percentage with 3 or more positive items and also percentage with 6 or more positive items. It was observed that the DSM-IV version produced more positive diagnoses and more comorbidity. Thus, it is necessary to consider whether the ICD-10 version subdiagnoses personality disorders or the DSM-IV version gives false positives. The qualitative differences between the ICD-10 and the DSM-IV must also be considered. The ICD-10 does not include narcissistic and schizotypal personality disorders and subdivides the borderline personality disorder into two subcategories, so that a given patient can receive different diagnoses according to the nosology used. CONCLUSIONS: In the patient sample studied, diagnostic discrepancies in personality disorders between DSM-IV and ICD-10 are so important that the World Health Organization and the American Psychiatry Association should consider unifying categories and diagnostic criteria of personality disorders in the next nosologies.

Aspectos socioculturales en la génesis de los trastornos de la personalidad / Sociocultural aspects of the genesis of personality disorders

Los trastornos de la personalidad parecen estar en aumento en las últimas décadas. Muchos sociólogos e historiadores piensan que desde el final de la Segunda Guerra Mundial ha habido grandes cambios culturales, sociales y económicos, que podrían indicar que se ha entrado en una nueva edad: la Edad Postmoderna tras 500 años de Edad Moderna. La postmodernidad se caracteriza por un aumento de la velocidad en todos los ámbitos de la vida, cambios continuos, materialismo, predominio del modelo económico capitalista, cambios de roles, etc. Se especula sobre la posibilidad de que las características de la sociedad postmoderna pudiesen contribuir al aumento de la prevalencia de los trastornos de la personalidad en general, y de algunos en particular (AU)