Clinical Associations Between Severity of Impulsivity, Psychiatric Morbidity, Dysfunctional Defences and Personality Disorder: A Comparative Study With Axis-I Disorders.

OBJECTIVE: Psychiatric morbidity, impulsive behaviour and use of dysfunctional and maladaptive defences are core features of personality disorder (PD). This study aims to evaluate the significance of the strength of the association between these three core dimensions and PD. METHOD: Using a cross-sectional design, a sample of co-morbid Axis-I & -II disorders, and a sample of Axis-I disorders with no co-morbid PD were recruited at three general psychiatric mental health resource centres and then compared.PD as dependent variable was analysed both as a categorical and as a dimensional entity using the Structured Clinical Interview for DSM-IV. The Symptoms Checklist 90-R general severity index (GSI), the Barratt Impulsivity Scale (BIS) and the Defense Style Questionnaire (DSQ) were used to measure severity of psychiatric morbidity, impulsivity and defensive style, respectively. RESULTS: BIS was a highly significant predictor of categorical PD (ß = .13, SE = .03, p < .001), but not GSI and DSQ. BIS and GSI significantly predicted PD as a dimensional construct (ß = 0.32, SE = .08, t = 4.05, p < 0.001; and ß = 5.04, SE = 1.54, t = 3.28, p = 0.002, respectively). The diagnostic efficiency statistics found that BIS had greater sensitivity (.82) and specificity (.79), and overall predictive power (.87) of correctly identifying true positive and true negative PD diagnosis compared to the other two measures. CONCLUSIONS: BIS may be used in routine clinical practice as a screening measure to identify the presence of PD in complex presentations.

Personality traits in chronic daily headache patients with and without psychiatric comorbidity: an observational study in a tertiary care headache center.

BACKGROUND: Previous studies suggest that patients with Chronic Daily Headache (CDH) have higher levels of anxiety and depressive disorders than patients with episodic migraine or tension-type headache. However, no study has considered the presence of psychiatric comorbidity in the analysis of personality traits. The aim of this study is to investigate the prevalence of psychiatric comorbidity and specific personality traits in CDH patients, exploring if specific personality traits are associated to headache itself or to the psychiatric comorbidity associated with headache. METHODS: An observational, cross-sectional study. Ninety-four CDH patients with and without medication overuse were included in the study and assessed by clinical psychiatric interview and Mini International Neuropsychiatric Interview (M.I.N.I.) as diagnostic tools. Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Hamilton Depression Rating Scale (HAM-D) were afterwards administered. Patients with and without psychiatric comorbidity were compared. Further analyses were made by splitting the whole group according to the headache diagnosis and the presence or not of medication overuse. RESULTS: Psychiatric comorbidity was detected in 44 patients (46.8%) (group A) and was absent in the remaining 50 patients (53.2%) (group B). Mood and anxiety disorders were the most frequently diagnosed (43.6%).In the overall group, mean scores of MMPI-2 showed a high level in the so-called neurotic triad; in particular the mean score in the Hypochondriasis subscale was in the pathologic area (73.55 ± 13.59), while Depression and Hysteria scores were moderate but not severe (62.53 and 61.61, respectively). In content scales, score in Health Concern was also high (66.73).Group A presented higher scores compared to Group B in the following MMPI-2 subscales: Hypochondriasis (p= .036), Depression (p= .032), Hysteria (p< .0001), Hypomania (p= .030). Group B had a high score only in the Hypochondriasis subscale. No significant differences were found between chronic migraine (CM)-probable CM (pCM) plus probable medication overuse headache (pMOH) and chronic tension-type headache (CTTH)-probable CTTH (pCTTH) plus pMOH patients or between patients with and without drug overuse. CONCLUSIONS: The so-called "Neurotic Profile" reached clinical level only in CDH patients with psychiatric comorbidity while a high concern about their general health status was a common feature in all CDH patients.

Predictors of dropout among personality disorders in a specialist outpatients psychosocial treatment: a preliminary study.

AIM: The aim of this study was to identify factors that may affect treatment retention in a 1-year psychosocial program for adult personality disorders. METHODS: The sample consists of patients admitted to the Adult Personality Disorder Outpatient Programme of the Bologna Community Mental Health Centre in the period 2003-2008. At the beginning of the program, patients were evaluated through a comprehensive assessment including sociodemographic form, diagnostic interviews and self-report questionnaires. Patients who dropped out from treatment were retrospectively compared with patients who completed the program. RESULTS: Out of 39 patients enrolled in the program, 20 (51.3%) dropped out and 19 (48.7%) completed the treatment. Out of 20 patients who dropped out, 14 terminated the treatment within the first 2 months. The dropout group and the group which remained showed significant differences in diagnosis (borderline personality disorder [BPD]), demographic data (age, time from first contact with psychiatric services), clinical variable (impulsiveness) and subjective experience (motivation, treatment expectation, therapeutic relation perception and barriers to access). BPD and subjective evaluation were found to be predictors of premature termination in the sample. In detail, BPD patients who experienced a less satisfactory therapeutic relationship and reported many external problems were more likely to drop out of the program. CONCLUSION: Important factors contributing to dropout were identified, with potential implication for clinical practice. Further efforts need to be made to find ways to retain BPD patients who find the first subjective experience of the service more problematic.