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/pdf/practice-guideline-for-the-treatment-of-patients-with-major-ofberaz3o1.pdf

PRACTICE GUIDELINE FOR THE Treatment of Patients With Major Depressive Disorder

https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(16)30030-X.pdf

Suicide prevention strategies revisited: 10-year systematic review

Diagnostic and Statistical Manual of Mental Disorders(DSM)-5による分類と診断 (特集 周産期メンタルヘルス : 妊婦の不安とどう立ち向かうか)

Schizophrenia, “just the facts” 4. Clinical features and conceptualization

Objective: The purpose of the present paper was to assess the attitudes of clinicians working with personality disordered patients.Methods: Secondary analysis of the Comorbidity of Substance Misuse and Mental Illness Collaborative (COSMIC) data set was undertaken using a priori hypothesis testing. The null hypothesis was that there would be no measurable difference between the attitudes of mental health professionals toward patients with a clinical diagnosis of personality disorder and those with an instrument-rated diagnosis of personality disorder. The potential confounders of global psychopathology, need, social functioning and documented aggression were assessed as possible reasons explaining a rejection of the null hypothesis.Results: Clinicians believed those with the clinical diagnostic label of personality disorder to be more difficult to manage than personality-disordered patients identified by a research tool who did not carry this label. These attitudes were not explained by the potential confo...

Attitudes of staff towards patients with personality disorder in community mental health teams

Personality disorder (PD) is increasingly categorized according to its severity, but there is no simple way to screen for severity according to ICD-11 criteria. We set out to develop the Standardized Assessment of Severity of Personality Disorder (SASPD). A total of 110 patients completed the SASPD together with a clinical assessment of the severity of personality disorder. We examined the predictive ability of the SASPD using the area under the ROC curve (AUC). Two to four weeks later, 43 patients repeated the SASPD to examine reliability. The SASPD had good predictive ability for determining mild (AUC = 0.86) and moderate (AUC = 0.84) PD at cut points of 8 and 10, respectively. Test-retest reliability of the SASPD was high (intraclass correlation coefficient = 0.93, 95% CI [0.88, 0.96]). The SASPD thus provides a simple, brief, and reliable indicator of the presence of mild or moderate PD according to ICD-11 criteria.

/pdf/development-and-psychometric-properties-of-the-standardized-5gjjc3xdsa.pdf

Development and Psychometric Properties of the Standardized Assessment of Severity of Personality Disorder (SASPD)

Background Personality disorder (PD) in psychosis is poorly studied. As PD can affect outcome in mental disorders, it is important to understand its prevalence in order to plan services, understand prognosis more fully and maximize management options. MethodLiterature searching revealed 3972 potential papers. Twenty papers including 6345 patients were included in the final analysis. There was great variation in prevalence and multilevel modelling was used to identify possible reasons for this heterogeneity. Results The prevalence of PD varied from 4.5% to 100%. Multilevel analysis suggested country of study, study type, the instruments used to diagnose PD and patient care correlated with the prevalence data explaining the study level heterogeneity, with 34.2, 33.4, 17.0 and 4.5% by each variable respectively. Personality studies in Canada and Sweden reported lower PD prevalence, whereas in Spain it was higher than the multinational study. Compared with randomized controlled trials, case-control studies reported lower prevalence [odds ratio (OR)=0.35, 95% confidence interval (CI) 0.15-0.79] and observational studies higher prevalence (OR 70.5, 95% CI 8.5-583). Primary-care patients were less likely to be diagnosed (OR 0.02, 95% CI 0-0.19) than hospital patients, and out-patients had higher prevalence (OR 12.5, 95% CI 1.77-88.6). Conclusions The reported prevalence of PD in schizophrenia varies significantly. Statistical modelling suggests care, country, study type and diagnostic tools for PD all bias prevalence rates. The number of papers reaching the inclusion criteria, the relative paucity of information and the difficulties in developing an accurate statistical model limited interpretation from the study.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291707002036

The prevalence of personality disorder in schizophrenia and psychotic disorders: systematic review of rates and explanatory modelling.

There is general agreement that the classification of personality disorders in DSM-IV is unsatisfactory. We systematically reviewed all studies that have analyzed patterns of personality disorder symptoms and signs in psychiatric patients; twenty-two papers were included in the final synthesis. There is reasonable consistency over the number and type of personality pathology traits reported despite differing samples, varying assessment methods, and different statistical manipulations. There are three or four high order traits; an externalizing factor incorporating borderline, narcissistic, histrionic, and antisocial traits (the latter is sometimes recorded as a separate trait); an internalizing factor incorporating avoidant and dependent traits; a schizoid factor; and often a compulsive factor. Using these domains of personality pathology would simplify classification, have higher clinical utility, and allow relatively easy translation of current research.

The central domains of personality pathology in psychiatric patients.

Background and aims
There has been a great deal of evidence showing that high novelty seeking (NS) is a risk factor for the development of substance use disorders (SUDs). However, the possible causal role of NS in SUDs is unconfirmed. The aim of this study was to examine the associations between NS at age 16 and SUDs from ages 18 to 35 years, net of a series of covariate factors.

Design
Longitudinal study of a birth cohort.

Setting
Christchurch, New Zealand.

Participants
General community sample with sample sizes ranging from n = 1011 (age 21) to n = 962 (age 35).

Measurements
The Composite International Diagnostic Interview was used to derive DSM-IV diagnoses of alcohol, nicotine, cannabis and other illicit SUDs at four time intervals from ages 18 to 35. NS was measured at age 16 using the Tridimensional Personality Questionnaire.

Findings
An increase in NS was associated with increases in the prevalence of all four SUDs at age 18–35. Following adjustment for a broad range of covariate factors, estimated effect sizes (odds ratios) were reducing in magnitude, but remained moderate to large. Adjusted odds ratios of SUDs for the highest NS quartile compared to with the lowest were 2.0 [95% confidence interval (CI) = 1.5, 2.7] for alcohol; 1.8 (95% CI = 1.3, 2.7) for nicotine; 3.6 (95% CI = 2.4, 5.6) for cannabis and 5.1 (95% CI = 2.9, 9.2) for other illicit substances.

Conclusions
The association between high novelty seeking and substance use disorders is not explained by common underlying individual factors and environmental exposures. This is consistent with the view that novelty seeking may play a causal role in the development of substance use disorders.

Giles Newton-Howes

Papers

Attitudes of staff towards patients with personality disorder in community mental health teams

Development and Psychometric Properties of the Standardized Assessment of Severity of Personality Disorder (SASPD)

The prevalence of personality disorder in schizophrenia and psychotic disorders: systematic review of rates and explanatory modelling.

The central domains of personality pathology in psychiatric patients.

The role of novelty seeking as a predictor of substance use disorder outcomes in early adulthood