Substance abuse and personality disorder comorbidity in adolescent outpatients: Are girls more severely ill than boys?

Background

Substance use disorders (SUDs) constitute a major health problem and are associated with an extensive psychiatric comorbidity. Personality disorders (PDs) and SUDs commonly co-occur. Comorbid PD is characterized by more severe addiction problems and by an unfavorable clinical outcome. The present study investigated the prevalence of SUDs, PDs and common Axis I disorders in a sample of adolescent outpatients. We also investigated the association between PDs and SUDs, and how this association was influenced by adjustment for other Axis I disorders, age and gender.

Methods

The sample consisted of 153 adolescents, aged 14–17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. SUDs and other Axis I conditions were assessed using the mini international neuropsychiatric interview. PDs were assessed using the structured interview for DSM-IV personality.

Results

18.3 % of the adolescents screened positive for a SUD, with no significant gender difference. There was a highly significant association between number of PD symptoms and having one or more SUDs; this relationship was practically unchanged by adjustment for gender, age and presence of Axis I disorders. For boys, no significant associations between SUDs and specific PDs, conduct disorder (CD) or attention deficit hyperactivity disorder (ADHD) were found. For girls, there were significant associations between SUD and BPD, negativistic PD, more than one PD, CD and ADHD.

Conclusions

We found no significant gender difference in the prevalence of SUD in a sample of adolescents referred to a general mental health outpatient clinic. The association between number of PD symptoms and having one or more SUDs was practically unchanged by adjustment for gender, age and presence of one or more Axis I disorders, which suggested that having an increased number of PD symptoms in itself may constitute a risk factor for developing SUDs in adolescence. The association in girls between SUDs and PDs, CD and ADHD raises the question if adolescent girls suffering from these conditions may be especially at risk for developing SUDs. In clinical settings, they should therefore be monitored with particular diligence with regard to their use of psychoactive substances.

Below:  PD symptoms in adolescents with SUD and other Axis I disorders. PD Symptoms any PD criteria meeting a score of 1,2 or 3 when measured with the SIDP-IV; SUD substance use disorders; alcohol and/or drug abuse or dependence. Alcohol alcohol abuse or dependence; CannabisCannabis abuse or dependence; Anxiety anxiety disorders, simple phobias, generalized anxiety disorder, panic disorder, agoraphobia, social phobia and post-traumatic stress disorder; Mood mood disorders, dysthymia and major depressive episode; CD conduct disorder; ADHDattention deficit hyperactivity disorder. ** p < 0.05

Full article at:   http://goo.gl/szh4O2

By:  Hans Ole Korsgaard, Svenn Torgersen, Tore Wentzel-Larsen, and Randi Ulberg

Department for Child and Adolescent Mental Health (The Nic Waal Institute), Lovisenberg Diakonale Hospital, Oslo, Norway

Department of Psychology, University of Oslo, Oslo, Norway

Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway

Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway

Vestfold Hospital Trust, Tønsberg, Norway

Institute of Clinical Medicine, University of Oslo, Oslo, Norway

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Sexual Dysfunction, Mood, Anxiety & Personality Disorders in Female Patients with Fibromyalgia

Background

We aimed to investigate the current prevalence of sexual dysfunction (SD), mood, anxiety, and personality disorders in female patients with fibromyalgia (FM).

Methods

This case–control study involved 96 patients with FM and 94 healthy women. The SD diagnosis was based on a psychiatric interview in accordance with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. Mood and anxiety disorders were diagnosed using the Structured Clinical Interview. Personality disorders were diagnosed according to the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders.

Results

Fifty of the 96 patients (52.1%) suffered from SD. The most common SD was lack of sexual desire (n=36, 37.5%) and arousal disorder (n=10, 10.4%). Of the 96 patients, 45 (46.9%) had a mood or anxiety disorder and 13 (13.5%) had a personality disorder. The most common mood, anxiety, and personality disorders were major depression (26%), generalized anxiety disorder (8.3%), and histrionic personality disorder (10.4%).

Conclusion

SD, mood, and anxiety disorders are frequently observed in female patients with FM. Pain plays a greater role in the development of SD in female patients with FM.

Current prevalence rate of SD, mood, anxiety, and personality disorders in the study groups

	Patient group, n=96	Control group, n=94	Odds ratio (95% CI)	P-value
Any sexual dysfunction	46 (47.9)	12 (12.8)	0.15 (0.07–0.32)	0.000a
Sexual desire disorder	36 (37.5)	13 (13.8)	0.26 (0.13–0.54)	0.000a
Orgasm disorder	7 (7.3)	1 (1.1)	0.13 (0.01–1.13)	0.033a
Arousal disorder	10 (10.4)	3 (3.2)	0.28 (0.07–1.06)	0.049a
Sexual aversion	1 (1)	0	0.99 (0.96–1.10)	1.000b
Dyspareunia	4 (4.2)	1 (1.1)	0.24 (0.02–2.25)	0.368b
Any mood disorder	27 (28.1)	2 (2.1)	0.05 (0.01–0.24)	0.000a
Major depression	25 (26)	2 (2.1)	0.06 (0.01–0.26)	0.000b
Dysthymic disorder	2 (2.1)	0	0.97 (0.95–1.00)	0.497b
Bipolar disorder	0	0	–	–
Any anxiety disorder	18 (18.8)	4 (4.3)	0.19 (0.06–0.59)	0.002a
Generalized anxiety disorder	8 (8.3)	1 (1.1)	0.11 (0.01–0.96)	0.035b
Panic disorder	2 (2.1)	1 (1.1)	0.50 (0.04–5.66)	1.000b
Social phobia	2 (2.1)	1 (1.1)	0.50 (0.04–5.66)	1.000b
Specific phobia	3 (3.1)	2 (2.1)	0.67 (0.11–4.12)	1.000b
Posttraumatic stress disorder	0	0	–	–
Not otherwise specified anxiety disorder	6 (6.2)	1 (1.1)	0.16 (0.04–1.36)	0.118b
Obsessive–compulsive disorder	2 (2.1)	1 (1.1)	0.50 (0.04–5.66)	1.000b
Any mood or anxiety disorder	45 (46.9)	5 (5.3)	0.06 (0.02–0.17)	0.000b
Any axis II disorder	13 (13.5)	5 (5.3)	0.35 (0.12–1.05)	0.053a
Avoidant	2 (2.1)	0	0.97 (0.95–1.00)	0.497b
Dependent	2 (2.1)	1 (1.1)	0.50 (0.04–5.66)	1.000b
Obsessive compulsive	1 (1)	2 (2.1)	2.06 (0.18–23.16)	0.619b
Passive–aggressive	2 (2.1)	0	0.97 (0.95–1.00)	0.497b
Paranoid	0	0	–	–
Schizotypal	0	0	–	–
Schizoid	0	0	–	–
Histrionic	10 (10.4)	1 (1.1)	0.09 (0.01–0.73)	0.006a
Borderline	0	0	–	–
Narcissistic	0	0	–	–
Antisocial	0	0	–	–
Comorbidity of any psychiatric and personality disorder	10 (10.4)	2 (2.1)	0.18 (0.04–0.87)	0.019a

Notes:

aχ2 test.

bFisher’s exact test. Values shown in bold are statistically significant.

Abbreviations: SD, sexual dysfunction; CI, confidence interval.

Full article at:   http://goo.gl/H15hIQ

By:  Fatih Kayhan,1 Adem Küçük,2 Yılmaz Satan,3 Erdem İlgün,4 Şevket Arslan,5 and Faik İlik6

¹Department of Psychiatry, Faculty of Medicine, Selçuk University, Konya, Turkey

²Department of Rheumatology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey

³Department of Psychiatry, Konya Numune State Hospital, Konya, Turkey

⁴Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Mevlana University, Konya, Turkey

⁵Department of Internal Medicine, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey

⁶Department of Neurology, Faculty of Medicine, Başkent University, Konya, Turkey

Correspondence: Fatih Kayhan, Department of Psychiatry, Faculty of Medicine, Selçuk University, Alaeddin Keykubat Campus, 42131 Selçuklu, Konya, Turkey, Tel +90 332 241 2181, Email moc.oohay@nahyakrd

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Assessment of Sexual Fantasies in Psychiatric Inpatients with Mood and Psychotic Disorders and Comorbid Personality Disorder Traits

Introduction

Sexuality is an important aspect of quality of life and sexual fantasies comprise a normal part of human sexuality. However, the nature of sexuality and sexual fantasies of patients with mental illness remains an understudied area.

Aim

To investigate the nature and frequency of sexual fantasies in psychiatric patients, the present study compared the frequency of four types of sexual fantasies across four different mood and psychotic diagnoses and three personality disorder clusters.

Methods

Study participants included 133 psychiatric inpatients recruited from an urban hospital. Sexual fantasies were compared across patients with schizophrenia, bipolar disorder, schizoaffective disorder, major depressive disorder and three nonclinical samples from the literature and then correlated with personality cluster scores.

Main Outcome Measures

Subjects were administered the Structured Clinical Interview for DSM-IV for Axis I and for Axis II Disorders. Sexual fantasies were assessed by the Wilson Sexual Fantasies Questionnaire, which measures four types of sexual fantasies (exploratory, intimate, impersonal, and sadomasochistic).

Results

Within the entire sample, there were significant differences across sexual fantasy types, with subjects scoring highest on intimate sexual fantasies and then exploratory, impersonal, and sadomasochistic. There were no significant differences across mood and psychotic diagnostic groups for any of the sexual fantasy scales and the scores were within the normative range of nonclinical samples. Patients with high cluster B scores scored significantly higher on all four fantasy scales than those without. Patients with high cluster A scores scored lower on intimate fantasies, but there was no association between cluster C scores and sexual fantasies. The association between cluster B and sexual fantasies remained consistent across Structured Clinical Interview for DSM-IV for Axis I diagnoses (no interaction effect).

Conclusion

Patients with severe mental illness report sexual fantasies that are largely affiliative in nature and consistent with normative patterns. This suggests that assessment and treatment of sexual issues in the mentally ill should be part of the clinical routine as it is in healthy individuals.

Full article at:   http://goo.gl/vkOShV

By:  Giancarlo Colón Vilar, MD, Erika Concepción, MD, Igor Galynker, MD, PhD, Thachell Tanis, BA, Firouz Ardalan, BA, Zimri Yaseen, MD, Lisa J. Cohen, PhD

Icahn School of Medicine at Mount Sinai Beth Israel, New York, NY, USA

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A Total Population‐Based Cohort Study of Female Psychiatric Inpatients Who Have Served a Prison Sentence

Background

Studies of the overlap between severe mental disorder and criminality tend to focus on prison populations rather than psychiatric populations.

Aims

Our aims were to establish the prevalence of previous imprisonment among female psychiatric inpatients and test relationships between diagnoses, mortality and imprisonment.

Methods

A nationwide cohort of 18–65-year-old women who had been hospitalised for psychiatric disorder between January 1983 and March 2008 was identified from a hospital records database and linked to the database of the Prison and Probation Administration of Iceland as well as the National Register of causes of death at Statistics Iceland from January 1985.

Results

Six thousand and ninety-four women had had at least one psychiatric hospitalisation, 102 of them had been imprisoned on 172 occasions between them, giving an imprisonment rate of 118 per 100,000 over the 24 year period of study. The crude imprisonment proportion was 1.7% during a 20-year follow-up period; it was at its peak (5%) among 18–30 year-olds at index admission. Substance use and personality disorders were the most common diagnoses associated with imprisonment. Mortality rates were not statistically different between those imprisoned and not.

Conclusion and implications for practice

Women admitted to a psychiatric hospital have higher rates of imprisonment than the general population. Because admission predated imprisonment in most cases, this may be seen as an opportunity for early intervention to reduce later criminality.

Purchase full article at:  http://goo.gl/WPSeV7

By:   

Steinn Steingrimsson^1,4,*, 

Martin I. Sigurdsson², 

Hafdis Gudmundsdottir³, 

Thor Aspelund² and

Andres Magnusson¹

1. 1 Department of Psychiatry, Landspitali University Hospital, Reykjavik, Iceland
2. 2 Faculty of Medicine, University of Iceland, Reykjavik, Iceland
3. 3 Prison and Probation Administration of Iceland, Reykjavik, Iceland
4. 4 Centre of Ethics, Law and Mental Health (CELAM), Sahlgrenska Academy, Univ of Gothenburg, Sweden

 

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Personality Disorders among Spanish Prisoners Starting Hepatitis C Treatment: Prevalence & Associated Factors

The purpose of this study was to assess the prevalence of personality disorders (PDs) and their associated factors in prisoners who initiate chronic hepatitis C (CHC) treatment in 25 Spanish prisons. 

The Personality Diagnostic Questionnaire-4 was used to diagnose PDs according to DSM-IV criteria. Factors potentially associated with a PD diagnosis were evaluated by logistic regression analysis. Two hundred and fifty-five patients were initially assessed and 62 (24.3%) were excluded due to an incomplete or invalid self-report screening questionnaire. PD prevalence was 70.5%, with antisocial PD being the most prevalent (46.1%). In terms of PD clusters, the most prevalent was cluster-B (55.4%). 

PD diagnosis was associated with HCV genotypes 1, 2, or 3. Patients with a cluster-B PD were more likely to be infected with HCV genotypes 1, 2, or 3 and be HIV-infected, to report past-year injection drug use, and to have stage 3 or 4 fibrosis. The prevalence of PDs in Spanish prisoners who initiate CHC treatment is very high. PD management issues should be considered in treating CHC patients in prisons.

Purchase full article at:  http://goo.gl/s0uy8N

By:  Marco A1, Antón JJ2, Saiz de la Hoya P3, de Juan J4, Faraco I5, Caylà JA6, Trujols J7; PERSEO Group.

• 1Health Services of Barcelona Men's Penitentiary Centre, Barcelona, Spain.
• 2Health Services of Albolote Penitentiary Centre, Granada, Spain.
• 3Health Services of Fontcalent Penitentiary Centre, Alicante, Spain.
• 4Health Services of Córdoba Penitentiary Centre, Córdoba, Spain.
• 5Health Services of Sevilla Penitentiary Centre, Sevilla, Spain.
• 6Epidemiology Service, Public Health Agency of Barcelona, CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
• 7Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), CIBER de Salud Mental (CIBERSAM), Barcelona, Spain. Electronic address: jtrujols@santpau.cat. 

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A Study of the Prevalence of Psychiatric Disorders in Patients with Methamphetamine-Induced Psychosis (Iran)

Among the 121 patients of the sample group, 4 patients (3.3%) had anxiety, 58 patients (47.9%) depression, 30 patients (24.8%) obsessive-compulsive disorder (OCD), 20 patients (16.5%) bipolar mood disorder (BMD), 8 patients (6.6%) persistent psychotic symptoms, 85 patients (70.2%) personality disorder, and 36 patients (29.8%) had no personality disorders. The highest prevalence was related to borderline personality disorder (35.5%). However, 45 patients (37.2%) had no impairment associated with methamphetamine-induced psychosis.

It seems that there is comorbidity between psychiatric disorders, including mood disorders, especially depressive disorder, childhood history of attention deficit hyperactivity disorder (ADHD), bipolar disorder, and personality disorders such as borderline personality disorder, and antisocial personality disorders, and methamphetamine abuse.

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Personality Disorders Do Not Affect Treatment Outcomes for Chronic HCV Infection in Spanish Prisoners: The Perseo Study

Below:  Treatment discontinuation in prisoners with and without personality disorders, stratified by cause of treatment interruption. *Release and/or transfer between prisons. PD: personality disorder; NS: not significant

Results

The sample included 236 patients (mean age: 40.3 years, 92.8 % male, 79.2 % intravenous drug users, and 26.3 % HIV-coinfected). The prevalence of PD was 72.5 %. 32.2 % of patients discontinued treatment; this percentage was higher in patients with HCV genotypes 1/4 (AOR = 3.55; CI:1.76–7.18) and those without PD (AOR = 2.51; 1.23–5.11). Treatment discontinuation was mainly for penitentiary reasons (40.3 %): release or transfer between prisons.

The rate of sustained viral response (SVR) was 52.1 % by ITT and 76.9 % by observed treatment (OT). SVR was higher among patients with genotype 2 or 3, and those with low baseline HCV-RNA. We did not observe any differences between individuals with and without PD in term of SVR, HCV genotype or HIV infection.

Conclusions

Our results support the safety and clinical effectiveness of the treatment of chronic HCV infection in correctional facilities, both in prisoners with PD and those without. Our data support non-discrimination between patients with and without PD when offering treatment for HCV infection to prison inmates.

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