Giuseppe Borgherini

Comorbidity of DSM-IV personality disorders in unipolar and bipolar affective disorders: A comparative study

The aim of this study was to compare the prevalence of Personality Disorders assessed by Structured Clinical Interview for Axis-II in 155 inpatients diagnosed with Unipolar Disorder vs inpatients with Bipolar Disorder (39). The most frequent Axis II diagnoses among Unipolar inpatients were Borderline (31.6%), Dependent (25.2%), and Obsessive-Compulsive (14.2%) Personality Disorders. Among Bipolar inpatients, the most prevalent personality disorders were Borderline (41%), Narcissistic (20.5%), Dependent (12.8%), and Histrionic disorders (10.3%). Using chi squared analysis, few differences in distribution emerged between the two groups: Unipolar patients had more recurrent Obsessive-Compulsive Personality Disorder than Bipolar patients (χ12 = 6.24, p < .005). Comorbid Narcissistic Personality Disorder was significantly more frequent in the Bipolar than in the Unipolar group (χ12 = 6.34, p < .01). Considering the three clusters (DSM–IV classification), there was a significant difference between the groups, Cluster C (fearful, avoidant) diagnoses being more frequent in the Unipolar than in the Bipolar group (48.4% vs 20.5%, respectively). Cluster B (dramatic, emotionally erratic) diagnoses were found more frequently in patients with Bipolar Disorders (71.8% vs 45.2% in Unipolar patients, χ22 = 10.1, p < .006). The differences in the distribution and prevalence of Personality Disorders between the two patient groups are discussed.

Comparison of self-rated and clinician-rated measures of depressive symptoms: a naturalistic study.

In order to assess the concordance between self-rating and clinicians assessment tools of depression, as well as factors involved in the differences between auto and hetero evaluation, 198 depressed in-patients were assessed at admission and at discharge using the Montgomery Asberg Depression Rating Scale (10-item version, MADRS) and the self-rating scale Symptoms CheckList (90-item version, SCL-90). We found that about 18% of patients overestimated and about 15% underestimated their depressive symptomatology (SCL-90 depression subscale) relative to the psychiatrists assessment. Logistic regression analysis showed that the presence of personality disorders and previous history of psychiatric disorders predicted the overestimating group. Discriminant analysis showed that approximately 75% of participants were correctly classified when previous history of psychiatric disorders, presence of personality disorders and age were entered separately into the equation.

Depression in Inpatients: Bipolar vs Unipolar

162 depressed inpatients were divided into three diagnostic groups to compare patterns of sociodemographic characteristics, psychopathology, and psychosocial: 35 had a single episode of major depression, 96 had recurrent major depression, and 31 had a bipolar disorder. Psychopathology and psychosocial functioning were measured by clinician-rated scales, Montgomery-Asberg Depression Rating Scale, Hamilton Rating Scale for Depression, Clinical Global Impression, and self-rating scales, Symptom Checklist-90, Social Support Questionnaire, Social Adjustment Scale. The three groups were comparable on sociodemographic variables, with the exception of education. Univariate analyses showed a similar social impairment as measured by Social Support Questionnaire, Social Adjustment Scale, and no significant differences were recorded for the psychopathology when the total test scores (Montgomery-Asberg Depression Rating Scale, Hamilton Rating Scale for Depression, Clinical Global Index, Symptom Checklist-90) were evaluated. Some differences emerged for single items in the Montgomery-Asberg Depression Rating Scale and Symptom Checklist-90. These findings suggest a substantial similarity among the three groups. Results are discussed in terms of the clinical similarities between unipolar and bipolar patients during a depressive episode as well as the limitations of cross-sectional study implies.

Psychological stress and gastric emptying in normal subjects

Gastric emptying half-time was measured in 10 healthy volunteers on two different occasions over a one-week interval, with an identical test meal. The first was the control evaluation, and at the second assessment, psychological stress was induced by the technique of dichotomous listening. Psychological and physiological parameters were assessed before and during the test period. No significant or consistent modifications of gastric-emptying time were induced by the stress procedure. Looking at individual subjects instead of mean values, gastric emptying was unchanged in 5 subjects, slower in 3, and faster in the remaining 2. These 3 groups had different mean values on two subscales of the Sixteen Personality Factor Questionnaire.

Social adjustment in in-patients with affective disorders: predictive factors

We assessed social adjustment in 145 depressed in-patients using the self-reporting Social Adjustment Scale (42-item version) to evaluate the contribution of demographic and clinical variables and examine social functioning at different levels of depression. Our results indicate that the presence of a psychopathology in association with interpersonal sensitivity, hostility and perceived social support aspects -- and not the severity of current depressive symptoms -- were the most important factors affecting social adjustment. As expected, social disturbances are more pronounced in severe depressives who experience difficulties in all areas: by contrast, patients with low depressive symptom levels do not appear to be maladjusted, by comparison with a community sample.

Social adjustment in bipolar and unipolar single-episode and recurrently depressed inpatients.

Social adjustment scores were compared using the Social Adjustment Scale for 24 inpatients with single-episode major depression, 72 with recurrent major depression, and 28 with bipolar disorder. There were no differences between the three groups either in overall score or on single scales.

A New Interpersonal Theory and the Treatment of Dependent Personality Disorder

The method of treatment of dependent personality disorder that will be described in this chapter requires an understanding of the setting of this disorder within the entire range of personality disorders. Such an understanding is provided by a classificatory system, called the interpersonal octagon (Fig. 2) within which the ten DSM-IV, Axis II (American Psychiatric Association, 1994) personality disorders have been accommodated (Birtchnell, 1997a). The system is based upon a new interpersonal theory that has been developed by the senior author (Birtchnell, 1993/6). Within it, personality disorders are categorised according to the individual’s relating characteristics. The therapy, based upon the theory, involves minimising what will be called negative relating characteristics and maximising what will be called positive ones. The chapter will be divided into five parts. In the first, the version of interpersonal theory to be used will be described; in the second, dependent personality disorder will be defined within the context of this theory; in the third, the therapy of dependent personality disorder, based upon this definition, will be explained; in the fourth, a method of measuring change in therapy, based upon the theory, will be introduced and, by this method, the responsiveness of dependent patients to therapy will be demonstrated; and in the fifth, the general themes of the chapter will be brought together. Although it is acknowledged that dependent personality disorder is more prevalent in women, for ease of reading only, the male gender will be used throughout the chapter.

PAIN AND PERSONALITY IN DUODENAL ULCER: A PRELIMINARY REPORT '

Personality factors measured by the Cattells 16 Personality Factor Questionnaire were assessed for 78 duodenal ulcer patients with moderate to severe pain and in 30 duodenal ulcer patients with mild or no pain. The two groups were comparable for relevant sociodemographic variables. Patients with moderate to severe pain were significantly more tender-minded, kindly, and tended to be more introspective and glum than those reporting mild or no pain. However, the reported differences are small; adjustment of the p values to avoid Type I errors makes these differences no longer statistically significant. These results must be considered preliminary; further studies are necessary to understand the topic better.

Personality and duodenal ulcer response to antisecretory treatment

Two groups of duodenal ulcer (DU) patients, responders and nonresponders, have been compared in order to verify if psychological factors are linked to relapse. Responders are defined as those patients who on endoscopy did not present proven relapse during treatment with maintenance doses of antisecretory drugs (cimetidine 400 mg/day, ranitidine 150 mg/day, pirenzepine 50 mg/day) for a period of 12 months after healing of the lesion. Nonresponders were all patients presenting with at least one relapse during treatment with antisecretory drugs. One hundred and twelve DU patients (81 responders, 31 nonresponders) were examined with the Cattell 16 Personality Factors Questionnaire (16PF) form C. There were no significant differences between the two groups for age, sex, duration of illness and type of drug treatment. The 16 PF scores of responders and nonresponders were not statistically different except in the case of factor E (dominance), in which the nonresponder subjects scored higher than responder subjects (p less than 0.01). However, when the significance level was corrected for the number of variables involved, the above finding is not considered to be meaningful.

The role of stressful life events in duodenal ulcer recurrence: a prospective study.

This study prospectively assessed whether stressful life events (LE) were predictive of duodenal ulcer (DU) recurrence during remission of disease. We administered Paykels Interview for Recent Life Events to 80 patients to assess events that occurred 12 months prior to the first interview and again 6 to 12 months later for LE that occurred during the interval. Upper gastrointestinal endoscopy detected DU recurrence in 11 patients. Prospective data analysis showed no significant difference in LE between relapsing and relapse-free groups, whereas retrospective analysis showed significantly more LE (p > .03) among relapsing patients. LE seems to have played a marginal role in DU recurrence.