Prevalence of personality disorder in alcohol and drug services and associated comorbidity

Bowden‐Jones, Owen; Iqbal, Muhammad; Tyrer, Peter; Seivewright, Nicholas; Cooper, Sylvia; Judd, Ali; Weaver, Tim

doi:10.1111/j.1360-0443.2004.00813.x

Cited by 70 publications

(46 citation statements)

References 34 publications

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“…The prevalence of PD in our study was, however, lower than in most other studies [4,6,13] . There may be several reasons for this difference.…”

Section: Discussioncontrasting

confidence: 54%

“…Other psychiatric disorders and socioeconomic problems along with PD often occur among alcoholics [5,6] , and patients suffering from PD have additional symptoms and problems compared with patients who only suffer from alcohol abuse [6,7] . Some studies describing the effect of PD on alcohol treatment have found that patients with PD (A+PD) derive reduced benefit from the therapy and increased risk of relapse [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

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Personality Disorders among Danish Alcoholics Attending Outpatient Treatment

Nordholm

Nielsen

2007

Eur Addict Res

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The aim of the present study was firstly to describe the characteristics of alcoholic outpatients (A) suffering from co-morbid personality disorder (PD) of either the cluster B (A+PDB) or cluster C (A+PDC) type. Secondly, to investigate the effect of various kinds of treatment to be able to single out the most beneficial therapy. Thirdly, to identify the most beneficial treatment. The patients were offered the following outpatient treatments: cognitive behaviour therapy, family therapy and supportive consultations. The material consisted of 363 patients who started psychosocial treatment at the outpatient alcohol clinic at Odense University Hospital, Denmark. It was possible to re-interview 276 (76%) patients 1 year after onset of treatment. Of the 363 patients, 87% were alcohol-dependent (ICD-10) and 34% fulfilled the ICD-10-R criteria for PDs. The basic interviews focused on the seven main areas of the Addiction Severity Index. A+PDC had significantly more serious medical problems than A–PD, while the A+PDB group had significantly more employment, drug use and social problems than the A–PD. As for psychiatric status, A–PD had significantly different scores compared with A+PDB and A+PDC. A+PDB were younger and had a longer history of alcohol abuse than A–PD and A+PDC. After treatment there was no significance between the patients with and without PD concerning alcohol outcome and psychosocial outcome. The significance of co-morbid PD for the prognosis of alcohol abusers may be overestimated. Our results indicate that A+PD can be treated as successfully as other patients in an outpatient alcohol clinic can.

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“…The prevalence of PD in our study was, however, lower than in most other studies [4,6,13] . There may be several reasons for this difference.…”

Section: Discussioncontrasting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Personality Disorders among Danish Alcoholics Attending Outpatient Treatment

Nordholm

Nielsen

2007

Eur Addict Res

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“…With regard to the risk factors for suicidal behavior, an association of CCPD with depression (Russel, Kornstein, Shea et al, 2003) as well as alcohol (Bowden-Jones, Iqbal, Tyrer et al, 2004) and substance use (Skinstad & Swain, 2001) has been reported. Furthermore, CCPD has been reported to be associated with anger/hostility (Fava, 1998;Gould, Ball, Kaspi et al, 1996), another risk factor for suicidal behavior (Mann, Waternaux, Haas et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

“…In the studies of suicidal behavior in CCPD subjects cited above, co-morbidity of other PDs, which could affect the association of CCPD with suicidal behavior, was not excluded. To our knowledge, only one psychological autopsy study excluded co-morbidity of other PD, and reported that "pure" CCPD was an independent predictor for completed suicide only for men (Schneider, Watterling, Sargk et al, 2005).With regard to the risk factors for suicidal behavior, an association of CCPD with depression (Russel, Kornstein, Shea et al, 2003) as well as alcohol (Bowden-Jones, Iqbal, Tyrer et al, 2004) and substance use (Skinstad & Swain, 2001) has been reported. Furthermore, CCPD has been reported to be associated with anger/hostility (Fava, 1998;Gould, Ball, Kaspi et al, 1996), another risk factor for suicidal behavior (Mann, Waternaux, Haas et al, 1999).…”

mentioning

confidence: 99%

Cluster C Personality Disorders in Major Depressive Episodes: The Relationship Between Hostility and Suicidal Behavior

Dervic¹,

Grunebaum²,

Burke³

et al. 2007

Archives of Suicide Research

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There is some evidence for an association between Cluster C Personality Disorders (CCPD) and suicidal behavior. We compared depressed inpatients with and without CCPD in terms of suicidal behavior and associated psychopathology. Cluster A or B personality disorder co-morbidity were exclusion criteria for both groups (cases and controls). Depressed inpatients with "pure" CCPD had higher levels of suicidal ideation but not more previous suicide attempts compared with patients without CCPD. Greater suicidal ideation in depressed patients with CCPD in our study was associated with more hostility. Future studies examining the relationship between suicidal ideation and hostility in CCPD may clarify whether treatment focused on hostility might be of use for decreasing suicidal ideation in depressed patients with CCPD (Spitzer, Williams, Gibbon et al., 1990). Keywordscluster C personality disorders; depression; hostility; suicide Whereas there is strong support for an association of other personality disorders, such as cluster B personality disorders with suicidal behavior (Corbitt, Malone, Haas et al., 1996;Isometsa, Henriksson, Heikkinen et al., 1996;Lecrubier, 2001 Sher, Oquendo, & Mann, 2001), reports about cluster C personality disorders (CCPD) (fearful/avoidant cluster) are mixed. Few studies have investigated the association between CCPD (obsessive-compulsive, avoidant, and dependent) and suicidal behavior. In a longitudinal study of a community sample, Johnson, Cohen, Skodol, et al. (1999) reported that patients with CCPD were at increased risk for suicidal behavior even after controlling for affective disorders. In psychological autopsy studies, Brent, Johnson, Perper, et al. (1994) reported a higher prevalence of probable or definite cluster C PD among adolescent suicide victims than in controls, and Foster, Gillespie, McClelland, et al. (1999) reported CCPD as a suicide risk factor even after adjustment for axis I disorders in adults. On the other hand, Isometsa, Henriksson, Heikkinen, et al. (1996) found no differences between adult suicide victims with CCPD and controls in any of the examined variables including a history of previous suicide attempt. Chioqueta and Stiles (2004) investigated the relationship between specific disorders within cluster C and suicide attempt in a study of psychiatric outpatients, and found that only dependent personality disorder, but not obsessivecompulsive and avoidant PD, was associated with suicide attempt. Of interest, this association disappeared after controlling for co-morbid depressive disorder.Yet, co-occurrence of personality disorders of more than one cluster has been reported to be associated with increased suicide risk (Schneider, Watterling, Sargk et al., 2005). In this context, in a community sample, 32% of subjects who met criteria for a personality disorder had diagnoses in 2 or more PD clusters (Johnson, Cohen, Skodo et al., 1999). In the studies of suicidal behavior in CCPD subjects cited above, co-morbidity of other PDs, which could affect the associ...

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“…The benefit of these drugs is unlikely to be a direct consequence of their antidepressant effect, although it could be connected -a similar study of fluoxetine in patients with depression and alcoholism showed improvement in both depression and drinking behaviour compared with placebo (Cornelius et al, 1997). Although personality disorder was not measured in this study, it is likely that a substantial proportion -about 50%, from prevalence figures in this clinical population (Bowden-Jones et al, 2004) -had this condition.…”

Section: Tricyclic Antidepressants and Selective Serotonin Reuptake Imentioning

confidence: 99%

Drug treatment for personality disorders

Tyrer¹,

Bateman²

2004

Adv. psychiatr. treat

Self Cite

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There is some evidence that antidepressants, particularly the selective serotonin reuptake inhibitors and the monoamine oxidase inhibitors, have some benefits in the management of borderline personality disorder, and lesser evidence (partly because of limited trial data) for the benefits of antipsychotic drugs and mood stabilisers. There is not sufficient distinction between the different personality disorders to recommend that any one disorder should be treated by any one drug, and successful treatment is dependent on careful management, sensitive to the patient's expectations.Peter Tyrer is Professor of Community Psychiatry and Head

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Prevalence of personality disorder in alcohol and drug services and associated comorbidity

Cited by 70 publications

References 34 publications

Personality Disorders among Danish Alcoholics Attending Outpatient Treatment

Personality Disorders among Danish Alcoholics Attending Outpatient Treatment

Cluster C Personality Disorders in Major Depressive Episodes: The Relationship Between Hostility and Suicidal Behavior

Drug treatment for personality disorders

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