Prevalence of personality disorders using two diagnostic systems in psychiatric outpatients in Shanghai, China: a comparison of uni-axial and multi-axial formulation

Abstract

Objective To compare multi-axial (DSM-IV) with uni-axial diagnostic system (CCMD-3, Chinese Classification and Diagnostic Criteria of Mental Disorders) as diagnostic methods to determine the prevalence of personality disorders (PDs) in Chinese psychiatric outpatients. Method 3,075 outpatients were randomly sampled from clinical settings in China. CCMD-3 PDs were evaluated as per routine psychiatric practice. DSM-IV PDs were assessed using both self-reported questionnaire and structured clinical interview. Results The prevalence estimate for any type of PD in the total sample is 31.93% as reflected in the DSM-IV. This figure is nearly 110 times as large as the prevalence estimate for the CCMD-3. Only 9 outpatients were diagnosed with PD based on the CCMD-3. Amongst the 10 forms of DSM-IV PDs, avoidant (8.1%), obsessive-compulsive (7.6%), paranoid (6.0%), and borderline (5.8%) PDs were the most prevalent sub-types. This study found that PDs are commonly associated with the following: (i) the younger aged; (ii) single marital status; (iii) those who were not raised by their parents; (iv) introverted personalities; (v) first-time seekers of psycho-counseling treatment; and (vi) patients with co-morbid mood or anxiety disorders. Conclusions PDs are easily overlooked when the diagnosis is made based on the CCMD-3 uni-axial diagnostic system. However it was found that personality pathology is common in the Chinese psychiatric community when using the DSM-IV classification system. Existing evidence suggest, at least indirectly, that there are important benefits of moving towards a multi-axial diagnostic approach in psychiatric practice.

Childhood maltreatment profile in a clinical population in China: A further analysis with existing data of an epidemiologic survey

“…Considering the psychotic symptoms may impact the assessment of CM and PD, outpatients with acute attacks or recently relapsed psychoses were excluded. Detailed descriptions of the study population have been published previously [7, 33, 34] but are briefly reviewed here. 3,075 patients seeking medical treatment were recruited between May and October 2006.…”

“…As detailed in our other studies [7, 33, 34], The Personality Diagnostic Questionnaire fourth edition plus (PDQ-4+) is a concise structured self-report questionnaire that contains 107 true-false items and screens for 10 Axis II DSM-IV PDs. Furthermore, the PDQ-4+ seeks to discriminate between subjects with and without a formal diagnosis of PD [35-37].…”

Screening schizotypal personality disorder for detection of clinical high risk of psychosis in Chinese mental health services

“…1): the epidemiological survey of personality disorder (PD) was conducted at the Shanghai Mental Health Center in 2006. As detailed in previous papers (Zhang et al, 2012a(Zhang et al, , 2012b(Zhang et al, , 2012c(Zhang et al, , 2013 invitation letters were issued to outpatients using a systematic sampling method (i.e., select every 10th in psychotherapy and 20th in psychiatric clinics). The Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4 þ) was used as screening tool for PD assessment, which included subscales of PDQ-SPD questionnaires.…”

“…The Wave 1 survey included a representative sample of 3075 outpatients in 2006 and described in detail elsewhere (Zhang et al, 2012c), but are briefly reviewed here (In Fig. 1 below, we have included a sample flow chart showing enrollment of 850 outpatients with SZ).…”

“…Although not widely found in practice, SPD is generally acceptable as a schizophrenic spectrum disorder with a genetic etiology by Chinese psychiatrists. Our previous survey (sample set 2006) (Zhang et al, 2012c) found a 2.8% (95% CI 2.2-3.4%) prevalence rate for DSM-IV SPD in outpatients of mental health service in China, but none of these patients had been diagnosed with CCMD-3 SPD. Consequently, integrating genetic risk inquiry questions to probe for psychotic family history and questions related to SPD into screening questionnaires for CHR detection is important and deserves attention.…”