Personality disorders in adolescents with major depression, substance abuse disorders, and coexisting major depression and substance use disorders.

This study examined the presence of personality disorders in adolescent inpatients with major depression (MDD; n?=?45), substance use disorders (SUD; n?=?27), or both disorders combined (MDD-SUD; n?=?42). A consecutive series of patients were given structured diagnostic interviews for Axes I and II disorders. The groups did not differ with regard to age, gender, ethnicity, socioeconomic status, psychiatric history, or global assessment of functioning. Borderline personality disorder was diagnosed more frequently in the MDD-SUD group than in the MDD or SUD groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in psychiatric comorbidity among adolescents with substance use disorders.

The authors examined gender differences in rates of comorbid psychiatric disorders among adolescents with 1 or more psychoactive substance use disorders. Baseline diagnostic data were obtained from 135 adolescents, ages 12 to 19, and their parents-guardians, who participated in a study to develop and efficacy test Integrated Family and Cognitive-Behavioral Therapy. Rates of attention-deficit/hyperactivity disorder and conduct disorder were higher among drug-abusing male adolescents compared with drug-abusing female adolescents. However, high rates of disruptive behavior disorders also characterized drug-abusing female adolescents. Similarly, drug-abusing female adolescents exhibited a higher rate of major depression compared with drug-abusing male adolescents. However, rates of dysthymia, double depression (i.e., major depression and dysthymia), and bipolar disorder were equivalent between genders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impulsivity and risk-taking in borderline personality disorder with and without substance use disorders.

Impulsivity and risk taking propensity were assessed in participants with borderline personality disorder (BPD-only; n = 19), BPD and a current or past substance use disorder (BPD-SUD; n = 32), and a matched comparison group (MC; n = 28). Participants were administered behavioral measures of two facets of the multidimensional construct of impulsivity [GoStop, delay discounting task (DDT)], one measure of risk-taking propensity [Balloon Analog Risk Task (BART)], and two self-report measures of impulsivity (i.e., Barrett Impulsiveness Scale, Eysenck Impulsiveness Scale). The BPD-SUD group, but not the BPD-only group, discounted delayed rewards faster than the MC group on the DDT, suggesting that the BPD-SUD/MC group difference may be because of the SUD rather than BPD. In contrast, both the BPD-SUD and BPD-only groups exhibited poorer behavioral response inhibition compared with the MC group, but the two BPD groups did not differ from one another. This finding suggests that the differences in behavioral response inhibition may be because of BPD rather than SUD and that behavioral response disinhibition may be a core feature of BPD. None of the groups differed on the measure of risk-taking propensity (i.e., BART). On self-report questionnaires, the BPD-SUD group reported more impulsivity than the BPD-only group and both BPD groups reported more impulsivity than the MC group. Data from the DDT and self-report measures provide partial support for the hypothesis that BPD individuals with a SUD are more impulsive than BPD individuals without a SUD on some facets of impulsivity (e.g., desire to obtain a smaller immediate reward rather than wait to obtain a larger reward in the future). Results suggest that behavioral response inhibition may be a novel treatment outcome variable for BPD treatment studies. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Trajectories of PTSD and substance use disorders in a longitudinal study of personality disorders.

This study investigated the co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) in a sample (N = 668) recruited for personality disorders and followed longitudinally as part of the Collaborative Longitudinal Personality Disorders Study. The study both examined rates of co-occurring disorders at baseline and temporal relationships between PTSD and substance use disorders over 4 years. Subjects with a lifetime history of PTSD at baseline had significantly higher rates of SUDs (both alcohol and drug) than subjects without PTSD. Latent class growth analysis, a relatively novel approach used to analyze trajectories and identify homogeneous subgroups of participant on the basis of probabilities of PTSD and SUD over time, identified 6 classes, which were compared with respect to a set of functioning and personality variables. The most consistent differences were observed between the group that displayed low probabilities of both SUD and PTSD and the group that displayed high probabilities of both. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting personality pathology among adult patients with substance use disorders: effects of childhood maltreatment

The purpose of this study was to examine predictive relationships between types of childhood maltreatment and personality disorders in a substance-abusing population. Three hundred thirty-nine drug- or alcohol-dependent patients completed a reliable and valid retrospective measure of childhood trauma, the CTQ, and a self-report inventory that assesses the entire range of DSM-III-R personality disorders, the PDQ-R. As a preliminary step, factor analyses were used to group personality disorders into the three DSM-III-R Axis II clusters (Clusters A, B, and C), although some diagnostic subclusters were also found. Structural equation modeling analyses revealed several significant paths between types of maltreatment and personality disorder clusters (and subclusters). Physical abuse and physical neglect were related to a subcluster of "psychopathic" personality disorders consisting of childhood and adult antisocial personality traits and sadistic traits. Emotional abuse emerged as a broad risk factor for personality disorders in Clusters A, B, and C. Emotional neglect was related to the traits of schizoid personality disorder, which formed its own subcluster. Finally, sexual abuse, which had been expected to predict borderline personality disorder traits, was unrelated to any personality disorder cluster. These findings support the view that child maltreatment contributes to the high prevalence of co-morbid personality disorders in addicted populations.     

Risk factors for substance use disorders among inpatients with major affective disorders in Taiwan Chinese

The explanation by differential diagnosis of pathological changes of the fundus may be particularly difficult in case of diseases of sporadic occurrence. The examination findings in a 19-year-old patient with a choroidal osteoma are presented. Large arciform, atrophic areas with distinct boundaries and star-shaped vascular structures were dominant in the fundus on both sides. With peripapillar manifestation, the optic nerve head was ophthalmoscopically noncontributory. A submacular bleeding had caused sudden reduction of visual acuity and caused the patient to visit the ophthalmologist. The most important diagnostic key was supplied by echography, which established peripapillar scleral calcification. The posterior eye segment was highly reflective in ultrasonic echography (B mode), showing concave deformation and causing the sound shadow. Visually evoked potentials indicated the onset of the compression of the optic nerve by the choroidal osteoma. Diagnostic and treatment possibilities are discussed.     

Clinical implications of the co-occurrence of substance use and other psychiatric disorders.

The co-occurrence of substance use and psychiatric disorders is the rule rather than the exception in mental health and substance use treatment settings across the United States. Such co-occurrence may call for special assessment and evaluation procedures, modified treatment plans, and specialized follow-up. Treatment of co-occurrence of substance abuse and psychiatric disorders requires more cross-disciplinary collaboration; greater integration of substance use, mental health, and social services treatment approaches; and modifications in the training of care providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term patterns of service use and cost among patients with both psychiatric and substance abuse disorders

OBJECTIVES: This is a longitudinal study designed to determine: (1) if patients dually diagnosed with psychiatric and substance abuse disorders incur higher health care costs than other psychiatric patients and (2) if higher costs can be attributed to particular subgroups of the dually diagnosed or types of care. METHODS: Two cohorts of veterans treated in Veterans Affairs mental health programs at the start of fiscal year 1991 were followed for 6 years: one cohort of inpatients (n = 9,813) and the other of outpatients (n = 58,001). Data were analyzed on utilization of all types of Veterans Affairs health care. Repeated measures analysis of variance was used to examine cost differentials between dually diagnosed patients and other patients. RESULTS: Dually diagnosed outpatients incurred consistently higher health care costs than other psychiatric outpatients, attributable to higher rates of inpatient psychiatric and substance abuse care; however, this difference decreased with time. Costs were substantially higher in the inpatient cohort overall, but there were no differences in cost between dually diagnosed and other patients. CONCLUSIONS: In an atmosphere of cost cutting and moves toward outpatient care, the dually diagnosed may lose access to needed mental health services. Possibilities of developing more intensive outpatient services for these patients should be explored.     

Impact of assertive community treatment on homeless persons with co-occurring severe psychiatric and substance use disorders

To investigate the possibility of engrafting fetal liver hematopoietic cells by in utero intraperitoneal transplantation, we transplanted donor cells obtained from mouse fetuses at 13, 15 and 17 days of gestation to mouse fetuses at 15, 16 and 17 days of gestation. Engraftment was assessed by Sry gene amplification of DNA extracted from peripheral blood samples of transplanted mice six weeks after birth. In comparison, we performed an in vitro colony-assay of fetal liver cells at 13, 15, and 17 days of gestation. The incidence of engraftment was significantly higher in cells of 15 days of gestation than in cells of 13 or 17 days of gestation, whereas the colony forming activity decreased gradually from 13 to 15 days of gestation. From these results, we suggest that the 15 day liver contains hematopoietic progenitors which have the specific characteristics required for engraftment by intraperitoneal transplantation.     

Physical and mental comorbidity of substance use disorders in psychiatric consultations. European Consultation-Liaison Workgroup

Comorbidity of substance use disorders with physical and mental disorders was investigated among 1249 consecutive psychiatric consultation patients admitted to six general hospitals in Finland. Of the patients 354 (28%) were diagnosed with substance use disorders (ICD-10), of which 22% were due to use of at least two different types of psychoactive substances. Alcohol dependence (117/226) in male patients and acute drug intoxication (49/128) at a similar rate as alcohol dependence (44/128) in female patients were the most common clinical conditions. With few exceptions, all substance use disorders were comorbid and in 63% of affected patients comprised a "triple diagnosis" (i.e., physical, mental, and substance use diagnoses concurrently). Poisonings and personality disorders in both sexes, digestive system diseases in men, and injuries in women were related to substance use disorders. Conclusions for service provision were: (1) the high level of co-occurrence of physical and mental disorders with substance use disorders calls for comprehensive, multi-disciplinary assessment of any substance use problems ascertained in psychiatric consultations; (2) poisoning with substance use involvement and mental comorbidity was the most common combined clinical condition justifying provision of addiction psychiatric emergency consultations in general hospitals; (3) polydrug use indicating severe problems and complex treatment needs should be identified; and (4) psychiatric referrals of patients with physical alcohol-related disorders should be ensured in general hospitals.     

The ability of individuals with psychoactive substance use disorders to escape detection by the Personality Assessment Inventory.

The ability of individuals with psychoactive substance use disorders to dissimulate successfully on the Personality Assessment Inventory (PAI; L. C. Morey, 1991) was evaluated. Patients receiving treatment for drug abuse who were instructed to respond honestly (n?=?59) had significantly higher scores on the PAI scales measuring problems with alcohol and other drug use than (a) patients instructed to respond defensively (n?=?59), (b) respondents suspected of abusing psychoactive substances who were referred for an evaluation by the criminal justice system and who had reasons to conceal their drug use (n?=?59), and (c) respondents from a nonclinical control group (n?=?9). However, a PAI validity scale designed to measure positive dissimulation was prone to making false positive and false negative errors, depending on the cutoff employed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The structure of personality disorders in individuals with posttraumatic stress disorder.

Research on the structure of personality disorders (PDs) has relied primarily on exploratory analyses to evaluate trait-based models of the factors underlying the covariation of these disorders. This study used confirmatory factor analysis to evaluate whether a model that included both PD traits and a general personality dysfunction factor would account for the comorbidity of the PDs better than a trait-only model. It also examined if the internalizing/externalizing model of psychopathology, developed previously through research on the structure of Axis I disorders, might similarly account for the covariation of the Axis II disorders in a sample of 245 veterans and nonveterans with posttraumatic stress disorder. Results indicated that the best fitting model was a modified bifactor structure composed of nine lower-order common factors. These factors indexed pathology ranging from aggression to dependency, with the correlations among them accounted for by higher-order Internalizing and Externalizing factors. Further, a general factor, reflecting a construct that we termed boundary disturbance, accounted for additional variance and covariance across nearly all the indicators. The Internalizing, Externalizing, and Boundary Disturbance factors evidenced differential associations with trauma-related covariates. These findings suggest continuity in the underlying structure of psychopathology across DSM–IV Axes I and II and provide empirical evidence of a pervasive, core disturbance in the boundary between self and other across the PDs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Manualized treatment for substance abusers with personality disorders: dual focus schema therapy

The presence of an untreated personality disorder may be associated with worse compliance and outcome in substance abuse treatment. Therapeutic attention to the symptoms of personality disorder may reduce the severity of substance abuse and other Axis I symptoms which potentially contribute to relapse. A 24-week manual-guided individual cognitive-behavioral therapy approach has been developed that integrates relapse prevention with targeted intervention for early maladaptive schemas (enduring negative beliefs about oneself, others, and events) and coping styles. This Dual Focus Schema Therapy is being compared to 12-Step Drug Counseling for opioid-dependent individuals with personality disorders in an ongoing study funded by the National Institute on Drug Abuse. This article reviews Young's (1994) schema-focused theory and approach and summarizes the treatment manual, which integrates relapse prevention for substance abuse.     

Personality and substance use disorders: II. Alcoholism versus drug use disorders.

The relationship between personality and substance use disorders was investigated in a community-based sample of 638 individuals who were alcoholic and/or had a drug use disorder, and 1,530 individuals who did not have a substance use disorder. Personality was assessed by the Multidimensional Personality Questionnaire; substance use diagnoses were based on standard criteria as assessed by interview. Data were analyzed using a 3-factor (Gender?×?Alcoholism?×? Drug Use Disorder) multivariate analysis of variance. The significant alcoholism main effect was associated primarily with negative emotionality, whereas the significant drug use disorder main effect was associated primarily with constraint. No significant interactions with gender were observed. These findings suggest that the elevated levels of behavioral disinhibition observed with alcoholic individuals may be attributable to a subset of alcoholic individuals who also abuse drugs other than alcohol. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Constructive thinking in adolescents with substance use disorders.

This study examined the concurrent validity and clinical correlates of the Constructive Thinking Inventory (CTI), a measure of experiential coping, in 551 adolescents aged 14–18 years with and without Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) substance use disorders (SUDs). The CTI was correlated with depression, anxiety, and conduct problems. After controlling for demographics and comorbid lifetime psychiatric disorders, the CTI scales of Behavioral Coping and Categorical Thinking distinguished adolescents with and without SUDs. Implications of these findings for assessment and treatment are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbidity of personality disorders and unipolar major depression: a review

The association of major depressive disorders with personality disorders is relevant in terms of clinical, therapeutic and prognostic aspects. However, the prevalence of this association remains unclear. This may be due to methodological considerations. Nonetheless, it could be estimated from this review that 20% to 50% of inpatients and 50% to 85% of out-patients with a current major depressive disorder have an associated personality disorder. Cluster B personality disorders, in particular borderline (10-30%), histrionic (2-20%) and antisocial (0-10%), seem to be overrepresented, even if the narcissistic one is rare (less than 5%). The main characteristic of Cluster C personality disorders is the great variability of results across studies, except for the obsessive compulsive personality disorder, whose prevalence is consistent and rather high (0-20%). Cluster A personality disorders are an heterogeneous group, since the prevalence of schizotypal personality disorder is rather high (0-20%), the prevalence of paranoid personality disorder is low (less than 5%) and the prevalence of schizoid personality disorder is quite variable from one study to another. The prevalence of personality disorders among patients with a lifetime major depression has been insufficiently studied, although it may concern half of these patients. The prevalence of current of lifetime major depression among patients with a personality disorder has not been sufficiently studied and results are very scattered. Also, the coexistence of personality disorder and major depression is frequent, and this review emphasizes the heterogeneity of the personality styles associated with major depression. Finally, an optimization of methods and the adjunction of a dimensional point of view to the categorical approach may help to study the comorbidity of major depression and personality disorders and its consequences.     

Comorbidity of substance use disorders with mood and anxiety disorders: results of the International Consortium in Psychiatric Epidemiology

This article reports the results of a cross-national investigation of patterns of comorbidity between substance use and psychiatric disorders in six studies participating in the International Consortium in Psychiatric Epidemiology. In general, there was a strong association between mood and anxiety disorders as well as conduct and antisocial personality disorder with substance disorders at all sites. The results also suggest that there is a continuum in the magnitude of comorbidity as a function of the spectrum of substance use category (use, problems, dependence), as well as a direct relationship between the number of comorbid disorders and increasing levels of severity of substance use disorders (which was particularly pronounced for drugs). Finally, whereas there was no specific temporal pattern of onset for mood disorders in relation to substance disorders, the onset of anxiety disorders was more likely to precede that of substance disorders in all countries. These results illustrate the contribution of cross-national data to understanding the patterns and risk factors for psychopathology and substance use disorders.     

Trajectories of change in adolescent substance use and symptomatology: Impact of paternal and maternal substance use disorders.

The effects of paternal and maternal substance use disorders (SUDs) on trajectories of change in adolescent offspring nicotine, alcohol, and drug use and symptomatology were investigated in a population-based sample of adolescent twins (N = 1,514). Adolescent and parental substance phenotypes were assessed when most adolescents were 11 years old, with 2 assessments of adolescents approximately every 3 years thereafter. Growth curves were fit using hierarchical linear modeling. Results indicated acceleration of substance involvement during adolescence, particularly for boys. Paternal and maternal SUD were each associated with more extreme trajectories. There was evidence for an additive, rather than interactive, combined parental effect. Findings help clarify the impact of paternal and maternal SUD on the development of substance involvement during adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parents and families as contexts for the development of substance use and substance use disorders.

Parenting and familial influences on substance use and substance use disorders (SUDs) are important areas of study both for theories of etiology and for the development of preventive and treatment interventions. The articles in this special section illustrate both the value and the challenges of studying parenting and familial influences. Noteworthy issues include the need for mediational and moderational models examining the processes by which familial influences operate in a longitudinal framework to consider outcomes in a developmental context. Future directions include a multidisciplinary expansion of these studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A clinical study of substance dependence patients combined with other psychiatric disorders

The present study was conducted for clarifying the comorbidity of substance dependence and other psychiatric disorders in outpatients of four psychiatric hospitals in May, 1995. The results were as follows; 7.4% (N = 234) of the total 3155 psychiatric outpatients were diagnosed as substance dependence. Among those substance dependence patients, alcohol dependence accounted for 82.5% and the percentage of the other substance dependence were very small, i.e., methamphetamine dependence 6.4%, solvent dependence 1.7%, multiple substance dependence 9.4%, respectively. The percentage of comorbidity of substance dependence and psychiatric disorders was 23.9% (N = 56) of 234 substance dependence patients. The percentage of co-morbid alcohol dependence patients with affective disorder in all affective disorder patients was 5.0%; the percentage of comorbidity of alcohol dependence in neurotic patients 4.1%; the percentage of alcohol dependence comorbidity in schizophrenic patients 0.7%. In many cases, onsets of substance dependence and psychiatric disorders were within 2 years, which suggests the common backgrounds for substance dependence and psychiatric disorders, such as disruption of family and occupational life, stress and individual vulnerability, and substance use for self-medication. The study indicates that the percentages of diagnosed comorbidity of substance dependence and psychiatric disorders are generally smaller in Japan than in the U.S., which may be based on the differences of diagnostic standards between the two countries. Further studies are needed on the comorbidity of substance dependence and psychiatric disorders in other general hospital and psychiatric clinic patients.