Psychological trauma and schizotypal personality disorder.

Two studies examined the relation between psychological trauma and schizotypal symptoms. In Study 1, in which 1,510 adults completed telephone interviews, both childhood maltreatment and the experience of an injury or life-threatening event were significantly associated with schizotypal symptoms. In Study 2, in which 303 adults (oversampled for having elevated levels of schizotypal symptoms) completed extensive in-person assessments, both childhood maltreatment and meeting posttraumatic stress disorder (PTSD) Criterion A were significantly associated with schizotypal symptoms. The links between schizotypal symptoms and at least some forms of psychological trauma could not be fully accounted for by shared variance with antisocial and borderline personality disorders, absorption/dissociation, PTSD symptom severity, family history of psychotic disorder, or signs of neurodevelopmental disturbance (as indexed by minor physical anomalies and inconsistent hand use). Schizotypal symptoms were more strongly associated with childhood maltreatment among men than among women, whereas schizotypal symptoms were more strongly associated with PTSD Criterion A among women than among men. Finally, among men, the association between childhood maltreatment and schizotypal symptoms was moderated by signs of neurodevelopmental disturbance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Saccuzzo and Schubert.

Reports an error in "Backward Masking as a Measure of Slow Processing in Schizophrenia Spectrum Disorders" by Dennis P. Saccuzzo and Donald L. Schubert (Journal of Abnormal Psychology, 1981, Vol. 90, No. 4, 305-312). There are several errors on page 307. The schizotypal personalities met the criteria identified by Spitzer, Endicott, and Gibbon (1979), not those of Spitzer, Endicott, and Robins (1977). The borderline personalities met the criteria identified by Spitzer et al. (1979) for unstable personalities, not those of Spitzer et al. (1977) for borderline personalities. (The following abstract of this article originally appeared in record 1981-28173-001.) Three groups of hospitalized adolescents (mean age 15.1 yrs; schizophrenics, schizotypal personalities, and borderline personality adolescent adjustment reactions) with 10 Ss in each group were compared for their ability to identify masked and unmasked stimuli. Results reveal that the schizophrenics required longer minimum exposure durations for criterion identification of unmasked stimuli. Under conditions of visual backward masking, however, schizotypal personalities as well as schizophrenics showed a relative deficit. Results support L. L. Heston's notion that schizophrenia spectrum disorders may be different degrees of expression of the same underlying defect. Previous results with visual backward masking in adults are also extended to adolescents. Findings are consistent with a slow information processing hypothesis for schizophrenia spectrum disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential impairment as an indicator of sex bias in DSM-IV criteria for four personality disorders.

The aim of the present study was to investigate the possibility of sex bias in the diagnostic criteria for borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders. A clinical sample of 668 individuals was evaluated for personality disorder criteria using a semistructured interview, and areas of functional impairment were assessed with both self-report and semistructured interview. The authors used a regression model of bias to identify bias as differences in slopes or intercepts between men and women in the relationship between each diagnostic criterion and level of impairment. The results suggest that most of the diagnostic criteria examined do not seem to display sex bias. However, those criteria that displayed evidence of bias came largely from the borderline diagnosis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing borderline definitions: DSM-III borderline and schizotypal personality disorders.

Compared the two types of borderline disorder formally defined by Diagnostic and Statistical Manual of Mental Disorders (DSM-III), borderline personality disorder and schizotypal personality disorder (SPD), at the diagnostic category and individual criterion level. Unlike previous research in this area, which had focused on inpatient and outpatient populations, the sample was a psychometrically defined, nonpatient sample including Ss meeting DSM-III criteria for each disorder. The results indicated that the two diagnostic categories each define a type of borderline with distinctive combinations of features. Perceptual and cognitive distortion, however, seem to be present in both and define an area of overlap between the two disorders. The implications of these findings for the revision of the SPD diagnostic criteria in DSM-III are discussed, and the theoretical separation of two subtypes of borderline personality is affirmed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Axis I comorbidity of borderline personality disorder

OBJECTIVE: The purpose of this study was to assess the lifetime rates of occurrence of a full range of DSM-III-R axis I disorders in a group of patients with criteria-defined borderline personality disorder and comparison subjects with other personality disorders. METHOD: The axis I comorbidity of 504 inpatients with personality disorders was assessed by interviewers who were blind to clinical diagnosis and who used a semistructured research interview of demonstrated reliability. RESULTS: Four new findings emerged from this study. First, anxiety disorders were found to be almost as common among borderline patients (N=379) as mood disorders but far more discriminating from axis II comparison subjects (N=125). Second, posttraumatic stress disorder (PTSD) was found to be a common but not universal comorbid disorder among borderline patients, a finding inconsistent with the view that borderline personality disorder is actually a form of chronic PTSD. Third, male and female borderline patients were found to differ in the type of disorder of impulse in which they "specialized." More specifically, substance use disorders were significantly more common among male borderline patients, while eating disorders were significantly more common among female borderline patients. Fourth, a lifetime pattern of complex comorbidity (i.e., met DSM-III-R criteria for both a disorder of affect and a disorder of impulse at some point before the patients' index admission) was found to have strong positive predictive power for the borderline diagnosis as well as a high degree of sensitivity and specificity. CONCLUSIONS: These results suggest that the lifetime pattern of axis I comorbidity characteristic of borderline patients and distinguishing for the disorder is a particularly good marker for borderline personality disorder.     

Backward masking as a measure of slow processing in schizophrenia spectrum disorders.

Three groups of hospitalized adolescents (mean age 15.1 yrs; schizophrenics, schizotypal personalities, and borderline personality adolescent adjustment reactions) with 10 Ss in each group were compared for their ability to identify masked and unmasked stimuli. Results reveal that the schizophrenics required longer minimum exposure durations for criterion identification of unmasked stimuli. Under conditions of visual backward masking, however, schizotypal personalities as well as schizophrenics showed a relative deficit. Results support L. L. Heston's (see record 1971-10373-001) notion that schizophrenia spectrum disorders may be different degrees of expression of the same underlying defect. Previous results with visual backward masking in adults are also extended to adolescents. Findings are consistent with a slow information processing hypothesis for schizophrenia spectrum disorders. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differentiation of Axis I and Axis II disorders.

The revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III—R; American Psychiatric Association, 1987) distinguishes between Axis I and Axis II disorders: Axis II includes personality (and developmental) disorders, and all others are on Axis I. This distinction is often useful, but the reification of Axis I and II constructs through diagnostic criteria sets that demarcate categorically distinct entities is at times problematic. T. A. Widiger and T. Shea review the issues of differentiating personality from Axis I disorders, specifically illustrated by schizotypal and schizophrenic disorders, borderline and mood disorders, antisocial and substance use disorders, and avoidant personality from social phobia. The options for addressing their differentiation include adding exclusion criteria, shifting the placement of disorders, deleting overlapping criteria, adding differentiating criteria, and converting to a dimensional format. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential diagnosis of attention deficit and conduct disorders using conditional probabilities.

Attention deficit and conduct disorders require an important yet often difficult differential diagnosis. Prior efforts to determine which symptoms are optimal for making this differential diagnosis have been limited by a reliance on statistics that do not supply the probability of the disorders given a symptom's presence (positive predictive power) or the probability that the disorder is not present given the absence of the symptom (negative predictive power). This investigation examined the utility of these latter statistics in the differential diagnosis of childhood attention deficit and conduct disorders. The data consisted of symptoms from a standardized maternal psychiatric interview collected for a sample of 76 clinic-referred boys. Results indicated that some symptoms are optimal as inclusion criteria, some as exclusion criteria, some as neither, and some as both. Furthermore, some symptoms that have been traditionally associated with the diagnosis of one disorder were actually found to be more useful in the diagnosis of the other disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Safety and tolerability of intravenous cibenzoline for acute termination of spontaneous sustained ventricular tachycardia. Cibenzoline and spontaneous VT

OBJECTIVE: To examine the rate of persistence of borderline personality disorder (BPD), the existence of concomitant personality disorders on follow-up, and the predictors of outcome in patients who met criteria for BPD compared with patients with borderline features who failed to meet all of the criteria. METHOD: This prospective cohort study reassessed subjects for BPD diagnosis and cooccurring personality pathology at 7 years follow-up. Initial measures of borderline and comorbid personality psychopathology were used to predict levels of borderline or other personality disorder psychopathology at follow-up. RESULTS: Of the 57 subjects who initially met the criteria for BPD, 30 (52.6%) were found to have remitted BPD, and 27 (47.4%) were characterized as having persistent BPD. The remitted group met significantly fewer comorbid personality disorder diagnoses than the persistent group (mean = 0.8, mean = 3.5 respectively; P < 0.05). Results also indicated that the initial level of borderline psychopathology was predictive of borderline psychopathology at follow-up, which explained 17% of the variance. CONCLUSIONS: This prospective follow-up study found that almost 50% of former inpatients with BPD continue to test positive for BPD at 7 years follow-up, and these persistent BPD patients also had significantly more comorbid personality psychopathology. Borderline psychopathology at follow-up was primarily predicted by the level of borderline psychopathology recorded at the initial assessment.     

Ten-year stability and latent structure of the DSM–IV schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders.

Evaluation of the validity of personality disorder (PD) diagnostic constructs is important for the impending revision of the Diagnostic and Statistical Manual of Mental Disorders. Prior factor analytic studies have tested these constructs in cross-sectional studies, and models have been replicated longitudinally, but no study has tested a constrained longitudinal model. The authors examined 4 PDs in the Collaborative Longitudinal Personality Disorders study (schizotypal, borderline, avoidant, and obsessive-compulsive) over 7 time points (baseline, 6 months, 1 year, 2 years, 4 years, 6 years, and 10 years). Data for 2-, 4-, 6- and 10-year assessments were obtained in semistructured interviews by raters blind to prior PD diagnoses at each assessment. The latent structure of the 4 constructs was differentiated during the initial time points but became less differentiated over time as the mean levels of the constructs dropped and stability increased. Obsessive-compulsive PD became more correlated with schizotypal and borderline PD than with avoidant PD. The higher correlation among the constructs in later years may reflect greater shared base of pathology for chronic personality disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Two-Year Stability and Change of Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders.

The authors examined the stability of schizotypal (STPD), borderline (BPD), avoidant (AVPD) and obsessive-compulsive (OCPD) personality disorders (PDs) over 2 years of prospective multiwave follow-up. Six hundred thirty-three participants recruited at 4 collaborating sites who met criteria for 1 or more of the 4 PDs or for major depressive disorder (MOD) without PD were assessed with semistructured interviews at baseline, 6, 12, and 24 months. Lifetable survival analyses revealed that the PD groups had slower time to remission than the MDD group. Categorically, PD remission rates range from 50% (AVPD) to 61% (STPD) for dropping below diagnostic threshold on a blind 24-month reassessment but range from 23% (STPD) to 38% (OCPD) for a more stringent definition of improvement. Dimensionally, these findings suggest that PDs may be characterized by maladaptive trait constellations that are stable in their structure (individual differences) but can change in severity or expression over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On criterion weighting in the DSM-IV..

Differential weighting of illness signs and symptoms has surfaced recurrently in psychiatric nosology. Six altemately weighted algorithms for diagnosing alcohol dependence in accordance with the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV ; American Psychiatric Association, 1994), based on statistical, unit, rational and random criterion weighting systems, were used to predict an array of concurrent validators and 6-month drinking outcomes in a regional clinical sample of 365 participants. Comparable predictive efficiency across all algorithms, including the randomly weighted versus statistical best-fit model, was observed. Further analyses and geometric modeling suggested that this was due to the extremely high internal consistency of the DSM-IV criteria. An alternative strategy that favors factorially complex, less homogeneous criteria was used to develop an experimental DSM-IV algorithm from an array of 39 candidate criteria. This algorithm had extremely low internal consistency, high difficulty, and complex factor loadings. Differential weighting of its criteria produced a good range of efficiencies, predictive power for rational models exceeding the random weight model, and a best-fit algorithm with surplus predictive power.… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eye movement impairment and schizotypal psychopathology

OBJECTIVE: Eye movement dysfunction in relation to a smooth pursuit task has been documented in schizophrenic patients and in patients with the related personality disorder, schizotypal personality disorder. To investigate which quantitative measures are associated with the eye movement dysfunction and whether the dysfunction is more related to the psychotic-like or the deficit-like symptoms of schizotypal personality disorder, ratings of eye movements in several groups of subjects were compared. METHOD: The study groups consisted of 26 patients with schizotypal personality disorder, 42 patients with other personality disorders (22 who also had two or more schizotypal personality traits and 20 who had fewer than two), and 37 normal comparison subjects. Smooth pursuit eye tracking of sinusoidal and constant velocity targets was recorded by an infrared eye tracking system. Two raters evaluated pursuit gain and large and small saccades in the direction of the target and in the direction opposite to that of the target (quantitative ratings) and constant velocity (qualitative rating). RESULTS: Patients with schizotypal personality disorder and patients with other personality disorders and two or more schizotypal traits, but not those with fewer than two schizotypal traits, had significantly poorer qualitative ratings of tracking than the normal comparison subjects. Neither gain nor any of the saccadic measures significantly differed between groups. The number of large saccades in the direction of the target was the only quantitative variable that predicted low qualitative ratings. Qualitatively poor tracking was associated with the deficit-like, but not the psychotic-like, symptoms of schizotypal personality disorder. CONCLUSIONS: Patients with schizotypal personality disorder demonstrate qualitatively poorer tracking than comparison groups, and the impaired tracking is associated with deficit-like symptoms.     

Empirical evaluation of DSM-IV generalized anxiety disorder criteria in children and adolescents

Evaluated the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994) generalized anxiety disorder (GAD) criteria in children and adolescents. Clinic-referred children meeting criteria for DSM-IV GAD, those meeting criteria for another DSM-IV anxiety disorder, and normal children participated in a structured interview and completed self-report questionnaires. Groups were compared in terms of interview and self-report measures to examine convergent and discriminant validity. In addition, developmental differences, cross-informant symptom and syndrome agreement, and validity of parent and child report were determined. Finally, the symptoms comprising the GAD associated symptom criterion (Criterion C) were examined in terms of rate of endorsement and predictive power. Results showed that parameters of worry differentiated children with GAD from those with other anxiety disorders and controls. Developmental differences in the sample did not appear to necessitate a separate criteria set for the classification of generalized anxiety in children of this age. Symptoms from GAD Criterion C evidenced moderately high rates of endorsement and acceptable predictive power. Overall, the DSM-IV GAD criteria for children and adolescents are supported, but further evaluation is necessary before firm conclusions can be drawn.     

The relationship between acute stress disorder and posttraumatic stress disorder: A prospective evaluation of motor vehicle accident survivors.

Motor vehicle accident survivors (n?=?92) were assessed for acute stress disorder (ASD) within 1 month of the trauma and reassessed (n?=?71) for posttraumatic stress disorder (PTSD) 6 months posttrauma. ASD was diagnosed in 13% of participants, and a further 21% had subclinical levels of ASD. At follow-up, 78% of ASD participants and 60% of subclinical ASD participants met criteria for PTSD. The strong predictive power of acute numbing, depersonalization, a sense of reliving the trauma, and motor restlessness, in contrast to the low to moderate predictive power of other symptoms, indicates that only a subset of ASD symptoms is strongly related to the development of chronic PTSD. Although these findings support the use of the ASD diagnosis, they suggest that the dissociative and arousal clusters may require revision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Usefulness of angiotensin converting enzyme inhibitors in the diagnosis of renovascular hypertension. III. Evaluation of the validity of the captopril test and the reno-scintigraphic captopril test in the diagnosis of renovascular hypertension according to accepted criteria

The aim of the study was to evaluate diagnostic validity of captopril test and scintigraphic test before and after captopril for the detection of renovascular hypertension (RVH) according to applied criteria. Employing blood pressure response to captopril as a criteria sensitivity was 37.0%, specificity 92.1%, positive predictive value 75.0% and negative predictive value 70.2% in the captopril test. Applying plasma renin activity (PRA) response to captopril as a criteria sensitivity was 92.5%, specificity 100%, positive predictive value 100% and negative predictive value 96.0% in the same test. Renin captopril test has excellent sensitivity and positive predictive value, is easy to perform and inexpensive and therefore may be a useful screening test for RVH in unselected population. With the own criteria used, captopril renoscintigraphy detected RVH with 87.5% sensitivity, 91.7% specificity, 87.5% positive predictive value and 91.7% negative predictive value. Captopril renoscintigraphy is an accurate diagnostic test for the identification of RVH in a clinically selected high-risk population. Common evaluation of both tests does not improve their accuracy in diagnosis of RVH.     

Borderline personality: Traits and disorder.

Although the 5-factor model (FFM) has been advocated as an alternative to representing the construct of borderline personality, some argue that this diagnosis carries essential information that is not well captured by the FFM. The present study examined antecedent, concurrent, and predictive markers of construct validity in a sample of 362 patients with personality disorders. The results indicated that neuroticism best distinguished borderline and nonborderline patients, whereas the FFM as a whole captured a sizable proportion of the variance in the borderline diagnosis. However, the residual of the borderline diagnosis that was not explained by the FFM was found to be significantly related to childhood abuse history, family history of mood and substance use disorders, concurrent symptoms, and 2-year and 4-year outcomes. Thus, some elements of the borderline diagnosis may not be fully captured in a 5-factor representation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical study of the relation of borderline personality disorder to Briquet's syndrome (hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorders

OBJECTIVE: The criteria for borderline personality disorder seem to select patients with very high rates of Briquet's syndrome (hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorders. This study was undertaken to determine whether systematic assessment of patients with borderline personality disorder would reveal characteristic features of that condition which would distinguish it from these other disorders. METHOD: Eighty-seven white female patients (75 in St. Louis and 12 in Milan, Italy) who had borderline personality disorder according to both the DSM-III-R criteria and the Revised Diagnostic Interview for Borderlines were further examined with the DSM-III-R Checklist and the Perley-Guze Hysteria Checklist to determine their patterns of psychiatric comorbidity. RESULTS: Every patient had at least one additional DSM diagnosis. Patients in St. Louis and Milan averaged five and four additional diagnoses, respectively. Eighty-four percent of the patients in St. Louis met criteria for either somatization disorder, Briquet's syndrome, antisocial personality disorder, or substance abuse disorders. Patterns of comorbidity for panic (51%), generalized anxiety disorder (55%), and major depression (87%) in St. Louis were consistent with those in other studies. CONCLUSIONS: The data indicate that the boundaries for the borderline condition are not specific and identify a high percentage of patients with these other disorders. Furthermore, the comorbidity profiles closely resemble the psychiatric profiles of patients with these disorders. If the borderline syndrome is meant to include all of these disorders, its usefulness as a diagnosis is limited. Until the fundamental features of borderline personality disorder that distinguish it from the others are identified, it is recommended that clinicians carefully assess patients for these other diagnoses. Efforts should be made to change the borderline personality disorder criteria by shifting away from overlap with the criteria for the other disorders.     

Two-Year Prospective Naturalistic Study of Remission From Major Depressive Disorder as a Function of Personality Disorder Comorbidity.

In this study, the authors examined prospectively the 24-month natural course of remission from major depressive disorder (MDD) as a function of personality disorder (PD) comorbidity. In 302 participants (196 women, 106 men), psychiatric and PDs were assessed at baseline with diagnostic interviews, and the course of MDD was assessed with the Longitudinal Interval Follow-Up Evaluation at 6-, 12-, and 24-month follow-ups. Survival analyses revealed an overall 24-month remission rate of 73.5% for MDD that differed little by gender. Participants with MDD who had certain forms of coexisting PD psychopathology (schizotypal, borderline, or avoidant) as their primary PD diagnoses had a significantly longer time to remission from MDD than did patients with MDD without any PD. These PDs emerged as robust predictors of slowed remission from MDD even when controlling for other negative prognostic predictors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of DSM-IV cluster B personality disorder symptoms on the termination and continuation of psychotherapy.

This study investigates the relationship between therapy attendance with DSM-IV criteria for the cluster B personality disorders (antisocial [ANPD]; borderline [BPD]; histrionic [HPD]; and narcissistic [NPD]). Ninety patients who were found to meet DSM-IV criteria for an Axis II disorder (cluster A personality disorders?=?10; ANPD?=?20, BPD?=?25, HPD?=?5, NPD?=?14; cluster C personality disorders?=?16). Total number of DSM-IV criteria for BPD (r?=?.33, p?=?.001) and ANPD (r?=?–.22, p?=?.04) were significantly related to the number of psychotherapy sessions attended by a patient. Stepwise regression indicated that the 5 individual criteria BPD-1, NPD-4, BPD-8, HPD-8, and ANPD-7 (in order of entry into the regression equation) were independent and nonredundant predictors that explained 31% of variance found in the number of psychotherapy sessions attended by patients. The presence or absence of 3 of these individual criteria provided a good balance of positive predictive power (.78–.95) and overall correct classification rate (.53–.69) for therapy continuation. Clinical and research implications of personality characteristics are discussed in relation to the termination and continuation of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)