Standardized Assessment Of Personality Research Articles

Prevalence of premorbid personality disorder and its clinical correlates in patients with delusional disorder

The aim of this study was to investigate the presence of premorbid Personality Disorder (PD) and its relationship with clinical correlates in patients with Delusional Disorder (DD). Eighty-six outpatients with DD whose diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Axis I (SCID-I) Disorders (psychosis module) were evaluated for premorbid PD utilizing the Standardized Assessment of Personality (SAP). Psychopathology was assessed using Module B of SCID-I and the Positive and Negative Syndrome Scale (PANSS); psychosocial functioning was evaluated with the Global Assessment of Functioning scale. Premorbid intelligence was assessed using the Wechsler Adult Intelligence Scale-Third Edition, vocabulary subtest. A sociodemographic-clinical questionnaire was completed. Sixty-four percent of the patients had at least one premorbid PD, the most common being paranoid PD (38.4%), followed by schizoid PD (12.8%). The presence of at least one premorbid PD was significantly associated with higher scores for psychopathology, in particular, on the affective dimension of DD symptoms. However, the presence of premorbid PD was not associated with psychosocial functioning. Each of the premorbid PD was associated with different psychopathological profiles. Premorbid PD is a relevant phenomenon in DD, given its high prevalence and comorbidity, its influence on clinical correlates and its potential ability to predict specific sub-syndromes.

Validation of two informant-based screening instruments for personality disorders in a psychiatric outpatient population

Purpose: The predictive validity of two informant-based screening instruments for personality disorders (PDs), the Standardized Assessment of Personality (SAP) and a short eight-item version (SAPAS-INF), were studied in 103 Dutch psychiatric outpatients, using the SCID-II as the ‘gold standard’. Methods: All patients and their informants were interviewed separately and independently by different interviewers who were unaware of the results in the other conditions. Results: According to the SCID-II, 66 patients had at least one personality disorder (PD). The SAP correctly classified 72% of all participants in the category PD present/absent. The sensitivity and specificity were 69% and 76%, respectively. The positive and negative predictive values were 84% and 58%. The SAPAS-INF, using a cut-off score of 3, correctly classified 70%; the sensitivity and specificity were 76% and 58%, respectively. The positive and the negative predictive values were 77% and 57%. Conclusion: These results show that the informant-based SAP as well as the shorter informant-based SAPAS-INF are adequate; though rather moderate screening instruments for identifying PD. The SAP and the SAPAS-INF, however, both performed worse than the SAPAS-SR, which is based on the patient’s self-report. Therefore, it is concluded that the SAP or the SAPAS-INF can be used as a satisfactory screening instruments for the presence/absence of PD in those cases where patients themselves are unable to provide the required information.

Clinical and Cognitive Correlates of Psychiatric Comorbidity in Delusional Disorder Outpatients

The aims of this study were to investigate the prevalence, as well as the clinical, cognitive, and functional correlates of psychiatric comorbidity in patients with delusional disorder (DD). Eighty-six outpatients with DSM-IV DD were evaluated for psychiatric comorbidity on Axis I disorders using the Mini International Neuropsychiatry Interview (MINI). The following instruments were administered: the Standardized Assessment of Personality (SAP), the Positive and Negative Symptom Scale (PANSS), the Montgomery-Asberg Depression Rating Scale (MADRS), a neuropsychological battery (consisting of measures for attention, verbal and working memory, and executive functions), the Sheehan Disability Inventory (SDI), and the Global Assessment of Functioning (GAF) scale. A socio-demographic and clinical questionnaire was also completed. Forty-six percent of the subjects had at least one additional lifetime psychiatric diagnosis, the most common being depressive disorders (N = 16, 32.6%), followed by anxiety disorders (N = 8, 14%). DD with comorbid Axis I disorders (N = 40, 46.5%) was associated with a specific syndromic constellation (more common cluster C personality psychopathology, somatic delusions, olfactory and gustatory hallucinations, and suicide risk), and greater severity of the psychopathology, particularly as regards emotional dysregulation (total and general PANSS scales, MADRS, and perceived stress SDI scoring). In contrast, DD without psychiatric comorbidity - "pure" DD - (N = 46, 53.5%) was associated with worse overall neurocognitive performance, mainly in working memory. There were no differences in functionality between the two groups (as per the GAF and SDI total, work, social and family life disability scores). Our findings reveal one type of DD with associated psychiatric comorbidity with greater emotion-related psychopathology and another "pure" DD, without psychiatric comorbidity, related to worse global cognitive functioning. Treatment for DD should address both types of processes.

P02-423 - How to choose the best screening instrument for personality disorder for your specific practice

IntroductionPersonality disorders (PD) are common in psychiatric services and can adversely affect the management and outcome of mental illnesses. Therefore assessment of the personality is an essential part of initial psychiatric examination. To diagnose a PD takes time and competence. A screening instrument in the diagnostic phase can be a solution.AimThe goal of the study was to provide clinicians a powerful screening tool for personality disorders that is ‘quick and dirty’.MethodNine screening instruments were studied in a prospective, observational, test development study with a random sample of Dutch psychiatric outpatients, using the SCID-II as the gold standard. There were three short questionnaires (Standardized Assessment of Personality- Abbreviated Scale (SAPAS), Iowa Personality Disorder Screen (IPDS), Short version of the SCID-II), three longer questionnaires (the SCID-II Personality Questionnaire, the NEO Five-Factor Inventory (NEO-FFI), Inventory of Interpersonal Problems (IIP-PD/C;) one short semi structured interview (Quick Personality Assessment Schedule (PAS-Q.) and two informant interviews (Standardised Assessment of personality (SAP), the Standardized Assessment of Personality- Abbreviated Scale for informants (SAPAS-INF)) involved.ResultsThe three short questionnaires and the semi structured interview were very useful for determining the presence/absence of PD. The other instruments can be used in particular situations for example to determine a specific PD or if the patient is not able to accomplish the test.ConclusionBefore deciding which screening instrument for PD is the best for your practice, you have to consider psychometric values as well as practical circumstances.

The association between personality disorder and an act of deliberate self harm in the older person

Suicide rates are higher in the over 65s than in younger adults and there is a strong link between deliberate self harm (DSH) and suicide in older people. The association between personality disorder (PD) and DSH in older adults remains uncertain. Our objective was to describe this association. A case control study was conducted in which participants were: (i) those who had undertaken an act of DSH and (ii) a hospital-based control group drawn from a geographical contiguous population. PD was assessed using the Standardised Assessment of Personality (SAP). Seventy-seven cases of DSH were identified; 61 (79.2%) of these participants were interviewed. There were 171 potential controls identified of whom 140 (81.9%) were included. An SAP was completed in 45/61 (73.8%) of cases and 100/140 (71.4%) of controls. The mean age was 79.8 years (SD = 9, range 65-103). The crude odds ratio for the association between PD and DSH was 5.91 [(95% CI 2.3, 14.9) p<0.0001]. There was a strong interaction with age stratified at 80 years. There was no association between PD and DSH after age 80. The adjusted odds ratio for PD in the group <80 years was 20.5 [(95% CI 3, 141) p = 0.002]. Borderline and impulsive PD traits tended to be associated with an episode of DSH more than other personality types. PD appears to be a strong and independent risk for an act of DSH in people aged between 65 and 80 years and should be looked for as part of any risk assessment in this population. Access to specialist services may be required to optimally manage this problem and reduce the subsequent risk of suicide.

Gender differences in delusional disorder: Evidence from an outpatient sample

Our objective was to study gender differences in delusional disorder (DD), by comparing potential risk factors, clinical correlates, illness course characteristics, and functionality. The sample was composed of 86 outpatients with DD (according to the SCID-I for DSM-IV criteria). The following assessment instruments were used service use and demographic questionnaires, Standardized Assessment of Personality (SAP), the Positive and Negative Symptom Scale (PANSS), Montgomery-Asberg Depression Rating Scale (MADRS), Mini-Mental State Examination (MMSE), Mini International Neuropsychiatry Interview (MINI), Sheehan Disability Inventory (SDI), and the Global Assessment of Functioning (GAF) scale. The female-to-male ratio was 1.6:1. Men were more likely to be single, while women were more likely to be widows. Men had a greater frequency of schizoid and schizotypal premorbid personality disorders and of premorbid substance abuse. There were no differences for other risk factors (immigration, deafness, late onset, other personality disorders, and family history). Men were younger at onset and more frequently had acute onset of the disorder. Men had more severe symptoms (higher score on the global or separate PANSS scales). There were no gender differences for the remaining symptomatological variables (types of DD, presence and severity of depression, presence of hallucinations, severity of global cognitive functioning and presence of axis I comorbidity). Global and partial (work, family, and social) functioning was significantly poorer among men. Course type and consumption of resources appeared to be similar. We conclude that men with DD had significantly more severe symptoms and worse functionality. They also had a higher frequency of schizoid and schizotypal premorbid personality disorders and premorbid substance abuse.

Validity of the diagnosis of personality disorder in adults with learning disability and severe behavioural problems. Preliminary study.

Personality disorder in people with learning disability has received little research attention, with only a handful of cross-sectional surveys of prevalence available. As yet, there have been no studies to include an examination of validity. To investigate the prevalence of personality disorder in adults with learning disability who are in specialist challenging behaviour in-patient services and to examine the validity of the diagnosis of personality disorder in this group in terms of its association with abusive experience in early life. The Standardised Assessment of Personality (SAP) was used to diagnose personality disorder in 36 individuals with mild/moderate learning disability. Case notes were reviewed for details of clinical diagnosis and early psychosocial history. Thirty-nine per cent of the sample met the criteria for severe personality disorder. This diagnosis showed a significant association with early traumatic experience. Severe personality disorder is a common diagnosis in this group. There is preliminary evidence that the diagnosis is associated with abuse in childhood.

Personality disorder among first ever admissions to an Irish public and private hospital

AbstractObjective: The identification of personality disorder among psychiatric in-patients is important because of the effect on the course and outcome of illness. The introduction of a multiaxial approach to diagnosis, has resulted in a higher than previously reported rate of occurrence of personality disorder in a variety of psychiatric settings. A prevalence of personality disorder of 4.9% is reported in the official statistics for Irish psychiatric hospitals. The aim of this study is to determine the true prevalence of personality disorders in two Irish psychiatric hospitals, one public and one private, using a multiaxial approach to diagnosis.Methods: The Standardised Assessment of Personality (SAP) is a validated, semistructured, informant based instrument that reliably generates diagnoses of personality disorder irrespective of current mental state. Over a four month period, 78 consecutive, first ever admissions to two hospitals were examined using the SAP.Results: The prevalence of personality disorder in this population was 26%. There was no significant difference in the rate of personality disorder between the public and private institutions.Conclusions: The prevalence of personality disorder amongst in-patients in both public and private psychiatric hospitals in Ireland is far higher than previously reported. This highlights the importance of a multiaxial approach to diagnosis in order to establish the true extent of psychiatric morbidity.

Prevalence of ICD-10 personality disorder in a psychosexual outpatient population

Abstract The prevalence of ICD-10 personality disorder among 50 new patients referred with partners to a psychosexual outpatient clinic was assessed using the Standardised Assessment of Personality (SAP). Relationships between personality disorder and a number of variables including the principal diagnosis, previous contact with psychiatric services and history of sex trauma were examined. The study identified a personality disorder prevalence of 38%. Significant associations were found between the presence of a personality disorder and a principal diagnosis of a marital (relationship) problem and between personality disorder and a history of previous contact with psychiatric services (p<0.05). The study highlighted a significant degree of comorbid personality disorder in a consecutive series of new patients at a psychosexual clinic. Awareness of such comorbidity can facilitate clinical decisions regarding the feasibility and form of therapy.

Psychopathology of People with Mental Handicap and Epilepsy III: Personality Disorder

A group of 75 mildly to moderately mentally handicapped people with epilepsy, resident in both a hospital and the community, were studied together with an individually matched control group of non-epileptic patients. Their carers were interviewed to gather information for two observer-rated personality questionnaires, the Standardised Assessment of Personality (SAP) and the T-L Personality Behaviour Inventory. The two groups were compared with respect to the prevalence rates of various personalities. An abnormal personality score according to the SAP schedule was reported in 26% (n = 39) of the cohort, of which 28 (18.6% of the cohort) were personality disorders. A diagnosis of SAP abnormal personality was made in 46% of the in-patients and 6.5% of the community-based population. Of the cohort, 15% had an abnormal personality score according to the T-L schedule. No statistically significant difference emerged between the epileptic and the non-epileptic groups in the prevalence of either the SAP or T-L personality.

The development and use of standardized assessment of abnormal personality.

A standardized assessment of personality (SAP) based on interview with an informant has been developed to classify a patient's premorbid personality in clinical terms for use for research purposes in or out of a hospital setting. Three preliminary investigations of its use are reported. These indicate that an informant's account of personality can be rated reliably by psychiatrists and is consistent over time. The addition of two extra descriptive types to the schema of ICD Section 301, the anxious and the self-conscious personalities, is found to contribute usefully to a taxonomy of personality in two series of patients investigated with the SAP. Further investigations are indicated to determine the accuracy of an informant's account before epidemiological studies with this instrument can be considered.