Structured Clinical Interview For DSM-IV Axis II Disorders Research Articles

Impulsivity and psychiatric comorbidity as risk factors for suicide attempts in borderline personality disorder.

BackgroundAddressing the risk of suicidality in borderline personality disorder (BPD) is a crucial issue. The notion that impulsive individuals are more likely to plan for suicide attempts is important for many reasons in both theoretical and clinical decision-making.AimThe aim of this study was to investigate potential risks of suicidality in BPD and to correlate it to impulsivity.SettingThe study was conducted at the Institute of Psychiatry, Ain Shams University and Al Mashfa Private Hospital.MethodsNinety-one participants were included in the study: 30 patients were diagnosed as BPD without axis I comorbidities, 31 BPD patients had psychiatric comorbidities and 30 healthy subjects were assessed by using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), Suicide Behavior Questionnaire-Revised (SBQ-R), the Arabic version of Barratt’s Impulsiveness Scale-11 (BIS-11) and Global Assessment of Functioning scale.ResultsThere was a significant difference in suicidality using the SBQ-R between the healthy controls and BPDs without and with comorbidities. Healthy controls showed low suicidality in only 3.3%, while it was higher in both groups of BPD. The total score of BIS was as follows: 62.5 (±10.1 SD) in group A, 79.4 (±12 SD) in group B and 80.3 (±12.5 SD) in group C, which denote mild, moderate and moderate-to-severe degree of impulsivity in group A, B and C, respectively. Suicidality was positively correlated with (AI item: lack of span Attention in Attentional Facet) (r = 0.489, p = 0.006), (PI item: lack of self-control in planning facet) (r = 0.401, p = 0.028), as well as (MII item: lack perseverance in holding off impulsive acts in motor facet) (r = 0.471, p = 0.009).ConclusionProper assessment of associated psychiatric comorbidities and impulsivity among BPD patients will help preventing of future suicidal attempts.

Psychiatric comorbidity in a sample of Egyptian women with vaginismus

BackgroundVaginismus is a female sexual dysfunction affecting the quality of women and the couple’s relationship. It is considered the main feminine cause of unconsummated marriage in Egypt. The study aims in assessment of comorbid psychiatric disorders, personality disorders, and levels of alexithymia among a sample of women with vaginismus. It is a case-control study where 30 women diagnosed with vaginismus following up in the psychosexual clinic in Ain Shams University Hospitals were enrolled in the study in comparison to 30 controls. Assessment was done based on the socio-demographic data, Toronto Alexithymia scale (TAS-20), Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I), and Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II).ResultsIt was found that women having vaginismus had significant below university level of education (P = 0.026) together with their partners (P = 0.006). It was also found that women having vaginismus are showing high levels of alexithymia (p < 0.001), more than one anxiety and/or depressive disorder (P = 0.032) in comparison to the control group. Also, borderline personality disorder/traits and avoidant personality traits were significantly more frequent among cases (P = 0.026, P = 0.001, and P = 0.045 respectively). Moreover, it was found that having two or more of either of rigidity, perfectionism, dramatization, mood swings, and impulsivity was significantly more frequent among cases (P < 0.001) showing a unique personality pattern of women with vaginismus.ConclusionsWomen with vaginismus were having higher levels of alexithymia, more developing anxiety, and depressive disorders than controls and they have specific personality characteristics.

Frequency of binge eating behavior in patients with borderline personality disorder and its relation to emotional regulation and impulsivity.

Eating disorders are common among patients with borderline personality disorder (BPD), contributing to their lack of treatment response and bad prognosis. In this context, it is helpful to examine the relevance of eating behavior and to understand whether borderline traits are higher in those individuals. In this study, a sample of patients with BPD screened to determine the frequency of binge eating (BE) behaviors and its relation to impulsivity and emotional dysregulation. Seventy participants aged 25.81 ± 6.34years were recruited from Okasha Institute of psychiatry, Cairo, Egypt. Diagnosed by the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II), assessed for impulsivity, emotion regulation using the Barratt Impulsiveness Scale and the Trait Meta Mood Scale (TMMS), respectively, and screened for BE behaviors by Binge Eating Scale. All of the participants had medium emotional regulation propensity 82.63 ± 10.81 and showed variable degrees of impulsivity, mainly moderate 42 (60%). More than half of the participants had BE behavior 37 (~ 53%), with a significant negative correlation with clarity of feeling, total score of TMMS, and age. Similarly, on comparing the participant with binging versus no binging group, a significant relation between BE behavior, fear of abandonment (p value 0.02), clarity of feeling, and total score of TMMS was found. However, no significant relation between BE behavior & impulsivity demonstrated. A substantial number of patients with BPD suffering from BE, showing relation between binging, emotion dysregulation, and fear of abandonment. III, evidence obtained from well-designed cohort or case-control analytic studies.

T113. CATEGORICAL AND DIMENSIONAL APPROACHES EXAMINING THE JOINT EFFECT OF AUTISM AND SCHIZOTYPAL PERSONALITY DISORDER ON SUSTAINED ATTENTION

BackgroundAccumulating evidence for the co-occurrence Autism spectrum disorder (ASD) and schizotypal personality disorder (SPD) at both the diagnostic and symptom/trait levels raises important questions about the nature of their association and the effect of their co-occurrence on the individual’s phenotype and functional outcome. It has been recommend that informing etiological and phenotypic overlaps between ASD and schizophrenia spectrum disorders (SSD) would require the utilization of a dual-diagnosis cohort compared with two control groups, each singly diagnosed with ASD or SSD, and that the development of a multidimensional model for understanding the relationship between these two spectra would require cohorts to be described not solely by diagnosis, but also by using dimensional measures that cut across diagnostic boundaries. Research comparing adults with ASD and SPD, as well as the impact of their co-occurrence on outcomes is extremely limited. To fill in this gap, we investigated executive functioning in terms of response inhibition and sustained attention, candidate endophenotypes of both conditions, in adults with ASD, SPD, comorbid ASD and SPD, and neurotypical adults using both categorical and dimensional approaches.MethodsA total of 88 adults (Mean Age ± SD = 37.54 ± 10.17): ASD (n = 26; m/f = 20/6); SPD (n = 20; m/f = 14/6); comorbid ASD and SPD (n=9; m/f =6/3) and neurotypicals (n=33; m/f =23/10) completed the Sustained Attention to Response Task (SART) in both its fixed and random forms.Individuals with ASD had a DSM-IV diagnosis of either autism or Asperger Syndrome and met ASD cut-offs on the Autism Diagnostic Observational Schedule-Generic (ADOS-G). All individuals with SPD met DSM-IV criteria for SPD using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). Individuals in the comorbid group met criteria for both ASD (determined by DSM-IV and the ADOS) and SPD (determined by the SCID-II). In addition, in both the clinical and healthy participants, positive and autistic symptom severity were assessed with the positive subscale of the Positive and Negative Syndrome Scale (PANSSpos) and the PANSS Autism Severity Score (PAUSS), respectively.ResultsControlling for full scale IQ, working memory and medication dosage, group analyses revealed that the comorbid group committed fewer omission errors than the ASD group on the fixed SART, and fewer omission errors than the ASD and SPD groups on the random SART. The individual difference analyses revealed that the PANSSpos and PAUSS interactively reduced omission errors in both the fixed and random SARTs, as well as increased d’ scores, indicative of improved overall performance.DiscussionConcurrent elevated levels of autistic and positive psychotic symptoms seem to be associated with improved sustained attention abilities. We propose that sustaining and switching attention may represent two poles of irregularities across the autism and schizotypal spectra, which appear to converge in a compensatory manner in the comorbid group. Our findings highlight the importance of investigating the concurrent effect of ASD and SPD at both the symptom and diagnostic levels, and the potential benefit of this research approach to understanding the underlying mechanisms of seemingly overlapping phenotypes.

Improvement of Emotional Empathy and Cluster B Personality Disorder Symptoms Associated With Decreased Cocaine Use Severity.

Aims: Chronic cocaine users display impaired social cognitive abilities, reduced prosocial behavior, and pronounced cluster B personality disorder (PD) symptoms all contributing to their social dysfunctions in daily life. These social dysfunctions have been proposed as a major factor for maintenance and relapse of stimulant use disorders in general. However, little is known about the reversibility of social cognitive deficits and socially problematic personality facets when stimulant use is reduced or ceased. Therefore, we examined the relation between changing intensity of cocaine use and the development of sociocognitive functioning and cluster B PD symptomatology over the course of 1 year. Methods: Social cognition, social decision-making, and cluster B PD symptoms were assessed in 38 cocaine users (19 with increased and 19 with decreased use) and 48 stimulant-naive healthy controls at baseline and at 1-year follow-up. Cocaine use severity was objectively determined by quantitative 6-month hair analyses. The categorization of the two cocaine user groups was based on a combination of absolute (± 0.5 ng/mg) and relative (± 10%) changes in the cocaine hair concentration between baseline and the 1-year follow-up. Social cognition was assessed using the Multifaceted Empathy Test (MET) and the Movie for the Assessment of Social Cognition (MASC). A combined Distribution/Dictator Game was applied for assessing social decision-making. Cluster B PD symptoms were measured by a Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) PD questionnaire according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Results: Increased cocaine use was linked to worsened empathy, while decreased cocaine use went along with improved emotional empathy. Moreover, whereas decreased cocaine use was associated with reduced severity of self-reported cluster B PD symptoms, these symptoms remained largely stable in increasers. In contrast to a significant reduction of prosocial behavior at baseline in the combined cocaine user group, specifically decreasers were not statistically distinguishable from controls at the follow-up. Conclusions: Sociocognitive deficits and cluster B PD symptoms of chronic cocaine users are adaptable over time as they covary with the increase or decrease in cocaine use. Hence, abstinence orientation and training of social cognition and interaction might improve social functioning, and should therefore be important therapeutic elements in cocaine addiction treatment.

Frequency and characteristics of suicide attempts in dissociative identity disorders: A 12-month follow-up study in psychiatric outpatients in Switzerland

IntroductionDissociative identity disorder (DID) is often accompanied by suicidal behavior. However, systematic research regarding suicide attempts in DID is rare. ObjectiveAims of this study were to examine frequency, characteristics and risk factors for suicidal behavior in DID patients. MethodA sample of outpatients and day care patients with (n=17) and without DID (n=34) from psychiatric outpatient and day care units and a private practice located in Switzerland were assessed at baseline and at 12-month follow-up. At baseline, Axis I and Axis II disorders according to DSM-IV were ascertained with the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I), the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II), and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R). Suicidal behavior during a 12-month period following the baseline assessment was assessed using the Longitudinal Interval Follow-Up Evaluation interview. ResultsWe found that 23.5% of subjects with DID and 0% of subjects without DID attempted at least one suicide during the 12-month period of observation (P=0.010). Medical threat of most suicide attempts was moderate to severe. Potential risk factors for suicidal behavior in DID subjects were a comorbid substance disorder or posttraumatic stress disorder, high number of any Axis I disorder, higher education, and foreign nationality. ConclusionOur results support previous evidence for a high risk of suicide attempts in patients with DID. The potential risk factors for suicidal behavior in DID subjects correspond largely to known risk factors for suicide in general population and mental disorders other than DID. The results emphasize the importance of assessing suicidal intentions when treating DID patients.

Personality disorders and affective temperament in unipolar and bipolar mood disorder

IntroductionPersonality disorders (PD) and Affective temperaments (AT) have been considered vulnerability factors for the development of mood disorder (MD).ObjectiveTo study the simultaneous presence of PD and AT in patients with DU and differences between unipolar depression (DD) and bipolar disorder BD.MethodsAn observational study was conducted. Patients were administered the Temperament Evaluation of Memphis, Pisa, Paris and San Diego questionnaire (TEMPS-A) for AT and the Structured Clinical Interview for DSM IV Axis II Disorders (SCID-II) for PD. The interrelationships of the different PD and AT were studied by factor analysis (principal component analysis, PCA) (orthogonal rotation, Varimax).ResultsParticipants were 156 adult patients with MD, 37.1% with DD and 62.9% with BD. DD patients presented with significantly more paranoid PD (P = 0.009), depressive (P = 0.029), anxious (P = 0.009) and irritable temperament (P = 0.006) compared to BD. PCA results showed four significant factors, explaining the 63.1% of total variance, corresponding to four potential groups of patients with specific PD and AT associations.ConclusionThe comorbidity between MD and PD and AT may differentiate DD from BD. Specific patterns of comorbidity may be useful as they may substantially influence the course of the mood disorders and how patients respond to treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Lokalizacja zaburzeń osobowości w Kołowym Modelu Metacech Osobowości

The aim of the paper was to characterize personality disorders in terms of the dimensions of the Circumplex of Personality Metatraits (CPM) developed by Strus, Cieciuch, and Rowiński. It was expected that personality disorders characterized by the profiles of traits from the five-factor model of personality (FFM) would be located in the sector delimited by poles Gamma- and Delta- and including pole Alfa-. The author analyzed data collected in a sample of 2,284 subjects tested by means of the NEO-FFI and three other instruments: the Personality Beliefs Questionnaire, the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), and the TALEIA-400A questionnaire (Test for AxiaL Evaluation and Interview for Clinical, Personnel, and Guidance Applications) for the assessment of personality disorders as well as compared them with the data from the meta-analysis by Saulsman and Page (2004) concerning the relations between personality disorders and FFM traits. The obtained correlations confirmed the research expectations. In Discussion, the author points out the heuristic value of the CPM for differentiating the norm from pathologies, which includes the differential diagnosis of personality disorders.

Lokalizacja zaburzeń osobowości w Kołowym Modelu Metacech Osobowości

The aim of the paper was to characterize personality disorders in terms of the dimensions of the Circumplex of Personality Metatraits (CPM) developed by Strus, Cieciuch, and Rowiński. It was expected that personality disorders characterized by the profiles of traits from the five-factor model of personality (FFM) would be located in the sector delimited by poles Gamma- and Delta- and including pole Alfa-. The author analyzed data collected in a sample of 2,284 subjects tested by means of the NEO-FFI and three other instruments: the Personality Beliefs Questionnaire, the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), and the TALEIA-400A questionnaire (Test for AxiaL Evaluation and Interview for Clinical, Personnel, and Guidance Applications) for the assessment of personality disorders as well as compared them with the data from the meta-analysis by Saulsman and Page (2004) concerning the relations between personality disorders and FFM traits. The obtained correlations confirmed the research expectations. In Discussion, the author points out the heuristic value of the CPM for differentiating the norm from pathologies, which includes the differential diagnosis of personality disorders.

Schema modes in cluster B personality disorders

Aim of the studyThe present study aimed to investigate the role of schema modes in the cluster B personality disorders.Subject or material and methodsParticipants comprised of 220 individuals – 38 men and 137 women – selected from psychiatric and psychological clinics in Tabriz, Iran. Among the participants, 153 individuals were diagnosed with cluster B personality (44 with the borderline disorder, 16 with antisocial disorder, 56 with histrionic disorder and 37 with narcissistic personality disorder). Furthermore, 67 participants appeared to be without any personality disorders (PDs). The diagnosis of personality disorders was done by using the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II). All participants (with or without PDs) were asked to answer the Millon Clinical Multi-axial Inventory-3 (MCMI-III) and the Schema Modes Inventory (SMI).ResultsVulnerable, angry and impulsive child modes are predictors of the borderline personality disorder, and the schema modes of the angry child, self-soother and healthy adult are predictors of antisocial personality disorder. Also, the impulsive and happy child, the attack-bully and healthy adult schema modes predict histrionic personality disorder. Finally, the angry, happy child, self-soother and self-aggrandizer schema modes could predict narcissistic personality disorder (NPD).DiscussionSpecial schema modes have roles in explaining cluster B personality disorders, and yet these disorders may overlap each other with regard to some dimensions, especially in terms of cognitions and beliefs among cluster B personality disorders. It can be interpreted as the lack of specificity in categorical classification systems like DSM.Conclusionsthe conclusion is made about the current and alternative models of personality disorders

EXPLORING PERSONALITY DIAGNOSIS STABILITY FOLLOWING ACUTE PSYCHOTHERAPY FOR CHRONIC POSTTRAUMATIC STRESS DISORDER.

Axis I comorbidity complicates diagnosing axis II personality disorders (PDs). PDs might influence Axis I outcome. No research has examined psychotherapy effects on PDs of treating Axis I comorbidity. Secondary analysis of a randomized controlled trial examined PD diagnostic stability after brief psychotherapy of chronic posttraumatic stress disorder (PTSD). Patients with chronic PTSD were randomly assigned to 14 weeks of prolonged exposure, interpersonal psychotherapy, or relaxation therapy. Assessments included the Structured Clinical Interview for DSM-IV, Patient Version (SCID-P) and Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) at baseline, week 14, and for treatment responders (≥30% clinician-administered PTSD scale improvement, defined a priori) at week 26 follow-up. We hypothesized patients whose PTSD improved would retain fewer baseline PD diagnoses posttreatment, particularly with personality traits PTSD mimics, e.g. paranoid and avoidant. Forty-seven (47%) of 99 SCID-II patients evaluated at baseline received a SCID-II diagnosis: paranoid (28%), obsessive-compulsive (27%), and avoidant (23%) PDs were most prevalent. Among 78 patients who repeated SCID-II evaluations posttreatment, 45% (N = 35) had baseline PD diagnoses, of which 43% (N = 15/35) lost at week 14. Three (7%) patients without baseline PDs acquired diagnoses at week 14; 10 others shifted diagnoses. Treatment modality and PTSD response were unrelated to PD improvement. Of treatment responders reevaluated at follow-up (N = 44), 56% with any baseline Axis II diagnosis had none at week 26. This first evaluation of Axis I psychotherapy effects on personality disorder stability found that acutely treating a chronic state decreased apparent trait-across most PDs observed. These exploratory findings suggest personality diagnoses may have limited prognostic meaning in treating chronic PTSD.

Axis II disorders, body image and childhood abuse in bariatric surgery candidates.

Psychiatric disorders are common in obese patients and they are often considered contraindications for bariatric surgery. In this patients Axis I profile has been widely investigated, while only few studies on Axis II profile are reported. Aim of the study was to examine the prevalence of Axis II psychopathology, to describe the typical body image and to evaluate the prevalence of childhood abuse in bariatric surgery candidates. A total of 102 consecutive obese patients (77 females) were evaluated by the Structured Clinical Interview for DSM IV which assessed Axis I Disorders. After the exclusion of Axis I Disorders, 50 patients (36 females, BMI: 44.68 ± 9.48 Kg/m2, age: 44.5 ± 11.7 years) were enrolled. All 50 patients received a psychiatric assessment including the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II); the Body Uneasiness Test, part a (BUT-A), which assesses body image disorders; the Childhood Trauma Questionnaire (CTQ) as a screening test of childhood maltreatment histories. Nineteen patients (38%) were affected by Axis II disorders. Cluster C disorders, including avoidant, dependent and obsessive-compulsive personality disorders, represented the most common diagnosis (24%). Moreover, 34 patients (68%) showed body image disorders (BID), with a GSI score ≥1.2 and 24 (48%) referred an abuse during childhood. Patients with Axis II disorder or a body image uneasiness or a history of maltreatment during childhood, showed higher BMI in adulthood. Psychiatric comorbidities in obese patients were not only represented by depression or anxiety (Axis I disorders), but also by personality disorders (Axis II), body image disorders and childhood abuse. The identification of these conditions could improve outcomes of bariatric surgery and represent an indication for a most important psychiatric support before, during and after surgery.

The structure of paranoia in the general population

Psychotic phenomena appear to form a continuum with normal experience and beliefs, and may build on common emotional interpersonal concerns. We tested predictions that paranoid ideation is exponentially distributed and hierarchically arranged in the general population, and that persecutory ideas build on more common cognitions of mistrust, interpersonal sensitivity and ideas of reference. Items were chosen from the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) questionnaire and the Psychosis Screening Questionnaire in the second British National Survey of Psychiatric Morbidity (n = 8580), to test a putative hierarchy of paranoid development using confirmatory factor analysis, latent class analysis and factor mixture modelling analysis. Different types of paranoid ideation ranged in frequency from less than 2% to nearly 30%. Total scores on these items followed an almost perfect exponential distribution (r = 0.99). Our four a priori first-order factors were corroborated (interpersonal sensitivity; mistrust; ideas of reference; ideas of persecution). These mapped onto four classes of individual respondents: a rare, severe, persecutory class with high endorsement of all item factors, including persecutory ideation; a quasi-normal class with infrequent endorsement of interpersonal sensitivity, mistrust and ideas of reference, and no ideas of persecution; and two intermediate classes, characterised respectively by relatively high endorsement of items relating to mistrust and to ideas of reference. The paranoia continuum has implications for the aetiology, mechanisms and treatment of psychotic disorders, while confirming the lack of a clear distinction from normal experiences and processes.

Similarities and differences in borderline and organic personality disorder

IntroductionPrevious research has shown that brain injury patients with Organic Personality Disorder (OPD) may display “borderline” traits due to prefrontal damage, and their personality structure may be unstable and close to a borderline personality organisation. They may have few general neuropsychological dysfunctions but specific executive deficits. Similar deficits have been found in patients with Borderline Personality Disorder (BPD). The objective of this study was to identify differences and similarities between the neuropsychological and personality profiles of BPD and OPD patients.MethodsTwenty BPD patients and 24 OPD patients were assessed with the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), the Karolinska Psychodynamic Profile (KAPP), and a comprehensive neuropsychological test battery.ResultsVery few neuropsychological differences were found between the two patient groups. However, the verbal fluency, verbal intelligence, verbal memory, and immediate auditory memory/attention of the BPD patients were significantly poorer than the OPD patients'. The KAPP profiles of the BPD patients showed significantly poorer functioning in three areas: frustration tolerance, the body as a factor of self-esteem, and overall personality organisation.ConclusionsThese results support our clinical experience and expectations concerning the severity of symptoms of both patient groups. We suggest considering in depth assessments of both neuropsychological and personality-related problems for each of these patients in order to inform treatment.

The Relationship Between Adult Reactive and Proactive Aggression, Hostile Interpretation Bias, and Antisocial Personality Disorder

Reactive aggression (RA) refers to angry responses to provocation or frustration, while proactive aggression (PA) denotes nonemotional, instrumental, and unprovoked aggression. The current study examined personality-related and cognitive correlates of both aggressive types. Respectively, the predictive values of antisocial personality disorder (ASPD), and of hostile interpretation bias, which is the tendency to interpret ambiguous stimuli in a hostile manner, were studied. The sample consisted of n = 37 male adult patients with mixed diagnoses and n = 29 male nonpatients that responded to vignettes and pictures of ambiguous situations, using both open and closed answer formats. ASPD was assessed by means of the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II), and the Reactive Proactive Questionnaire (RPQ) measured RA and PA. Results showed that although both RA and PA types were predicted by ASPD traits, RA was additionally predicted by a hostile interpretation bias. These findings suggest that reducing hostile bias is a promising avenue for clinical treatment of ASPD-patients high in RA.

Differentiating normal and disordered personality using the General Assessment of Personality Disorder (GAPD)

Criteria to differentiate personality disorder from extremes of normal personality variations are important given growing interest in dimensional classification because an extreme level of a personality dimension does not necessarily indicate disorder. The DSM-5 proposed classification of personality disorder offers a definition of general personality disorder based on chronic interpersonal and self/identity pathology. The ability of this approach to differentiate personality disorder from other mental disorders was evaluated using a self-report questionnaire, the General Assessment of Personality Disorder (GAPD). This measure was administered to a sample of psychiatric patients (N = 149) from different clinical sub-sites. Patients were divided into personality disordered and non-personality disordered groups on the basis of the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). The results showed a hit rate of 82% correct identified patients and a good accuracy of the predicted model. There was a substantial agreement between SCID-II interview and GAPD personality disorder diagnoses. The GAPD appears to predict personality disorder in general, which provides support of the DSM-5 general diagnostic criteria of personality disorder.

Results of the Search for Personality Disorder Screening Tools

To examine the characteristics, validity, posttest probabilities, and screening capabilities of 8 different instruments used to predict personality disorders. Screening instruments were examined in 3 prospective, observational, test-development studies in 3 random samples of Dutch psychiatric outpatients, using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) as the "gold standard." The studies were performed from March 2004 to March 2005 (study 1: N = 195, mean age = 32.7 years), October 2006 to January 2007 (study 2: N = 79, mean age = 34.3 years), and January 2008 to October 2009 (study 3: N = 102, mean age = 33.7 years). The following 8 assessment instruments were examined: 3 short questionnaires (a self-report form of the Standardized Assessment of Personality-Abbreviated Scale [SAPAS-SR], the self-report Iowa Personality Disorder Screen [IPDS], and a short self-report version of the SCID-II [S-SCID-II]); 2 longer questionnaires (the self-report SCID-II Personality Questionnaire [SCID-II-PQ] and the NEO Five-Factor Inventory [NEO-FFI]); 1 short semistructured interview (the Quick Personality Assessment Schedule [PAS-Q]); and 2 informant-based interviews (the Standardized Assessment of Personality [SAP] and the Standardized Assessment of Personality-Abbreviated Scale for Informants [SAPAS-INF]). The SCID-II rate of identification of personality disorders in the 3 studies was between 48.1% and 64.1%. The SAPAS-SR, the IPDS, and the PAS-Q had the best sensitivity (83%, 77%, and 80%, respectively) and specificity (80%, 85%, and 82%, respectively). Moreover, these 3 instruments correctly classified the largest number of patients. Using the SAPAS-SR, the IPDS, or the PAS-Q raises the odds from 50% to between 80% and 84% that a patient in a psychiatric outpatient population will receive a personality disorder diagnosis. The results provide evidence for the usefulness of the SAPAS-SR, IPDS, and PAS-Q instruments for personality disorder screening. Because the PAS-Q takes a longer time and requires qualified personnel to administer it, we recommend use of the SAPAS-SR or the self-report version of the IPDS.

Validity of the Personality Diagnostic Questionnaire—4 (PDQ-4+) among Mentally Ill Prison Inmates in Singapore

We examined the validity of the Personality Diagnostic Questionnaire--4+ (PDQ-4+) as a screening instrument for personality disorders among mentally ill prison inmates in Singapore. A total of 313 prison inmates completed the PDQ-4+ and the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). The subjects were 303 (96.8%) males and 10 (3.2%) females with a mean (SD) age of 40.7 (8.8) years. Kappa agreement between PDQ-4+ and SCID-II for the presence at least one personality disorder was moderate with high sensitivity and low specificity. For specific personality disorders and clusters, we found that the PDQ-4+ diagnosed more subjects as having each of the personality disorders than SCID-II with high negative predictive values. The area under the curve indicated moderate discriminatory capabilities. Our results suggest that the PDQ-4+ could be used as a potential screening instrument for personality disorders in prison inmates.

P02-126 - Relationships between eating disorders and personality disorders in adolescents

IntroductionSeveral research studies have investigated Personality Disorder (PD) comorbidity in adult with Eating Disorders (ED), which showed an association between the two types of disorder.ObjectiveThe aim of this study is to examine the relationships between ED and PD in a sample of adolescents between 14 to 18 years of age.MethodSixty-seven adolescents with ED treated in an outpatients setting [23 Anorexia Nervosa (AN), 17 Bulimia Nervosa (BN) and 27 Eating Disorder Not Otherwise Specified (EDNOS)] were assessed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), the Beck Depression Inventory (BDI) and the Eating Attitudes Test (EAT).ResultsOverall, 13 (19.4%) of ED patients had one or more PD. Cluster C PDs were the most common specific PDs. No significant difference was found between AN and BN based on the general presence of PDs. EDNOS patients had a lower prevalence of PDs compared to AN and BN patients. ED patients with a PD had an higher BDI rates compared to ED patients without PDs. No significant difference was observed in EAT rates between ED patients with and without PDs.ConclusionsCluster C PDs were the most frequent PDs found in ED adolescent patients. The prevalence of PDs is similar in AN and BN patients, whilst EDNOS patients have a lower prevalence of PDs compared to AN and BN patients. ED adolescent patients with current PD comorbidity show higher depression scores.

Screening for Borderline Personality Disorder in Outpatient Youth

Young people with borderline personality disorder (BPD) commonly seek help but often go unrecognized. Screening offers a means of identifying individuals for more detailed assessment for early intervention and for research. This study compared the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Borderline Personality Questionnaire (BPQ), the BPD items from the International Personality Disorder Examination Screening Questionnaire and the BPD items from the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II) Personality Questionnaire. 101 outpatient youth (aged 15-25 years) completed the screening measures and were interviewed, blind to screening status, with the SCID-II BPD module. The screening measures were readministered two weeks later to assess test-retest reliability. All four instruments performed similarly but the BPQ had the best mix of characteristics, with moderate sensitivity (0.68), the highest specificity (0.90), high negative predictive value (0.91) and moderate positive predictive value (0.65). Compared to the other three instruments, the BPQ had the highest overall diagnostic accuracy (0.85), a substantially higher kappa (0.57) with the criterion diagnosis, the highest test-retest reliability (ICC = 0.92) and the highest internal consistency (alpha = 0.92). The only clear difference to emerge in the Receiver Operator Curve (ROC) analysis was that the BPQ significantly outperformed the MSI (p = 0.05). Screening for BPD in out-patient youth is feasible but is not a replacement for clinical diagnosis.