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

Bipolar obsessive‐compulsive disorder and personality disorders

Relatively few systematic data exist on the clinical impact of bipolar comorbidity in obsessive-compulsive disorder (OCD) and no studies have investigated the influence of such a comorbidity on the prevalence and pattern of Axis II comorbidity. The aim of the present study was to explore the comorbidity of personality disorders in a group of patients with OCD and comorbid bipolar disorder (BD). The sample consisted of 204 subjects with a principal diagnosis of OCD (DSM-IV) and a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score>or=16 recruited from all patients consecutively referred to the Anxiety and Mood Disorders Unit, Department of Neuroscience, University of Turin over a period of 5 years (January 1998-December 2002). Diagnostic evaluation and Axis I comorbidities were collected by means of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Personality status was assessed by using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). Socio-demographic and clinical features (including Axis II comorbidities) were compared between OCD patients with and without a lifetime comorbidity of BD. A total of 21 patients with OCD (10.3%) met DSM-IV criteria for a lifetime BD diagnosis: 4 (2.0%) with BD type I and 17 (8.3%) with BD type II. Those without a BD diagnosis showed significantly higher rates of male gender, sexual and hoarding obsessions, repeating compulsions and lifetime comorbid substance use disorders, when compared with patients with BD/OCD. With regard to personality disorders, those with BD/OCD showed higher prevalence rates of Cluster A (42.9% versus 21.3%; p=0.027) and Cluster B (57.1% versus 29.0%; p=0.009) personality disorders. Narcissistic and antisocial personality disorders were more frequent in BD/OCD. Our results point towards clinically relevant effects of comorbid BD on the personality profiles of OCD patients, with higher rates of narcissistic and antisocial personality disorders in BD/OCD patients.

An empirical study of countertransference reactions toward patients with personality disorders

Objective The study examined to what extent patients with cluster A + B personality disorders (PDs) evoked other countertransference reactions among psychotherapists compared with patients with cluster C PDs as well as the relationship between the different countertransference reactions and outcome. Methods A total of 11 therapists at the Department for Personality Psychiatry, Ullevaal University Hospital, Oslo, Norway, filled out the Feeling Word Checklist-58 (FWC-58), 2 weeks after admission and 2 weeks before discharge, for 71 patients admitted to the day treatment program. The patients were diagnosed with the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). Results The study revealed that patients with cluster A + B PDs evoked more negative and less positive countertransference reactions than those with cluster C PDs. The psychotherapists varied significantly more in their reported countertransference reactions toward patients with cluster A + B PDs than toward those with cluster C PDs. Patients who dropped out of treatment evoked significantly more negative countertransference reactions after 2 weeks than patients who completed the treatment. In addition, the study revealed strong correlations between countertransference feelings and change during the treatment. Conclusions This empirical study confirms clinical narratives on specified relationships between countertransference reactions, different PDs, and treatment course.

The interaction of personality disorders and eating disorders: A two-year prospective study of patients with longstanding eating disorders

The current study aimed to investigate the relation between personality disorders and symptoms of both eating disorders and general psychopathology over time. Seventy-four patients, with a mean age of 30 years and admitted to a hospital for treatment of a chronic eating disorder, were assessed using the Eating Disorder Inventory (EDI), the Eating Disorder Examination (EDE), the Symptom Check List-90-Revised (SCL-90-R), and the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II) at admission, and after 1 and 2 years. At the 2-year follow-up, there was considerable reduction in both personality and symptoms (effect size = 0.83-0.94). Panel modeling using structural equation modeling techniques indicated that symptomatic changes generally preceded changes in the personality disorder. Eating disorder symptoms and general symptomatology had direct effects on a dimensional personality disorder index. Thus, personality disorders may be at least partially a consequence of general symptomatology in chronic eating disorders. Symptom improvement appears to precede changes in personality in this sample of patients with chronic eating disorders.

Depressive disorders in primary care: recurrent, chronic, and co-morbid

Preceding longitudinal course and current somatic and psychiatric co-morbidity of depression have been little investigated in primary care. Consecutive patients (n = 1111) in primary care in the city of Vantaa, Finland, were screened for depression with the PRIME-MD, and positive cases interviewed by telephone. Cases with current depressive symptoms were diagnosed face-to-face with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I/P). A cohort of 137 patients with unipolar depressive disorders, comprising all patients with at least two depressive symptoms and clinically significant distress or disability, was recruited. The Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), medical records, rating scales, and a retrospective life-chart were used to obtain comprehensive cross-sectional and longitudinal information. Current major depressive disorder (MDD) was the most prevalent depressive disorder (66%); it was usually mild to moderate but recurrent. A quarter of cases (23%) had MDD in partial remission or prodromal phase, and only 10% had true minor depression. Axis I co-morbidity was present in 59%, Axis II in 52%, and chronic Axis III disorders in 47%; only 12% had no co-morbidity. One third of patients presented with a psychological complaint, predicted by higher depression severity and younger age. From a lifetime perspective, the majority of primary-care patients with depressive disorders suffer from recurrent MDD, although they are currently often in prodromal or residual phase. Psychiatric and somatic co-morbidity are highly prevalent. Treatment of depression in primary care should not rely on an assumption of short-lived, uncomplicated mild disorders.

DSM-IV obsessive-compulsive personality disorder: Prevalence in patients with anxiety disorders and in healthy comparison subjects

The relationship between obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) has not yet been fully clarified. The aim of the present study was to analyze DSM-IV OCPD prevalence rates in OCD and panic disorder (PD) patients to test for the specificity of the OCPD-OCD link, and to compare them to OCPD prevalence in a control group of subjects without any psychiatric disorder. A total of 109 patients with a principal diagnosis of DSM-IV (SCID-I) OCD and 82 with PD were interviewed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) in order to assess the prevalence of OCPD. All patients with a coexisting axis I diagnosis were excluded from the study to eliminate confounding factors when evaluating the association between prevalence rates of OCPD and anxiety disorder diagnoses. An exclusion criteria was also a Hamilton Depression Rating Scale (HAM-D) score ≥16. A sample of comparison subjects (age 18 to 65 years) without any psychiatric disorder was recruited from people registered with two general practitioners (GPs), whether or not they consulted the doctor, in order to evaluate OCPD prevalence rate in the community. A significant difference was found between the prevalence of OCPD in OCD (22.9%) and in PD (17.1%) on one hand, and that in the comparison sample (3.0%) on the other. No differences were found between the two psychiatric groups, even when splitting the samples according to gender. Our study failed to support the hypothesis of a specific relationship between OCPD and OCD; we confirmed the higher prevalence rate of this personality disorder in OCD subjects with regard to the general population, but we also confirmed the higher rate of OCPD in another anxiety disorder which is phenomenologically well characterized and different from OCD, such as PD.

Phenomenology of patients with early and adult onset obsessive-compulsive disorder

To evaluate potential differences in socio-demographic and clinical characteristics (obsessive-compulsive symptomatology, axis I and II comorbidity) between OCD adults with an early age at onset (< 18 years) and later onset, (> or = 18 yrs). Clinical controlled study. Anxiety and Mood Disorders Unit, Department of Neuroscience, University of Turin. We included 149 subjects with a principal diagnosis of OCD (DSM-IV) and a Y-BOCS total score > or = 16. All patients underwent a semistructured clinical interview aimed at investigating sociodemographic characteristics and clinical features of the disorder. Lifetime Axis I comorbidity, according to DSM-IV criteria, was investigated with a structured interview following Othmer & Othmer guidelines (1994; 1999). Personality disorders were assessed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). 39 patients referred age at onset of OCD before 18 years (early-onset group) and 110 patients at 18 years or later (later-onset group). Significant differences were found between the two groups: early-onset subjects are characterized by a preponderance of males, a chronic course of illness and a strong association with Schizotypal Personality Disorder. When subtyping OCD according to age at onset we found significant differences which suggest a possible heterogeneity of the disorder. Our results seem to confirm that early-onset OCD may represent a more severe subgroup, with clinical characteristics such as the chronic course and the high association with Schizotypal PD which are significant in order to apply specific therapeutic strategies.