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      Co-morbidity of personality disorder in schizophrenia among psychiatric outpatients in China: data from epidemiologic survey in a clinical population

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          Abstract

          Background

          The reported rates of personality disorder (PD) in subjects with schizophrenia (SZ) are quite varied across different countries, and less is known about the heterogeneity of PD among subjects with SZ. We examined the co-morbidity of PD among patients who are in the stable phase of SZ.

          Method

          850 subjects were randomly sampled from patients diagnosed with SZ in psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. Co-morbidity of PDs was assessed through preliminary screening and patients were administered several modules of the SCID-II. Evidence of heterogeneity was evaluated by comparing patients diagnosed with SZ with those who presented with either affective disorder or neurosis (ADN).

          Results

          204 outpatients (24.0 %) in the stable phase of SZ met criteria for at least one type of DSM-IV PD. There was a higher prevalence of Cluster-A (odd and eccentric PD) and C (anxious and panic PD) PDs in SZ (around 12.0 %). The most prevalent PD was the paranoid subtype (7.65 %). Subjects with SZ were significantly more likely to have schizotypal PD (4.4 % vs. 2.1 %, p = 0.003) and paranoid PD (7.6 % vs. 5.4 %, p = 0.034), but much less likely to have borderline, obsessive-compulsive, depressive, narcissistic and histrionic PD.

          Conclusions

          These findings suggest that DSM-IV PD is common in patients with SZ than in the general population. Patterns of co-morbidity with PDs in SZ are different from ADN.

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          Most cited references49

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          Validity of the prodromal risk syndrome for first psychosis: findings from the North American Prodrome Longitudinal Study.

          Treatment and prevention studies over the past decade have enrolled patients believed to be at risk for future psychosis. These patients were considered at risk for psychosis by virtue of meeting research criteria derived from retrospective accounts of the psychosis prodrome. This study evaluated the diagnostic validity of the prospective "prodromal risk syndrome" construct. Patients assessed by the Structured Interview for Prodromal Syndromes as meeting criteria of prodromal syndromes (n = 377) from the North American Prodrome Longitudinal Study were compared with normal comparison (NC, n = 196), help-seeking comparison (HSC, n = 198), familial high-risk (FHR, n = 40), and schizotypal personality disorder (SPD, n = 49) groups. Comparisons were made on variables from cross-sectional demographic, symptom, functional, comorbid diagnostic, and family history domains of assessment as well as on follow-up outcome. Prodromal risk syndrome patients as a group were robustly distinguished from NC subjects across all domains and distinguished from HSC subjects and from FHR subjects on most measures in many of these domains. Adolescent and young adult SPD patients, while distinct from prodromal patients on definitional grounds, were similar to prodromals on multiple measures, consistent with SPD in young patients possibly being an independent risk syndrome for psychosis. The strong evidence of diagnostic validity for the prodromal risk syndrome for first psychosis raises the question of its evaluation for inclusion in Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition).
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            Age-related change in personality disorder trait levels between early adolescence and adulthood: a community-based longitudinal investigation.

            To investigate change in personality disorder (PD) traits between early adolescence and early adulthood among individuals in the community. PD traits were assessed in 1983 (mean age = 14), 1985-86 (mean age = 16) and 1992 (mean age = 22) in a representative community sample of 816 youths. Overall, PD traits declined 28% during both adolescence and early adulthood. PD traits were moderately stable during the first 2-year interval, and were as stable as they have been reported to be among adults over similar intervals. PD trait stability declined slightly as the inter-assessment interval increased. Adolescents with PDs tended to have elevated PD traits during early adulthood. PD traits tend to decline steadily in prevalence during adolescence and early adulthood. However, adolescents with PDs often have elevated PD traits as young adults, and the stability of PD traits appears to be similar during adolescence and early adulthood.
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              Prevalence and stability of the DSM-III-R personality disorders in a community-based survey of adolescents.

              The purpose of this study was to estimate the prevalence, concurrent validity, and stability of DSM-III-R personality disorders in a large community-based sample of adolescents. A randomly selected community sample of 733 youths ranging in age from 9 to 19 years was followed over a 2-year period. The protocol consisted of structured interviews with the adolescents and their mothers and self-report questionnaires. Algorithms for 10 DSM-III-R axis II disorders were developed to produce diagnoses at two levels of severity; these were validated against multiple indicators of distress and functional impairment. The overall prevalence of personality disorders peaked at age 12 in boys and at age 13 in girls and declined thereafter. Obsessive-compulsive personality disorder was the most prevalent moderate axis II disorder, narcissistic personality disorder the most prevalent severe disorder, and schizotypal personality disorder the least prevalent axis II disorder, based on both moderate and severe diagnostic thresholds. All moderate axis II disorders were associated with significantly greater odds for at least five of 12 diagnostic validators. Longitudinal follow-up revealed that although most axis II disorders did not persist over a 2-year period, subjects with disorders identified earlier remained at elevated risk for receiving a diagnosis again at follow-up. These findings suggest that a substantial minority of adolescents who are not in treatment qualify for DSM-III-R personality disorder diagnoses and that these diagnoses are associated with increased risk of psychological distress and functional impairment.
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                Author and article information

                Contributors
                weiyanyan19860729@126.com
                zhang_tianhong@126.com
                annabellechow@126.com
                yytang0522@gmail.com
                mas_xulihua2008@163.com
                yunfeidai@126.com
                drliuxiaohua@gmail.com
                sutong-2006@163.com
                pxiao08@aliyun.com
                cuiyi210@163.com
                1178343890@qq.com
                jiangkaida@yahoo.com.cn
                xiao_zeping@126.com
                tangyun7633@sina.com
                jijunwang27@163.com
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                8 July 2016
                8 July 2016
                2016
                : 16
                : 224
                Affiliations
                [ ]Department of Medical Psychology, Faculty of Mental Health, Second Military Medical University, Shanghai, 200433 People’s Republic of China
                [ ]Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 South Wanping Road, Shanghai, 200030 People’s Republic of China
                [ ]Department of Psychological Medicine, Changi General Hospital, Singapore, Singapore
                [ ]Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500), Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai, People’s Republic of China
                Article
                920
                10.1186/s12888-016-0920-8
                4939030
                27391323
                2ed54712-980a-43c1-8ce9-e897a87cdf65
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 5 July 2015
                : 22 June 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China (CN);
                Award ID: 81201043, 81372122, 81261120410, 81361120403
                Award Recipient :
                Funded by: The 12th Five-Year projects of PLA research
                Award ID: NO.13QJ003-005
                Award Recipient :
                Funded by: Shanghai Science and Technology Committee
                Award ID: 15411967200, 14411961400
                Award Recipient :
                Funded by: National Key Clinical Disciplines at Shanghai Mental Health Center
                Award ID: OMA-MH, 2011-873
                Award Recipient :
                Funded by: Shanghai Key Laboratory of Psychotic Disorders
                Award ID: 13dz2260500
                Award Recipient :
                Funded by: Shanghai Jiao Tong University Foundation
                Award ID: 14JCRY04, YG2014MS40
                Award Recipient :
                Funded by: Mental Health Application Research in PLA
                Award ID: NO.12XLZ109
                Award Recipient :
                Funded by: SHSMU-ION Research Center for Brain Disorders
                Award ID: 2015NKX001
                Award Recipient :
                Funded by: Shanghai health system advanced appropriate technology
                Award ID: 2013SY003
                Award Recipient :
                Funded by: Shanghai education science research project
                Award ID: No.B13028
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Clinical Psychology & Psychiatry
                schizotypal personality disorder,prevalence,cluster-a personality disorders,psychosis,clinical population

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