Prevalence of personality disorders using two diagnostic systems in psychiatric outpatients in Shanghai, China: a comparison of uni-axial and multi-axial formulation.
ABSTRACT To compare multi-axial (DSM-IV) with uni-axial diagnostic system (CCMD-3, Chinese Classification and Diagnostic Criteria of Mental Disorders) as diagnostic methods to determine the prevalence of personality disorders (PDs) in Chinese psychiatric outpatients.
3,075 outpatients were randomly sampled from clinical settings in China. CCMD-3 PDs were evaluated as per routine psychiatric practice. DSM-IV PDs were assessed using both self-reported questionnaire and structured clinical interview.
The prevalence estimate for any type of PD in the total sample is 31.93% as reflected in the DSM-IV. This figure is nearly 110 times as large as the prevalence estimate for the CCMD-3. Only 9 outpatients were diagnosed with PD based on the CCMD-3. Amongst the 10 forms of DSM-IV PDs, avoidant (8.1%), obsessive-compulsive (7.6%), paranoid (6.0%), and borderline (5.8%) PDs were the most prevalent subtypes. This study found that PDs are commonly associated with the following: (i) the younger aged; (ii) single marital status; (iii) those who were not raised by their parents; (iv) introverted personalities; (v) first-time seekers of psycho-counseling treatment; and (vi) patients with co-morbid mood or anxiety disorders.
PDs are easily overlooked when the diagnosis is made based on the CCMD-3 uni-axial diagnostic system. However, it was found that personality pathology is common in the Chinese psychiatric community when using the DSM-IV classification system. Existing evidence suggest, at least indirectly, that there are important benefits of moving towards a multi-axial diagnostic approach in psychiatric practice.
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ABSTRACT: A systematic literature review of studies measuring the prevalence of personality disorder in community secondary care is needed to identify both the met and unmet needs and plan services accordingly. PsycINFO, MEDLINE and EMBASE databases were searched using NHS Evidence. Only studies assessing overall personality disorder prevalence within help-seeking, outpatient populations were included. Papers were excluded for focusing solely on the prevalence of specific personality disorders or comorbid prevalence within specific populations. A total of 269 papers were identified. Nine papers met criteria and were critically appraised, showing a high level of heterogeneity with regards to methods, inclusion criteria, source of information, time of assessment, instruments used and overall quality of research. Prevalence estimates in Europe varied between 40% and 92%, were more consistently approximated between 45% and 51% in the USA and differed significantly in the two Asian studies: 1.07% (India) and 60% (Pakistan). The prevalence of personality disorder in community mental health care appears to be substantial, but better estimates will only emerge from high quality studies with greater consistency of method. Implementing screening tools within outpatient or community services may result in high rates of personality disorder identification, with both clinical and service implications. Copyright © 2014 John Wiley & Sons, Ltd.Personality and Mental Health 01/2014; DOI:10.1002/pmh.1252 · 1.10 Impact Factor
Article: Dépistage des troubles de la personnalité avec la version française du Personality Diagnostic Questionnaire-4+ dans une population psychiatrique : Une étude préliminaire [Personality disorders screening with the French version of the Personality Diagnostic Questionnaire-4+ in a psychiatric population: A preliminary study][Show abstract] [Hide abstract]
ABSTRACT: Background: We choose to examine the Personality Diagnostic Questionnaire-4+ (PDQ-4+), considered as one of the most used and representative measure for personality disorders as they are referenced in the DSM-IV. The PDQ-4+ is a self-report questionnaire assessing the ten personality disorders and the two additional personality disorders derived from the DSM-IV. Participants must answer by True or False to the 99 items, each item represents a personality disorder’ criteria. Few researches have pointed out the psychometric properties of the original version of the PDQ-4+. Validating studies on the French version have been rarely conducted and only among students and teenagers. Clinical samples have been laid aside. Objective: Considering the importance of the assessment of personality disorders, the aim of the present study was to evaluate the main psychometric properties of the French version of the PDQ-4+ as a screening tool for borderline, antisocial, schizotypal, schizoid, obsessional-compulsive, narcissistic, histrionic, paranoid, dependent and avoidant personality disorders, in a psychiatric population. Materials and methods: A sample of 137 French psychiatric patients completed the French versions of the Structured Interview for DSM-IV Personality disorder-IV (SIDP-IV) and the PDQ-4+. Convergent validity, sensibility, specificity, positive and negative predictive values, and internal consistency have been evaluated. Results: The level of agreement between the PDQ-4+ and the SIDP-IV was very low for the majority of personality disorders and low for the dependent personality disorder. The sensitivity was high for antisocial and borderline personality disorders and moderate or low for the other. Only dependent (0.44) and borderline (0.39) personality disorders had a moderate predictive positive value, associated with a high negative predictive value (0.82 and 0.79). The other personality disorders had a low positive predictive value (ranged from 0.00 to 0.28) and a high negative predictive value (ranged from 0.76 to 1.00). The specificity was high for five disorders and moderate for the other. Internal consistency of the PDQ-4+ and its subscales was unsatisfying. Correlation coefficients between each PDQ-4+ subscales were low or moderate. Conclusions: As other self-report measure, the PDQ-4+ screened more personality disorders than the clinical interview. Besides, even if the two diagnostic methods evaluated more borderline and avoidant personality disorders, level of agreements for each personality disorder were generally low, in concordance with previous studies. Only dependent personality disorder emerged with low agreement, moderate specificity and positive predictive value, and high sensitivity and negative predictive value. The influence of the cut-off scores on these results could be raised. The internal consistency for each personality disorders was unsatisfying and lower than other French and international validating studies. The psychometric properties of the French version of the PDQ-4+ were overall unsatisfying. This tool allows a large screening of personality disorders and thus only appears as a useful method to screen a global personality disturbance.Annales Médico-psychologiques revue psychiatrique 01/2014; DOI:10.1016/j.amp.2014.10.022 · 0.15 Impact Factor
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ABSTRACT: Background No systematic reviews have been conducted into the prevalence of personality disorders (PD) in Asian populations. This review aims to investigate the prevalence of all PD subtypes within community and clinical Asian (Chinese, Indian, Japanese and South Korean) populations worldwide.Method Seven databases were searched in addition to manual examination and reference tracking. Exclusion criteria were applied with the remaining studies subjected to quality appraisal.ResultsNineteen studies were included for review. Results were grouped by community studies in Asian countries, clinical studies in Asian countries and comparative studies. Prevalence of PD assessed by clinical judgement was lower than that by diagnostic tools. The highest rates of PD were found in suicidal cohorts within the various countries. Four of the five comparative studies found lower prevalence rates of PD in Asians compared with the overall sample.Conclusion Insufficient consistent research has been published to ascertain the prevalence of PD in Asians and whether it is higher or lower than in Western cohorts. Asians presenting with suicidal ideation may benefit from PD assessment. Copyright © 2014 John Wiley & Sons, Ltd.Personality and Mental Health 09/2014; 8(4). DOI:10.1002/pmh.1270 · 1.10 Impact Factor