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Previous research has shown a high prevalence of comorbid personality disorders among individuals seeking treatment for cocaine dependence. We studied axis II disorders (using the Structured Clinical Interview for DSM-III-R Personality Disorders [SCID-II]) in 50 patients admitted for inpatient rehabilitation. All patients met lifetime criteria for cocaine dependence and reported cocaine use during the month before admission. Seventy percent of patients met criteria for at least one axis II diagnosis; the mean number of axis II diagnoses among these patients was 2.54 (range, one to six). The most common axis II diagnosis was borderline (34% of all patients), followed by antisocial and narcissistic (each 28%), avoidant and paranoid (each 22%), obsessive-compulsive (16%), and dependent (10%). To evaluate the relationship between comorbid personality pathology, substance abuse, and other psychiatric symptomatology, patients were divided into two groups based on whether they received an axis II disorder diagnosis. The groups did not differ on substance abuse variables. However, there were significant group differences on a measure of psychosis proneness and in the number of comorbid depressive and anxiety disorder diagnoses. These results are consistent with other studies of personality disorders in substance abuse patients, and suggest that it may be clinically useful to characterize cocaine-dependent patients with respect to comorbid axis II disorders.
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PMID:Personality disorders and associated features in cocaine-dependent inpatients. 799 24

This study aimed to evaluate the concurrent and lifetime psychiatric comorbidity and drug use patterns in patients admitted to the hospital for detoxification from benzodiazepines. Psychiatric assessments using the Structured Clinical Interview for DSM-III-R with a psychosis screening module (SCID-P and II) were conducted in 30 inpatients admitted to the medical unit treatment unit of the Clinical Research and Treatment Institute of the Addiction Research Foundation for the treatment of severe benzodiazepine dependence. Patients (mean age, 36 years; range, 22-58; number of DSM-III-R criteria met for benzodiazepine substance dependence, > or = 7 out of 9 [73%], all 9 criteria [40%]) used benzodiazepines and other drugs over prolonged periods of time at high doses, and their daily functioning was substantially impaired (Mean Global Assessment of Functioning Score, 48; range, 31-60). The most common lifetime psychiatric diagnoses were major depression (33%), other psychoactive drug dependence (100%) (opioids, 77%; alcohol, 53%), and panic disorder (30%). Current psychiatric diagnoses in addition to benzodiazepine dependence included other psychoactive substance use disorders (83%) (opioids, 67%; cocaine, 13%; multiple concurrent substance use, 17%), panic disorder (13%), and generalized anxiety disorder, (20%). Personality disorders included antisocial (42%), avoidant (25%), and borderline (17%). These findings demonstrate that in patients severely dependent on benzodiazepines, additional psychoactive substance use and mental disorders are prominent. The pattern of drug use and psychiatric comorbidity differentiates these patients from therapeutic-dose benzodiazepine users.
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PMID:Multiple drug use and psychiatric comorbidity in patients admitted to the hospital with severe benzodiazepine dependence. 883 19

The objective of the present study was to determine the reliability of psychiatric diagnoses using a translation and adaptation of Portuguese of the "Structured Clinical Interview for DSM-III-R-patient version" (SCID-P) and the "Structured Clinical Interview for DSM-III-R Personality Disorders" (SCID-II), using the joint interviews methodology. Thirty-nine subjects were evaluated using the SCID-P and 20 of them using the SCID-II. Interrater reliability was analyzed statistically by means of the Kappa Coefficient. Agreement between results obtained with SCID-P was statistically significant for the major diagnostic categories of DSM-III-R and for 10 of the 12 specific diagnostic categories studied (a minimum of 4 subjects per diagnosis). Agreement was not statistically significant for Psychotic Disorder Not Otherwise Specified (NOS) and for Other Bipolar Disorder. The Weighted Kappa for the main diagnoses and the Overall Kappa for the entire set of 25 specific diagnostic categories proposed by the SCID-P were statistically significant. The general agreement for Personality Disorders with SCID-II was statistically significant. The Kappa Coefficient was determined for the Avoidant, Paranoid, Histrionic and Borderline Personality Disorders and for the Conduct Disorder. The remaining Personality Disorders were not analyzed statistically because of their low prevalence in the sample. Agreement was not significant only for the Histrionic Personality Disorder. These data suggest that the translation and adaptation of the SCID-P and SCID-II to Portuguese presents, in general, good reliability indices, and thus its use is recommended.
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PMID:Reliability of the Portuguese version of the structured clinical interview for DSM-III-R (SCID) in a Brazilian sample of psychiatric outpatients. 922 32

Structured clinical interviews of 63 female inpatients diagnosed with borderline personality disorder were used to study the relations of comorbid mood disorders to treatment response. Diagnostic information was gathered using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P). Information about psychotic symptoms was also based upon responses to the SCID-P. Treatment response was assessed through weekly ratings on the Symptom Checklist-90-Revised over 25 weeks of hospitalization. Initial depression but not initial or previous bipolar disorder was found to predict treatment course. Initial psychotic symptoms were also found to predict treatment course among patients with initial bipolar disorder and tended to modify the trajectory of symptoms over time among patients with initial depression. Possible explanations for these findings are explored and discussed.
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PMID:Comorbid mood disorders as modifiers of treatment response among inpatients with borderline personality disorder. 978 38

A pattern of negative symptoms associated with a high rate of ongoing brain and ventricular instability has been described in a cohort of schizophrenia spectrum probands (patients with schizophrenia, schizoaffective disorder depressed and bipolar, and psychosis NOS) (Garver, D.L., Nair, T.R., Christensen, J.D., Holcomb, J., Ramberg, J., Kingsbury, S., 1999. Differential patterns of premorbid functioning, symptoms and neuroleptic response in stable and unstable ventricular-volume schizophrenia. Neuropsychopharmacology 20, in press). The present study contrasts the prevalence of negative symptoms in first- and second-degree relatives of probands with unstable ventricle volume (UnsVV) and stable ventricle volume (SVV). One hundred and sixteen first- and second-degree relatives of 10 probands were interviewed using the SANS, the 'Characterization of Course: "Pattern of Symptoms"' [from Comprehensive Assessment of Symptoms and History (CASH)], SCID and SCID-II by interviewers blind to the status of the proband. Thirty-five of the 116 family members met DSM-IV criteria for schizophrenia, SA depressed, 'Cluster A' of the SCID-II (paranoid, schizotypal, schizoid personality disorder), psychosis NOS, or psychotic affective disorder. These 35 family members were defined as falling within a 'schizophrenia spectrum' as described by Farmer, A.E., McGuffin, P., Gottesman, I.I., 1987. Arch. Gen. Psychiatry 44, 634-641, but with the addition of DSM-IV affective psychosis. On that basis, the 35 members were considered 'affected family members' (AFMs). The remaining 81 family members were considered unaffected. The 'predominant symptoms of illness' (during the past 2-3 years) for 25 of the 35 AFMs could be characterized according to the 'Patterns of Symptoms' derived from the CASH. Twenty-five of the 35 AFMs were found to maintain a predominant symptom pattern during the course of illness, which could be characterized according to the 'Pattern of Symptoms' as 'predominantly positive' or 'predominantly negative'. Three of the probands had UnsVV; seven had SVV. Of the 35 AFMs, 11 were related to the UnsVV probands, and 24 were relatives of the SVV probands. The nine rated AFMs of the UnsVV probands showed a trend toward higher SANS scores (7.3 +/- 5.1) (mean +/- s.d.) than the 20 rated AFMs of SVV probands (4.3 +/- 5.1) (p = 0.08) at the time of the interview. Eighty-three per cent (eight of 10) of rated affected pedigree members of the pedigrees delineated by probands with UnsVV probands had a predominantly negative symptom course of illness, and 96% (23 of 24) of rated affected pedigree members of the pedigrees with SVV probands had a predominantly positive symptom course of illness during the preceding 2-3 years (p = 0.002). None of the 12 rated affected pedigree members within pedigrees having UnsVV probands were married at the time of the interview; 45% (14 of 31) of affected pedigree members having SVV probands were married (p = 0.004). A psychiatric disorder, characterized by unstable cerebral ventricles and predominant negative symptoms (including avoidance/failure of marital relationships) appears symptomatically to breed true in pedigrees containing schizophrenia-like illnesses.
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PMID:Negative symptoms of familial schizophrenia breed true in unstable (vs. stable) cerebral-ventricle pedigrees. 998 37

Psychotic bipolar depression was compared with nonpsychotic bipolar depression. Psychotic (n = 59) and nonpsychotic (n = 176) bipolar depressed outpatients were SCID-DSM-IV interviewed. Psychotic bipolar depression had significantly higher severity, more chronicity, fewer atypical features and axis I co-morbidity, more bipolar I, and fewer bipolar II patients. Age at onset, duration of illness, gender, and recurrences, were not significantly different.
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PMID:Psychotic versus nonpsychotic bipolar outpatient depression. 1068 32

This study compared structured vs. unstructured interviews for making psychiatric diagnoses. Three clinicians independently diagnosed 56 inpatient-subjects, each using a different method: (1) the unstructured Traditional Diagnostic Assessment (TDA), the standard method of clinical practice; (2) the Structured Clinical Interview for DSM-Clinical Version (SCID-CV), a widely used structured method; and (3) the Computer Assisted Diagnostic Interview (CADI), a structured computer-based method. Once finished, the three clinicians developed a Consensus diagnosis, using Spitzer's LEAD Standard (L=Longitudinal evaluation of symptomatology, E=Evaluation by expert consensus, AD=All Data from multiple sources). Diagnoses were assigned to one of 10 groups (cognitive impairment, general medical condition-induced, alcohol-induced, drug-induced, mania, depression, schizophrenia, schizoaffective, psychosis NOS, and anxiety). Diagnostic accuracy for each method, measured against Consensus, was as follows: TDA-agreement=53.8%, kappa=0.4325 ('fair'); SCID-CV-agreement=85.7%, kappa=0.8189 ('excellent'); CADI -agreement=85.7%, kappa=0.8147 ('excellent'). All three methods reached acceptable levels of diagnostic accuracy. Structured methods (SCID-CV, CADI) were significantly better than the unstructured TDA.
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PMID:Inpatient diagnostic assessments: 1. Accuracy of structured vs. unstructured interviews. 1181 44

Prior research has focused on schizophrenia-spectrum disorder traits in psychosis-prone subjects. The whole range of personality disorders were only explored in patient samples and with the relatives of patients. In light of this situation, the predictive value of Physical Anhedonia (PhA), Perceptual Aberration (PER), and Magical Ideation (MI) for personality disorder traits were examined dimensionally and categorically in a non-patient sample. We selected a non-student sample (n = 404) and focused on two risk groups (PhA: n = 14; combined PER/MI: n = 36), and a control group (n = 19) using the SCID II to assess personality disorders at a time period two years later. MI explained most of the variance in clinically relevant schizotypal personality disorder symptoms, while PER and PhA dimensionally were associated with the number of diagnostic criteria met for other personality disorders. While both risk groups exceeded the control group in clinically relevant borderline traits, only the PER/MI-individuals differed in fulfilling more criteria for schizotypal personality disorder.
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PMID:Prediction of personality disorder traits by psychosis proneness scales in a German sample of young adults. 1220 67

The purpose of this study was to identify the level of psychiatric symptoms reported by probationers involved with a drug court in Hennepin County, Minnesota. Sixty probationers completed a brief demographic interview, the Beck Depression and Anxiety Inventories (BDI and BAI) and a measure of medical quality of life. Fifteen participants completed a structured interview for psychiatric diagnosis (SCID-I). The sample was predominantly male, African American, and unemployed. Over 40% had received treatment for psychiatric problems, including 20% who reported a history of inpatient psychiatric admission and 15% currently taking a psychotropic medication. More than 1/3 of BDI and BAI scores were moderate to severe. The mean Short Form (SF)-36 scores were significantly lower than in the general population. Trends suggested more distress associated with: Caucasian race, female gender, less education, unemployment, and less previous legal involvement. Of 15 participants that completed a SCID-I, 13 participants met lifetime diagnostic criteria for at least one psychiatric disorder. The most common diagnoses were major depressive disorder and posttraumatic stress disorder (PTSD). Three participants met diagnostic criteria for current psychotic disorder. Half of participants who currently met criteria for a disorder reported that they had never received psychiatric treatment. Results indicate participants currently were experiencing high rates of emotional symptoms. Serious mental illness was common. Many of these individuals had not been identified previously as needing psychiatric treatment. More frequent and thorough screening for psychiatric illness in drug court settings is necessary to identify serious psychiatric illnesses.
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PMID:Psychiatric illness among drug court probationers. 1471 39

This study examined the validity of the family history method for diagnosing schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders in first-degree relatives of schizophrenia probands. This is the first large-scale study that examined the validity of the family history method for diagnosing DSM-III-R personality disorders. The best estimate DSM-III-R diagnoses of 264 first-degree relatives of 117 adult-onset schizophrenia probands based on direct structured diagnostic interviews, family history interview, and medical records were compared to Family History Research Diagnostic Criteria (FH-RDC) diagnoses based on the NIMH Relative Psychiatric History Interview and to family history Structured Clinical Interview for DSM-III-R: Personality Disorders (SCID-II) diagnoses based on the SCID-II adapted to a third person format. Diagnoses of relatives were made blind to proband diagnostic status. The median sensitivity for schizophrenia and the related psychoses was 29% (range 0-50%), the median specificity 99% (range 98-100%), and the median positive predictive value (PPV) 67% (range 20-80%). The median sensitivity for the personality diagnoses was 25% (range 14-71%), the median specificity 100% (range 99-100%), and the median PPV 100% (range 67-100%). The family history method has low sensitivity but has excellent specificity and PPV for schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders. The kappa coefficient for the family history method was moderately good for the psychoses (0.598) and for paranoid and schizotypal personality disorder (0.576). Using the family history method, the validity of making schizophrenia-related personality disorder diagnoses was comparable to that of making psychotic disorder diagnoses.
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PMID:Validity of the family history method for diagnosing schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders in first-degree relatives of schizophrenia probands. 1509 12


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