Recognition of personality disorder and anxiety disorder comorbidity in patients treated for depression in secondary psychiatric care
Autoři:
Marie Asp aff001; Daniel Lindqvist aff001; Johan Fernström aff001; Livia Ambrus aff001; Eva Tuninger aff001; Margareta Reis aff003; Åsa Westrin aff001
Působiště autorů:
Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
aff001; Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
aff002; Department of Clinical Pharmacology, Linköping University, Linköping, Sweden
aff003
Vyšlo v časopise:
PLoS ONE 15(1)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0227364
Souhrn
Objectives
Depression is a common illness with substantial economic consequences for society and a great burden for affected individuals. About 30% of patients with depression do not respond to repeated treatments. Psychiatric comorbidity is known to affect duration, recurrence and treatment outcome of depression. However, there is a lack of knowledge on the extent to which psychiatric comorbidity is identified in the clinical setting for depressed patients in secondary psychiatric care. Therefore, the aim of this study was to compare the agreement between traditional diagnostic assessment (TDA) and a structured and comprehensive diagnostic procedure (SCDP) for identification of personality and anxiety disorder comorbidity in depressed patients in secondary psychiatric care.
Methods
274 patients aged 18–77 were referred from four secondary psychiatric care clinics in Sweden during 2012–2017. ICD-10 diagnoses according to TDA (mostly unstructured by psychiatric specialist and residents in psychiatry), were retrieved from medical records and compared to diagnoses resulting from the SCDP in the study. This included the Mini International Neuropsychiatric Interview, the Structured Interview for DSM Axis II Personality Disorders and semi-structured questions on psychosocial circumstances, life-events, psychiatric symptoms, psychiatric treatments, substance use, and suicidal and self-harm behaviour. The assessment was carried out by psychiatric specialists or by residents in psychiatry with at least three years of psychiatric training.
Results
SCDP identified personality disorder comorbidity in 43% of the patients compared to 11% in TDA (p<0,0001). Anxiety disorder comorbidity was identified in 58% with SCDP compared to 12% with TDA (p<0,0001).
Conclusions
Important psychiatric comorbidity seems to be unrecognized in depressive patients when using TDA, which is routine in secondary psychiatric care. Comorbidities are better identified using the proposed model involving structured and semi-structured interviews together with clinical evaluations by clinical experts.
Klíčová slova:
Diagnostic medicine – Mental health and psychiatry – Depression – Neuropsychological testing – Suicide – Anxiety disorders – Personality disorders – Personality tests
Zdroje
1. Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, et al. The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiologia e psichiatria sociale. 2009;18(1):23–33. doi: 10.1017/s1121189x00001421 19378696
2. Greenberg PE, Fournier AA, Sisitsky T, Pike CT, Kessler RC. The economic burden of adults with major depressive disorder in the United States (2005 and 2010). The Journal of clinical psychiatry. 2015;76(2):155–62. doi: 10.4088/JCP.14m09298 25742202
3. Chisholm D, Sweeny K, Sheehan P, Rasmussen B, Smit F, Cuijpers P, et al. Scaling-up treatment of depression and anxiety: a global return on investment analysis. The lancet Psychiatry. 2016;3(5):415–24. doi: 10.1016/S2215-0366(16)30024-4 27083119
4. Holtzheimer PE, Mayberg HS. Stuck in a rut: rethinking depression and its treatment. Trends in neurosciences. 2011;34(1):1–9. doi: 10.1016/j.tins.2010.10.004 21067824
5. Souery D, Amsterdam J, de Montigny C, Lecrubier Y, Montgomery S, Lipp O, et al. Treatment resistant depression: methodological overview and operational criteria. European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology. 1999;9(1–2):83–91.
6. Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. The American journal of psychiatry. 2006;163(11):1905–17. doi: 10.1176/ajp.2006.163.11.1905 17074942
7. Sundquist J, Ohlsson H, Sundquist K, Kendler KS. Common adult psychiatric disorders in Swedish primary care where most mental health patients are treated. BMC Psychiatry. 2017;17(1):235. doi: 10.1186/s12888-017-1381-4 28666429
8. Skodol AE, Grilo CM, Keyes KM, Geier T, Grant BF, Hasin DS. Relationship of personality disorders to the course of major depressive disorder in a nationally representative sample. The American journal of psychiatry. 2011;168(3):257–64. doi: 10.1176/appi.ajp.2010.10050695 21245088
9. Grilo CM, Sanislow CA, Shea MT, Skodol AE, Stout RL, Gunderson JG, et al. Two-year prospective naturalistic study of remission from major depressive disorder as a function of personality disorder comorbidity. Journal of consulting and clinical psychology. 2005;73(1):78–85. doi: 10.1037/0022-006X.73.1.78 15709834
10. Mulder RT. Personality pathology and treatment outcome in major depression: a review. The American journal of psychiatry. 2002;159(3):359–71. doi: 10.1176/appi.ajp.159.3.359 11869996
11. Pompili M, Venturini P, Palermo M, Stefani H, Seretti ME, Lamis DA, et al. Mood disorders medications: predictors of nonadherence—review of the current literature. Expert review of neurotherapeutics. 2013;13(7):809–25. doi: 10.1586/14737175.2013.811976 23898852
12. Bagby RM, Ryder AG, Cristi C. Psychosocial and clinical predictors of response to pharmacotherapy for depression. Journal of psychiatry & neuroscience: JPN. 2002;27(4):250–7.
13. Howland RH, Rush AJ, Wisniewski SR, Trivedi MH, Warden D, Fava M, et al. Concurrent anxiety and substance use disorders among outpatients with major depression: clinical features and effect on treatment outcome. Drug and alcohol dependence. 2009;99(1–3):248–60. doi: 10.1016/j.drugalcdep.2008.08.010 18986774
14. Campbell-Sills L, Sherbourne CD, Roy-Byrne P, Craske MG, Sullivan G, Bystritsky A, et al. Effects of co-occurring depression on treatment for anxiety disorders: analysis of outcomes from a large primary care effectiveness trial. The Journal of clinical psychiatry. 2012;73(12):1509–16. doi: 10.4088/JCP.12m07955 23290323
15. Davis LL, Rush JA, Wisniewski SR, Rice K, Cassano P, Jewell ME, et al. Substance use disorder comorbidity in major depressive disorder: an exploratory analysis of the Sequenced Treatment Alternatives to Relieve Depression cohort. Comprehensive psychiatry. 2005;46(2):81–9. doi: 10.1016/j.comppsych.2004.07.025 15723023
16. Hawton K, Casanas ICC, Haw C, Saunders K. Risk factors for suicide in individuals with depression: a systematic review. Journal of affective disorders. 2013;147(1–3):17–28. doi: 10.1016/j.jad.2013.01.004 23411024
17. Pompili M, Rihmer Z, Akiskal H, Amore M, Gonda X, Innamorati M, et al. Temperaments mediate suicide risk and psychopathology among patients with bipolar disorders. Comprehensive psychiatry. 2012;53(3):280–5. doi: 10.1016/j.comppsych.2011.04.004 21641589
18. Skodol AE, Grilo CM, Pagano ME, Bender DS, Gunderson JG, Shea MT, et al. Effects of personality disorders on functioning and well-being in major depressive disorder. J Psychiatr Pract. 2005;11(6):363–8. doi: 10.1097/00131746-200511000-00002 16304504
19. Gulec MY, Hocaoglu C. Relationship between personality and disability in patients with major depressive disorder. Isr J Psychiatry Relat Sci. 2011;48(2):123–8. 22120448
20. Gili M, Garcia Toro M, Armengol S, Garcia-Campayo J, Castro A, Roca M. Functional impairment in patients with major depressive disorder and comorbid anxiety disorder. Can J Psychiatry. 2013;58(12):679–86. doi: 10.1177/070674371305801205 24331287
21. Hendriks SM, Spijker J, Licht CM, Hardeveld F, de Graaf R, Batelaan NM, et al. Long-term work disability and absenteeism in anxiety and depressive disorders. Journal of affective disorders. 2015;178:121–30. doi: 10.1016/j.jad.2015.03.004 25805404
22. De Carlo V, Calati R, Serretti A. Socio-demographic and clinical predictors of non-response/non-remission in treatment resistant depressed patients: A systematic review. Psychiatry research. 2016;240:421–30. doi: 10.1016/j.psychres.2016.04.034 27155594
23. Ramirez Basco M, Bostic JQ, Davies D, Rush AJ, Witte B, Hendrickse W, et al. Methods to improve diagnostic accuracy in a community mental health setting. The American journal of psychiatry. 2000;157(10):1599–605. doi: 10.1176/appi.ajp.157.10.1599 11007713
24. Zimmerman M, Mattia JI. Psychiatric diagnosis in clinical practice: is comorbidity being missed? Comprehensive psychiatry. 1999;40(3):182–91. doi: 10.1016/s0010-440x(99)90001-9 10360612
25. Miller PR, Dasher R, Collins R, Griffiths P, Brown F. Inpatient diagnostic assessments: 1. Accuracy of structured vs. unstructured interviews. Psychiatry research. 2001;105(3):255–64. doi: 10.1016/s0165-1781(01)00317-1 11814544
26. Miller PR. Inpatient diagnostic assessments: 3. Causes and effects of diagnostic imprecision. Psychiatry research. 2002;111(2–3):191–7. doi: 10.1016/s0165-1781(02)00147-6 12374636
27. Zimmerman M, Rothschild L, Chelminski I. The prevalence of DSM-IV personality disorders in psychiatric outpatients. The American journal of psychiatry. 2005;162(10):1911–8. doi: 10.1176/appi.ajp.162.10.1911 16199838
28. Rettew DC, Lynch AD, Achenbach TM, Dumenci L, Ivanova MY. Meta-analyses of agreement between diagnoses made from clinical evaluations and standardized diagnostic interviews. International journal of methods in psychiatric research. 2009;18(3):169–84. doi: 10.1002/mpr.289 19701924
29. Verhoeven FEA, Swaab L, Carlier IVE, van Hemert AM, Zitman FG, Ruhe HG, et al. Agreement between clinical and MINI diagnoses in outpatients with mood and anxiety disorders. Journal of affective disorders. 2017;221:268–74. doi: 10.1016/j.jad.2017.06.041 28662459
30. Komiti AA, Jackson HJ, Judd FK, Cockram AM, Kyrios M, Yeatman R, et al. A comparison of the Composite International Diagnostic Interview (CIDI-Auto) with clinical assessment in diagnosing mood and anxiety disorders. The Australian and New Zealand journal of psychiatry. 2001;35(2):224–30. doi: 10.1046/j.1440-1614.2001.00868.x 11284905
31. Kranzler HR, Kadden RM, Burleson JA, Babor TF, Apter A, Rounsaville BJ. Validity of psychiatric diagnoses in patients with substance use disorders: is the interview more important than the interviewer? Comprehensive psychiatry. 1995;36(4):278–88. doi: 10.1016/s0010-440x(95)90073-x 7554872
32. Shear MK, Greeno C, Kang J, Ludewig D, Frank E, Swartz HA, et al. Diagnosis of nonpsychotic patients in community clinics. The American journal of psychiatry. 2000;157(4):581–7. doi: 10.1176/appi.ajp.157.4.581 10739417
33. Rosenman SJ, Korten AE, Levings CT. Computerised diagnosis in acute psychiatry: validity of CIDI-Auto against routine clinical diagnosis. Journal of psychiatric research. 1997;31(5):581–92. doi: 10.1016/s0022-3956(97)00032-0 9368199
34. Steiner JL, Tebes JK, Sledge WH, Walker ML. A comparison of the structured clinical interview for DSM-III-R and clinical diagnoses. The Journal of nervous and mental disease. 1995;183(6):365–9. doi: 10.1097/00005053-199506000-00003 7798084
35. Taggart C, O'Grady J, Stevenson M, Hand E, Mc Clelland R, Kelly C. Accuracy of diagnosis at routine psychiatric assessment in patients presenting to an accident and emergency department. General hospital psychiatry. 2006;28(4):330–5. doi: 10.1016/j.genhosppsych.2006.05.002 16814633
36. Rush AJ, Kraemer HC, Sackeim HA, Fava M, Trivedi MH, Frank E, et al. Report by the ACNP Task Force on response and remission in major depressive disorder. Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology. 2006;31(9):1841–53.
37. Bennabi D, Charpeaud T, Yrondi A, Genty JB, Destouches S, Lancrenon S, et al. Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental. BMC psychiatry. 2019;19(1):262. doi: 10.1186/s12888-019-2237-x 31455302
38. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of clinical psychiatry. 1998;59 Suppl 20:22–33;quiz 4–57.
39. First MB, Spitzer R.L., Gibbon M., & Williams J.B.W.. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I).: New York: Biometric Research Department.; 1997.
40. First M, Gibbon M, Spitzer RL, Williams JBW, Benjamin LS. Structured Clinical Interview for DSM-IV Axis II Personality Disorders, (SCID-II). Washington, D.C.: American Psychiatric Press, Inc.; 1997.
41. Asberg M, Montgomery SA, Perris C, Schalling D, Sedvall G. A comprehensive psychopathological rating scale. Acta psychiatrica Scandinavica Supplementum. 1978(271):5–27. doi: 10.1111/j.1600-0447.1978.tb02357.x 277059
42. Nimeus A, Hjalmarsson Stahlfors F, Sunnqvist C, Stanley B, Traskman-Bendz L. Evaluation of a modified interview version and of a self-rating version of the Suicide Assessment Scale. European psychiatry: the journal of the Association of European Psychiatrists. 2006;21(7):471–7.
43. Svanborg P, Asberg M. A comparison between the Beck Depression Inventory (BDI) and the self-rating version of the Montgomery Asberg Depression Rating Scale (MADRS). Journal of affective disorders. 2001;64(2–3):203–16. doi: 10.1016/s0165-0327(00)00242-1 11313087
44. Lingjaerde O, Ahlfors UG, Bech P, Dencker SJ, Elgen K. The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta psychiatrica Scandinavica Supplementum. 1987;334:1–100. doi: 10.1111/j.1600-0447.1987.tb10566.x 2887090
45. Bergman H, Kallmen H, Rydberg U, Sandahl C. [Ten questions about alcohol as identifier of addiction problems. Psychometric tests at an emergency psychiatric department]. Lakartidningen. 1998;95(43):4731–5. 9821761
46. Newton-Howes G, Tyrer P, Anagnostakis K, Cooper S, Bowden-Jones O, Weaver T. The prevalence of personality disorder, its comorbidity with mental state disorders, and its clinical significance in community mental health teams. Soc Psychiatry Psychiatr Epidemiol. 2010;45(4):453–60. doi: 10.1007/s00127-009-0084-7 19543844
47. Volkert J, Gablonski TC, Rabung S. Prevalence of personality disorders in the general adult population in Western countries: systematic review and meta-analysis. The British journal of psychiatry: the journal of mental science. 2018:1–7.
48. Oldham JM, Skodol AE. Personality disorders in the public sector. Hosp Community Psychiatry. 1991;42(5):481–7. doi: 10.1176/ps.42.5.481 2060913
49. Angstman KB, Seshadri A, Marcelin A, Gonzalez CA, Garrison GM, Allen JS. Personality Disorders in Primary Care: Impact on Depression Outcomes Within Collaborative Care. Journal of primary care & community health. 2017;8(4):233–8.
50. Marchesi C, De Panfilis C, Cantoni A, Fonto S, Giannelli MR, Maggini C. Personality disorders and response to medication treatment in panic disorder: a 1-year naturalistic study. Progress in neuro-psychopharmacology & biological psychiatry. 2006;30(7):1240–5.
51. Grilo CM, Stout RL, Markowitz JC, Sanislow CA, Ansell EB, Skodol AE, et al. Personality disorders predict relapse after remission from an episode of major depressive disorder: a 6-year prospective study. The Journal of clinical psychiatry. 2010;71(12):1629–35. doi: 10.4088/JCP.08m04200gre 20584514
52. Bongiovi-Garcia ME, Merville J, Almeida MG, Burke A, Ellis S, Stanley BH, et al. Comparison of clinical and research assessments of diagnosis, suicide attempt history and suicidal ideation in major depression. Journal of affective disorders. 2009;115(1–2):183–8. doi: 10.1016/j.jad.2008.07.026 18814917
53. Beckwith H, Moran PF, Reilly J. Personality disorder prevalence in psychiatric outpatients: a systematic literature review. Personality and mental health. 2014;8(2):91–101. doi: 10.1002/pmh.1252 24431304
54. Souery D, Oswald P, Massat I, Bailer U, Bollen J, Demyttenaere K, et al. Clinical factors associated with treatment resistance in major depressive disorder: results from a European multicenter study. The Journal of clinical psychiatry. 2007;68(7):1062–70. doi: 10.4088/jcp.v68n0713 17685743
55. Friborg O, Martinsen EW, Martinussen M, Kaiser S, Overgard KT, Rosenvinge JH. Comorbidity of personality disorders in mood disorders: a meta-analytic review of 122 studies from 1988 to 2010. Journal of affective disorders. 2014;152–154:1–11. doi: 10.1016/j.jad.2013.08.023 24120406
56. Maffei C, Fossati A, Agostoni I, Barraco A, Bagnato M, Deborah D, et al. Interrater reliability and internal consistency of the structured clinical interview for DSM-IV axis II personality disorders (SCID-II), version 2.0. Journal of personality disorders. 1997;11(3):279–84. doi: 10.1521/pedi.1997.11.3.279 9348491
57. Lobbestael J, Leurgans M, Arntz A. Inter-rater reliability of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) and Axis II Disorders (SCID II). Clinical psychology & psychotherapy. 2011;18(1):75–9.
58. Alnaes R, Torgersen S. DSM-III symptom disorders (Axis I) and personality disorders (Axis II) in an outpatient population. Acta psychiatrica Scandinavica. 1988;78(3):348–55. doi: 10.1111/j.1600-0447.1988.tb06346.x 3195356
59. Helzer JE, Robins LN, McEvoy LT, Spitznagel EL, Stoltzman RK, Farmer A, et al. A comparison of clinical and diagnostic interview schedule diagnoses. Physician reexamination of lay-interviewed cases in the general population. Archives of general psychiatry. 1985;42(7):657–66. doi: 10.1001/archpsyc.1985.01790300019003 4015307
60. Meeuwissen JAC, Feenstra TL, Smit F, Blankers M, Spijker J, Bockting CLH, et al. The cost-utility of stepped-care algorithms according to depression guideline recommendations—Results of a state-transition model analysis. Journal of affective disorders. 2019;242:244–54. doi: 10.1016/j.jad.2018.08.024 30216769
61. Firth N, Barkham M, Kellett S. The clinical effectiveness of stepped care systems for depression in working age adults: a systematic review. Journal of affective disorders. 2015;170:119–30. doi: 10.1016/j.jad.2014.08.030 25240141
62. van Straten A, Hill J, Richards DA, Cuijpers P. Stepped care treatment delivery for depression: a systematic review and meta-analysis. Psychological medicine. 2015;45(2):231–46. doi: 10.1017/S0033291714000701 25065653
63. Ottosson H, Bodlund O, Ekselius L, Grann M, von Knorring L, Kullgren G, et al. DSM-IV and ICD-10 personality disorders: a comparison of a self-report questionnaire (DIP-Q) with a structured interview. European psychiatry: the journal of the Association of European Psychiatrists. 1998;13(5):246–53.
64. Moller HJ, Bandelow B, Volz HP, Barnikol UB, Seifritz E, Kasper S. The relevance of 'mixed anxiety and depression' as a diagnostic category in clinical practice. European archives of psychiatry and clinical neuroscience. 2016;266(8):725–36. doi: 10.1007/s00406-016-0684-7 27002521
65. Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, Compton W, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of general psychiatry. 2004;61(8):807–16. doi: 10.1001/archpsyc.61.8.807 15289279
66. Merikangas KR, McClair VL. Epidemiology of substance use disorders. Human genetics. 2012;131(6):779–89. doi: 10.1007/s00439-012-1168-0 22543841
67. Davis L, Uezato A, Newell JM, Frazier E. Major depression and comorbid substance use disorders. Current opinion in psychiatry. 2008;21(1):14–8. doi: 10.1097/YCO.0b013e3282f32408 18281835
68. Brenner P, Brandt L, Li G, DiBernardo A, Boden R, Reutfors J. Treatment-resistant depression as risk factor for substance use disorders-a nation-wide register-based cohort study. Addiction (Abingdon, England). 2019.
69. Choi-Kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT. What Works in the Treatment of Borderline Personality Disorder. Current behavioral neuroscience reports. 2017;4(1):21–30. doi: 10.1007/s40473-017-0103-z 28331780
70. Yu M, Linn KA, Shinohara RT, Oathes DJ, Cook PA, Duprat R, et al. Childhood trauma history is linked to abnormal brain connectivity in major depression. Proc Natl Acad Sci U S A. 2019;116(17):8582–90. doi: 10.1073/pnas.1900801116 30962366
Článok vyšiel v časopise
PLOS One
2020 Číslo 1
- Metamizol jako analgetikum první volby: kdy, pro koho, jak a proč?
- Nejasný stín na plicích – kazuistika
- Masturbační chování žen v ČR − dotazníková studie
- Těžké menstruační krvácení může značit poruchu krevní srážlivosti. Jaký management vyšetření a léčby je v takovém případě vhodný?
- Fixní kombinace paracetamol/kodein nabízí synergické analgetické účinky
Najčítanejšie v tomto čísle
- Psychometric validation of Czech version of the Sport Motivation Scale
- Comparison of Monocyte Distribution Width (MDW) and Procalcitonin for early recognition of sepsis
- Effects of supplemental creatine and guanidinoacetic acid on spatial memory and the brain of weaned Yucatan miniature pigs
- Accelerated sparsity based reconstruction of compressively sensed multichannel EEG signals