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The prevalence of personality disorder in schizophrenia and psychotic disorders: systematic review of rates and explanatory modelling

Published online by Cambridge University Press:  10 December 2007

G. Newton-Howes ,
P. Tyrer ,
B. North  and
M. Yang
G. Newton-Howes*
Affiliation:
Department of Psychological Medicine, Imperial College, London, UK
P. Tyrer
Affiliation:
Department of Psychological Medicine, Imperial College, London, UK
B. North
Affiliation:
Imperial College, South Kensington Campus, Sir Alexander Fleming Building, London, UK
M. Yang
Affiliation:
Queen Mary, University of London, William Harvey House, London, UK
*
*Address for correspondence: Dr G. Newton-Howes, MRCPsych, Department of Psychological Medicine, Imperial College, St Dunstan's Road, London W6 8RP, UK. (Email: [email protected])
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Abstract

Background

Personality disorder (PD) in psychosis is poorly studied. As PD can affect outcome in mental disorders, it is important to understand its prevalence in order to plan services, understand prognosis more fully and maximize management options.

Method

Literature searching revealed 3972 potential papers. Twenty papers including 6345 patients were included in the final analysis. There was great variation in prevalence and multilevel modelling was used to identify possible reasons for this heterogeneity.

Results

The prevalence of PD varied from 4.5% to 100%. Multilevel analysis suggested country of study, study type, the instruments used to diagnose PD and patient care correlated with the prevalence data explaining the study level heterogeneity, with 34.2, 33.4, 17.0 and 4.5% by each variable respectively. Personality studies in Canada and Sweden reported lower PD prevalence, whereas in Spain it was higher than the multinational study. Compared with randomized controlled trials, case-control studies reported lower prevalence [odds ratio (OR)=0.35, 95% confidence interval (CI) 0.15–0.79] and observational studies higher prevalence (OR 70.5, 95% CI 8.5–583). Primary-care patients were less likely to be diagnosed (OR 0.02, 95% CI 0–0.19) than hospital patients, and out-patients had higher prevalence (OR 12.5, 95% CI 1.77–88.6).

Conclusions

The reported prevalence of PD in schizophrenia varies significantly. Statistical modelling suggests care, country, study type and diagnostic tools for PD all bias prevalence rates. The number of papers reaching the inclusion criteria, the relative paucity of information and the difficulties in developing an accurate statistical model limited interpretation from the study.

Keywords

Personality disorderprevalenceschizophrenia
Type
Review Article
Information
Psychological Medicine , Volume 38 , Issue 8 , August 2008 , pp. 1075 - 1082
Copyright
Copyright © 2007 Cambridge University Press

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References

APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, revised. American Psychiatric Association: Washington, DC.Google Scholar
Bowden-Jones, O, Iqbal, MZ, Tyrer, P, Seivewright, N, Cooper, S, Weaver, T (2004). Prevalence of personality disorder in alcohol and drug services and associated co-morbidity. Addiction 99, 1306–1314.CrossRefGoogle Scholar
Casey, P, Tyrer, P (1990). Personality disorder and psychiatric illness in general practice. British Journal of Psychiatry 156, 261–265.CrossRefGoogle ScholarPubMed
Caton, CL, Shrout, PE, Dominguez, B, Eagle, PF, Opler, LA, Couros, F (1995). Risk factors for homelessness among women with schizophrenia. American Journal of Public Health 85, 1153–1156.CrossRefGoogle ScholarPubMed
Caton, CL, Shrout, PE, Eagle, PF, Opler, LA, Felix, A, Dominguez, B (1994). Risk factors for homelessness among schizophrenic men: a case-control study. American Journal of Public Health 84, 265–270.CrossRefGoogle ScholarPubMed
Coolidge, F, Merwin, M (1992). Reliability and validity of the Coolidge Axis II inventory: a new inventory for the assessment of personality disorders. Journal of Personality Assessment 59, 223–238.CrossRefGoogle ScholarPubMed
Coolidge, FL, Segal, DL, Pointer, JC, Knaus, EA, Yamazaki, TG, Silberman, CS (2000). Personality disorders in older adult inpatients with chronic mental illness. Journal of Clinical Geropsychology 6, 63–72.CrossRefGoogle Scholar
Docherty, J, Fiester, S, Shea, T (1986). Syndrome diagnosis and personality disorders. In American Psychiatric Press Review of Psychiatry (ed. Frances, A. and Hales, R.), pp. 315–355. American Psychiatric Press: New York.Google Scholar
First, M, Spitzer, R, Gibbon, M, Williams, J (1994). Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), version 2.0. New York State Psychiatric Institute: New York.Google Scholar
Hodgins, S, Toupin, J, Cote, G (1996). Schizophrenia and antisocial personality disorder: a criminal combination. In Explorations in Criminal Psychopathology (ed. Schlensinger, L.), chapter 11. Charles C. Thomas: Springfield, IL.Google Scholar
Hogg, B, Jackson, H, Rudd, R, Edwards, J (1990). Diagnosing personality disorders in recent onset schizophrenia. Journal of Mental and Nervous Disease 178, 194–199.CrossRefGoogle ScholarPubMed
Jackson, HJ, Whiteside, HK, Bates, GW, Bell, R, Rudd, RP, Edwards, J (1991). Diagnosing personality disorders in psychiatric inpatients. Acta Psychiatrica Scandinavica 83, 206–213.CrossRefGoogle ScholarPubMed
Keown, P, Holloway, F, Kuipers, E (2002). The prevalence of personality disorders, psychotic disorders and affective disorders amongst the patients seen by a community mental health team in London. Social Psychiatry and Psychiatric Epidemiology 37, 225–229.CrossRefGoogle Scholar
Koenisberg, HW, Kapalan, RD, Gilmore, MM, Cooper, AM (1985). The relationship between syndrome and personality disorder in DSM-III: experience with 2462 patients. American Journal of Psychiatry 142, 207–212.Google Scholar
Lindstrom, E, von Knorring, L, Ekselius, L (2000). Self-reported personality disorders in patients with schizophrenia and the relationship to symptoms, side effects and social functioning. Nordic Journal of Psychiatry 54, 341–346.Google Scholar
Livesley, W (1991). Classifying personality disorders: ideal types, prototypes, or dimensions? Journal of Personality Disorders 5, 52–59.CrossRefGoogle Scholar
Loftus, S, Jaeger, J (2006). Psychosocial outcome in bipolar I patients with a personality disorder. Journal of Nervous and Mental Diseases 194, 967–970.CrossRefGoogle ScholarPubMed
Loranger, AW, Susman, V, Oldham, J, Russakoff, L (1985). Personality Disorder Examination (PDE): A Structured Interview for DSM-III-R Personality Disorders. New York Hospital: White Plains, NY.Google Scholar
Mantere, O, Melartin, TK, Suominen, K, Rytsala, HJ, Valtonen, HM, Arvilommi, P, Leppamaki, S, Isometsa, ET (2006). Differences in axis I and II comorbidity between bipolar I and II disorders and major depressive disorder. Journal of Clinical Psychiatry 67, 584–593.CrossRefGoogle ScholarPubMed
McGlashen, T (1986). Schizotypal personality disorder. Chestnut Lodge follow-up study: VI. Long term follow-up perspectives. Archives of General Psychiatry 43, 329–334.CrossRefGoogle Scholar
Moran, P, Hodgins, S (2004). The correlates of comorbid antisocial personality disorder in schizophrenia. Schizophrenia Bulletin 30, 791–802.CrossRefGoogle ScholarPubMed
Moran, P, Walsh, E, Tyrer, P, Burns, T, Creed, F, Fahy, T (2003). Impact of comorbid personality disorder on violence in psychosis. British Journal of Psychiatry 182, 129–134.CrossRefGoogle ScholarPubMed
Mors, O, Sorensen, L (1994). Incidence and comorbidity of personality disorders among first ever admitted psychiatric patients. European Psychiatry 9, 175–184.CrossRefGoogle Scholar
Mueser, KT, Drake, RE, Ackerson, TH, Alterman, AI, Miles, KM, Noordsy, DL (1997). Antisocial personality disorder, conduct disorder, and substance abuse in schizophrenia. Journal of Abnormal Psychology 106, 473–477.CrossRefGoogle ScholarPubMed
Mueser, KT, Rosenberg, SD, Drake, RE, Miles, KM, Wolford, G, Vidaver, R, Carrieri, K (1999). Conduct disorder, antisocial personality disorder and substance use disorder in schizophrenia and major affective disorders. Journal of Studies on Alcohol 60, 278–284.CrossRefGoogle ScholarPubMed
Newton-Howes, G, Tyrer, P, Johnson, T (2006). Personality disorder and the outcome of depression: a meta-analysis of published studies. British Journal of Psychiatry 188, 13–20.CrossRefGoogle ScholarPubMed
Newton-Howes, G, Tyrer, P, Moore, A, Nur, U (2007). Personality disorder and outcome in schizophrenia: a negative systematic review. Personality and Mental Health 1, 21–26.CrossRefGoogle Scholar
Oldham, JM, Skodol, AE, Kellman, HD, Hyler, SE, Doidge, N, Rosnick, L, Gallaher, PE (1995). Comorbidity of axis I and axis II disorders. American Journal of Psychiatry 152, 571–578.Google ScholarPubMed
Ottosson, H, Bodlund, O, Ekselius, L, Grann, M, von Knorring, L, Kullgren, G, Lindstöm, E, Söderberg, S (1998). DSM-IV and ICD-10 personality disorders: a comparison of a self report questionnaire (DIP-Q) with a structured interview. European Psychiatry 13, 246–253.CrossRefGoogle ScholarPubMed
Oulis, P, Lykouras, L, Hatzimanolis, J, Tomaras, V (1997). Comorbidity of DSM-III-R personality disorders in schizophrenic and unipolar mood disorders: a comparative study. European Psychiatry 12, 316–318.CrossRefGoogle ScholarPubMed
Peralta, V, Cuesta, M, de Leon, J (1991). Premorbid personality and positive and negative symptoms in schizophrenia. Acta Psychiatrica Scandinavica 84, 336–339.CrossRefGoogle ScholarPubMed
Rasbash, J, Browne, WJ, Goldstein, H, Yang, M, Plewis, I, Healy, M, Woodhouse, G, Draper, D, Langford, I, Lewis, T (2000). A User's Guide to MLwiN. Institute of Education, University of London: London.Google Scholar
Rodriguez, S, Chavez, M (2000). Premorbid personality disorder in schizophrenia. Schizophrenia Research 44, 137–144.CrossRefGoogle Scholar
Skodol, AWE, Johnson, JG, Cohen, P, Sneed, JR, Crawford, TN (2007). Personality disorder and impaired functioning from adolescence to adulthood. British Journal of Psychiatry 190, 415–420.CrossRefGoogle ScholarPubMed
Smith, T, Deutsh, A, Schwartz, F, Terkelsen, K (1993). The role of personality in the treatment of schizophrenia and schizoaffective disorder inpatients: a pilot study. Bulletin of the Menninger Clinic 57, 88–99.Google ScholarPubMed
Torgersen, S, Edvardsen, J, Øien, PA, Onstad, S, Skre, I, Lygren, S, Kringlen, E (2002). Schizotypal personality disorder inside and outside the schizophrenic spectrum. Schizophrenia Research 54, 33–38.CrossRefGoogle ScholarPubMed
Turner, R, Omar, R, Yang, M, Goldstein, H, Thompson, S (2000). Random effects meta-analysis with binary outcomes using multilevel models. Statistics in Medicine 19, 3417–3432.3.0.CO;2-L>CrossRefGoogle Scholar
Tyrer, P (2000). Improving the assessment of personality disorders. Criminal Behaviour and Mental Health 10, S51–S65.CrossRefGoogle Scholar
Tyrer, P (2005). The problem of severity in the classification of personality disorder. Journal of Personality Disorders 19, 309–314.CrossRefGoogle ScholarPubMed
Tyrer, P, Alexander, J (1979). Classification of personality disorder. British Journal of Psychiatry 135, 163–167.CrossRefGoogle ScholarPubMed
Tyrer, P, Johnson, T (1996). Establishing the severity of personality disorder. American Journal of Psychiatry 153, 1593–1597.Google ScholarPubMed
Tyrer, P, Seivewright, H (2000). Studies of outcome. In Personality Disorders: Diagnosis, Management and Course (ed. Tyrer, P.), pp. 119–136. Arnold: London.Google Scholar
Verheul, R, van den Bosch, LMC, Koeter, MWJ, de Ridder, MAJ, Stijnen, T, van den Brink, W (2003). Dialectical behaviour therapy for women with borderline personality disorder: 12 month, randomised clinical trial in the Netherlands. British Journal of Psychiatry 182, 135–140.CrossRefGoogle ScholarPubMed