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Detection of personality disorders by a community mental health team: a study of diagnostic accuracy

Published online by Cambridge University Press:  13 June 2014

Angela Hassiotis ,
Peter Tyrer  and
Domenic Cicchetti
Peter Tyrer
Affiliation:
Imperial College School of Medicine, Academic Department of Psychiatry, St Mary's Hospital, Praed Street, London W2, UK
Domenic Cicchetti
Affiliation:
Research and Development, 151 VACHS, 950 Campbell Avenue West Haven, CT 06516, USA
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Abstract

Objective: It is now widely recognised that personality disorders play a significant role in psychiatric practice. This study was set up to examine the diagnostic accuracy of the assessment of personality disorder in normal practice by a multidisciplinary community mental health team when compared with a formal assessment using a structured interview.

Method: Forty-four patients originally assessed by team members of the Early Intervention Service (EIS), were re-examined using the Personality Assessment Schedule (PAS ICD-10 and original version) at a mean period of 16.3 months after first assessment. Specifically we tested the extent to which three personality disorder (PD) clusters (flamboyant, odd/eccentric, anxious/fearful) could be differentiated from either no PD at all or from the remaining PD clusters.

Results: As expected, both flamboyant and odd/eccentric PD clusters were much more easily differentiated from no PD at all (overall accuracy of 87 % and 85 % respectively) than from other PD clusters (corresponding accuracy of 65 % and 50%) . In distinct contrast, the anxious/fearful cluster was much less accurately differentiated from no PD (accuracy of only 52%) than from other PD clusters (accuracy of 85%).

Conclusion: The diagnosis of personality disorders in routine clinical practice is fraught with difficulties, especially when mental status symptoms closely resemble personality traits. The present results suggest that greater knowledge, training and experience can facilitate diagnostic accuracy.

Keywords

Personality disordersAssessmentDiagnosisClassification
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 14 , Issue 3 , September 1997 , pp. 88 - 91
Copyright
Copyright © Cambridge University Press 1997

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References

1.Lewis, G, Appleby, L. Personality disorder: the patients psychiatrists dislike. Br J Psychiatry 1988; 153: 44–9CrossRefGoogle Scholar
2.Department of Health. Mental Health Statistics. London: Department of Health, 1990.Google Scholar
3.De Girolamo, G, Reich, JH. The Epidemiology of personality disorders. Geneva: World Health Organisation, 1993.Google Scholar
4.Ferguson, B, Tyrer, P. Personality disorder in perspective. Br J Psychiatry 1991; 159: 463–71.Google Scholar
5.Shea, MT, Pilkonis, PA, Beckham, Eet al.Personality disorders and treatment outcome in the NIM H treatment of Depression Collaborative Research Program. Am J Psychiatry 1990; 147: 711–8.Google Scholar
6.Tyrer, P, Seivewright, N, Ferguson, Bet al.The Nottingham study of neurotic disorder: relationship between personality status and symptoms. Psychol Med 1990;20:423–31.CrossRefGoogle ScholarPubMed
7.Tyrer, P. The Nottingham study of neurotic disorder: impact of personality status on response to drug treatment, cognitive therapy and self-help over two years. Br J Psychiatry 1993; 162: 219–26.CrossRefGoogle Scholar
8.Tyrer, P, Merson, S, Onyett, S, Johnson, T. The effect of personality disorder on clinical outcome, social networks and adjustment: a controlled clinical trial of psychiatric emergencies. Psychol Med 1994; 24: 731–40.CrossRefGoogle ScholarPubMed
9.Dolan, B, Evans, C, Norton, K. Multiple Axis-II diagnoses of personality disorder. Br J Psychiatry 1995; 166: 107–12.CrossRefGoogle ScholarPubMed
10.Tyrer, P, Johnson, T. Establishing the severity of personality disorders. Am J Psychiatry 1996; 153: 1593–7.Google Scholar
11.Reich, JH. Update on instruments to measure DSM-III and DSM-III-R personality disorders. J Nerv Ment Dis 1989; 177: 366–70.CrossRefGoogle ScholarPubMed
12.Klein, MH. Issues in the assessment of personality disorders. J Pers Disorders Suppl 1993; Spring: 18–33.Google Scholar
13.Clark, LA. Resolving taxonomic issues in personality disorders. J Pers Disorders 1992; 6: 360–76.CrossRefGoogle Scholar
14.Onyett, S, Tyrer, P, Connolly, J, Malone, Set al.The Early Intervention Service: the first 18 months of an inner London demonstration project. Psychiatric Bulletin 1990; 14: 267–9.CrossRefGoogle Scholar
15.Tyrer, P, Alexander, J, Ferguson, B. PAS. In: Tyrer, P, ed. Personality disorders — diagnosis, management and course. London: Butterworth/Wright, 1988: 140–67.Google Scholar
16.Feinstein, AR. Clinimetrics. New Haven: Yale University Press, 1987.CrossRefGoogle Scholar
17.Cicchetti, DV, Volkmar, F, Klin, A, Showalter, D. Diagnosing Autism using ICD-10 criteria: A comparison of neural networks and standard multivariate procedures. Child Neuropsychol 1995; 1: 26–37.CrossRefGoogle Scholar
18.Pilgrim, JA, Mellers, JD, Boothby, HA, Mann, AH. Inter-rater and temporal reliability of the Standardised Assessment of Personality and the influence of informant characteristics. Psychol Med 1993; 23: 779–86.CrossRefGoogle ScholarPubMed
19.Merson, S, Tyrer, P, Duke, P, Henderson, F. Inter-rater reliability of ICD-10 guidelines for the diagnosis of personality disorders. J Pers Disorders 1994; 8: 89–95.CrossRefGoogle Scholar
20.Brothwell, J, Casey, P, Tyrer, P. Who gives the most reliable account of a psychiatric patient's personality. Ir J Psych Med 1992; 9: 90–3.CrossRefGoogle Scholar
21.Reich, JH, Vasile, RG. Effect of personality disorders on the treatment outcome of Axis I conditions: an update. J Nerv Ment Cond 1993; 181: 475–84.CrossRefGoogle ScholarPubMed