Comorbidity between obsessive-compulsive disorder (OCD) and personality disorders

The aims of the present study were to examine the frequency of personality disorders in 36 patients with obsessive-compulsive disorder (OCD), and to investigate whether patients with a coexisting personality disorder could be characterized by certain personality traits assessed by means of the Karolinska Scales of Personality (KSP). In total, 27 (75%) of the OCD patients fulfilled the DSM-III-R criteria for a personality disorder, and 13 patients (36%) had an obsessive-compulsive personality disorder. Subjects with a comorbid personality disorder had significantly higher scores on most of the KSP scales, including all anxiety scales, as well as scales measuring indirect aggression, irritability, guilt and detachment, whereas subjects without personality disorders did not differ significantly from healthy controls with regard to personality traits.     

Changes in some personality traits after recovery from alcohol dependence/abuse, anxiety and depression--results of a 5-year follow-up in a general population sample of women

The aim of this study was to analyse stability of and change in personality traits in a general population sample of women over 5 years. Specific questions were how personality traits changed after a first episode of alcohol dependence/abuse (ADA), anxiety or depression disorders and after remission of an episode. The study was based on data from a longitudinal general population-based survey titled, "Women and alcohol in G?teborg (WAG)". A total of 641 women were interviewed in 1990 or 1995 and re-interviewed after 5 years. Personality traits were assessed with the Karolinska Scales of Personality (KSP) and lifetime psychiatric diagnoses given according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd revised edition (DSM-III-R). Mean T-scores (KSP) for the general population sample were stable between initial assessment and follow-up 5 years later. Correlations between assessments were high for most KSP scores, indicating high individual stability. For women with resolved ADA, KSP scores were normalized to five scales at the follow-up assessment: somatic anxiety, muscular tension, monotony avoidance, social desirability and irritability. Women who recovered from anxiety disorders during the follow-up had decreased scores in somatic anxiety and muscular tension and increased scores in verbal aggression. Women who developed ADA during follow-up had increased scores on the scales impulsiveness and verbal aggression. Women who developed depression during follow-up had increased monotony avoidance. Personality traits were generally stable in this adult female population but some personality traits changed in association with changes in psychiatric disorders. This knowledge could be useful in evaluation of treatment needs and treatment outcome.     

Relationships between attempted suicide, temperamental vulnerability, and violent criminality in a Swedish forensic psychiatric population.

The relationship between suicide attempts and different vulnerability factors was investigated in 61 male subjects during forensic psychiatric examination. Personality traits and psychopathy were determined by means of the Karolinska Scales of Personality (KSP) and the Psychopathy Checklist-Revised (PCL-R). Clinical diagnoses were determined by the use of Structured Clinical Interview for DSM-III-R (SCID). Platelet monoamine oxidase (MAO) activity was investigated in 58 subjects.Suicide attempters had extremely low socialization and high impulsive aggression. This was independent of a history of repeatedly criminal violence or not. They had higher PCL-R scores and lower levels of platelet MAO activity than non-attempters. No relationship was found between suicide attempts and repeated violent criminality. However, among the subjects with repeated criminal violence there was a highly significant difference between suicide attempters and non-attempters, indicating different personality profiles in violent offenders with and without suicidal behavior. Suicidal behavior was significantly associated with borderline personality disorder, but not with any other single DSM-III-R disorder. The results show a far more severe personality disturbance in suicide attempters than in other violent patients in this type of population. Suicidal behavior should therefore be evaluated and treated per se.     

Personality traits as predictors of occupational performance and life satisfaction among mentally disordered offenders

The study investigated to what extent personality traits, e.g. socialization, proneness for anxiety, aggression and hostility were associated with and predictive of self-reported and observed occupational performance and perceived life satisfaction among male mentally disordered offenders (MDOs). Also, subjects with psychopathic-related personality traits were compared with subjects without such traits regarding demographic data and dependent variables. The MDOs were included from the Swedish National Board of Forensic Medicine. A total of 55 subjects were visited at their hospital ward for data collection with the Karolinska Scales of Personality (KSP), Capability to Perform Daily Occupation (CPDO), Allen Cognitive Level Screen (ACLS) and the Manchester Quality of Life Scale (MANSA). Seven KSP scales and two KSP factors correlated significantly with the dependent variables. Regression analyses revealed that the KSP Socialization scale, the KSP Anxiety-proneness and Psychopathy factors were the most important predictors. Subjects with psychopathy differed from remaining groups by having more conduct disorders before 15 years, being more often brought up in outcasted families and less subjected to measures of pupil welfare activities. The life history was concluded to be important influencing occupational performance and life satisfaction. Subjects with high anxiety proneness should be given attention in treatment planning.     

Influence of personality traits on neuropsychological test performance in toxic encephalopathy cases and healthy referent subjects

The relationship between personality traits and cognitive performance was studied in two groups: men with symptoms and neuropsychological test results compatible with toxic encephalopathy (TE) and demographically similar healthy men (N=57 per group). Personality traits were assessed with the Karolinska Scales of Personality (KSP). The neuropsychological examination included 13 tests covering various functional domains. The TE group displayed elevated scores on all three KSP anxiety scales as well as an elevated impulsiveness score. Furthermore, the TE group had a lower score on the socialization scale than did the referent group. Different relationships between personality dispositions and cognitive functioning emerged in the two groups. Within the referent group the highest correlations were observed between KSP anxiety and socialization scale scores and reaction times measures. This pattern did not appear in the TE group; instead, divergent and a few weak relationships emerged. These relationships involved correlations between the KSP monotony avoidance score and some motor speed scores. By dividing the referent group into low anxiety and high anxiety subgroups on the basis of the multi-component anxiety scale score, it was shown that the test scores in the high anxiety subgroup mostly were indistinguishable from the scores in the TE group. In contrast, the low anxiety group had higher test scores than the TE group in 8 of the 13 tests. In conclusion, the expected relationship between anxiety and cognitive vigilance is absent in TE cases. This indicates that the neuropsychological performance decrement in TE cases is not primarily related to elevated mental distress, but is probably dominated by the effects of organic brain impairment. Thus, in TE cases low neuropsychological test scores should not be regarded as a consequence of emotional symptoms. Furthermore, personality traits may be considered as potential confounders even if traditional matching by demographic criteria has been successfully implemented.     

A prospective, long-term study of personality traits in patients with intractable obsessional illness treated by capsulotomy

The crux when contemplating neurosurgery for otherwise intractable mental illness is whether there is a price which the patient may have to pay, in terms of adverse personality changes, for symptom relief. In the present study of 19 patients undergoing thermo-capsulotomy for intractable obsessional illness, personality characteristics were studied pre-operatively, and at 1-year and 8-year follow-up, using the Karolinska Scales of Personality (KSP). Small mean score changes toward normalization were apparent on all 15 KSP scales at the 1-year follow-up, and significant improvements in anxiety proneness were noted at the 8-year follow-up. One patient who sustained a surgical complication showed deviant postoperative scores on scales related to psychopathic traits. There were no such deviant scores for the remaining subjects. The incidence of adverse personality changes following capsulotomy is low and does not increase with time. This conclusion, based on groups of patients, does not of course preclude the possibility that adverse personality changes may occur in individual patients.     

Markers for vulnerability to psychopathology: temperament traits associated with platelet MAO activity

The functional linkage between platelet MAO activity and psychopathology was explored by analyzing temperamental correlates in 40 male subjects by means of scales from the Eysenck Personality Questionnaire (EPQ), the Zuckerman Sensation Seeking Inventory, and the Karolinska Scales of Personality (KSP). Linear correlations were found with two sensation seeking scales, replicating earlier findings. However, nonlinear correlations predominated. Subjects with intermediate platelet MAO activity had higher scores in conformity scales and lower scores in anxiety and hostility scales than low and high MAO subgroups. Low MAO subjects showed a pattern of higher scores in KSP Impulsiveness, EPQ Neuroticism, and KSP Somatic Anxiety and Irritability and lower scores in KSP Socialization, in line with personality profiles found in alcoholics, psychopaths, and suicide attempters who also tend to have low platelet MAO activity. High MAO subjects scored lower in sensation seeking and conformity scales and higher in KSP Psychasthenia, Muscular Tension and Suspicion scales, consistent with clinical links between high platelet MAO activity and anxiety and paranoia.     

Thyroid hormones and personality traits in attempted suicide

The research on thyroid hormones and personality traits is quite sparse and mainly focused on male forensic psychiatric populations in which the relationship between thyroid hormones and psychopathy and aggression-related personality traits has been reported. The suicidal temperament hypothesis suggests that certain personality traits such as aggression, anxiety proneness, impulsivity, and low socialization may render an individual vulnerable to the risk of suicide. The aim of this study was to investigate personality traits assessed by the Karolinska Scales of Personality (KSP) in relation to hormones in the hypothalamic–pituitary–thyroid (HPT) axis in 100 euthyroid suicide attempters. Standard multiple regression analyses were performed with TSH, T3, T4, and the T3/T4 ratio, respectively, as the dependent variable and KSP factors (Anxiety Proneness, Aggressiveness, and Impulsivity) and subscales (Detachment, Social Desirability, and Socialization) as independent variables. In men, but not in women, the regression model of the T3/T4 ratio was significant and the results suggested that high scores on Aggressiveness and low ones on Detachment were associated with a low T3/T4 ratio. These results indicate that HPT function may be related to Aggressiveness and Detachment in male suicide attempters.     

Criminality and psychopathy as related to thyroid activity in former juvenile delinquents

Levels of triiodothyronine (T₃) and thyroid-stimulating hormone (TSH), psychopathy-related personality traits and criminality from the age of 15 years onward were examined in 70 former juvenile delinquents and 35 control subjects aged 38–46 years. T₃ levels were significantly associated with criminality but not with psychopathy-related personality traits. TSH levels were not related to any of these variables. Juvenile delinquents who displayed persistent criminal behaviour were found to have higher mean T₃ levels than juvenile delinquents who did not display criminality in adulthood and non-criminal controls. Former juvenile delinquents with T, levels above the mean level found in the controls were registered for criminality 3.8 times more often than juvenile delinquents with T₃ levels below the mean level found in the control group. The results are discussed in terms of elevated T₃ levels representing a compensatory or stress phenomenon for low social adaptive ability of individuals who display persistent criminal behaviour.     

Autistic traits in obsessive-compulsive disorder

In contrast to other non-psychotic psychiatric populations, subjects with obsessive-compulsive disorder (OCD) are more prone to have personality disorder from cluster A (the odd and eccentric cluster). The present study aims at further investigating the relationship between these and other personality traits in OCD subjects and their relation to high functioning autism (HFA) and Asperger disorder. Sixty-four subjects with OCD were included. Personality traits were assessed with the Karolinska Scales of Personality (KSP), and personality disorders with DSM-adapted questionnaires. In addition, autistic traits were assessed in 29 videotaped subjects, by 3 independent raters. Twenty percent of the subjects with OCD were identified as also having autistic traits. These subjects scored higher on KSP scales measuring muscular tension, psychasthenia, and inhibition of aggression and lower on socialization as compared with OCD subjects without autistic traits. Additionally, subjects with autistic traits fulfilled criteria for anxious personality disorders and paranoid personality disorders significantly more often than subjects without autistic traits. We propose that OCD is often related to HFA and Asperger disorder. Self-report questionnaires may be useful in establishing the diagnosis. However, those with the most obvious autistic features seem to be less able to identify these traits in themselves.     

Autistic traits in obsessive-compulsive disorder

In contrast to other non-psychotic psychiatric populations, subjects with obsessive-compulsive disorder (OCD) are more prone to have personality disorder from cluster A (the odd and eccentric cluster). The present study aims at further investigating the relationship between these and other personality traits in OCD subjects and their relation to high functioning autism (HFA) and Asperger disorder. Sixty-four subjects with OCD were included. Personality traits were assessed with the Karolinska Scales of Personality (KSP), and personality disorders with DSM-adapted questionnaires. In addition, autistic traits were assessed in 29 videotaped subjects, by 3 independent raters. Twenty percent of the subjects with OCD were identified as also having autistic traits. These subjects scored higher on KSP scales measuring muscular tension, psychasthenia, and inhibition of aggression and lower on socialization as compared with OCD subjects without autistic traits. Additionally, subjects with autistic traits fulfilled criteria for anxious personality disorders and paranoid personality disorders significantly more often than subjects without autistic traits. We propose that OCD is often related to HFA and Asperger disorder. Self-report questionnaires may be useful in establishing the diagnosis. However, those with the most obvious autistic features seem to be less able to identify these traits in themselves.     

Personality traits in social phobia.

The purpose was to assess personality traits in subjects with a DSM-IV diagnosis of social phobia. Thirty-two subjects were administered the Structured Clinical Interview for DSM-IV for Axes I and II disorders (SCID I and II). Personality traits were assessed by means of the Karolinska Scales of Personality (KSP). Current and lifetime axis I co-morbidity was diagnosed in 28% and 53% of the subjects, respectively. In total, 59% had at least one personality disorder and 47% were diagnosed with an avoidant personality disorder. The social phobics scored significantly higher than a Swedish normative sample on the KSP measuring anxiety proneness, irritability, detachment, and indirect aggression but lower on the scales for socialisation and social desirability. The presence as compared to absence of avoidant personality disorder in the social phobics was associated with significantly higher psychic anxiety and inhibition of aggression. In addition, symptom severity was higher in social phobics with an avoidant personality disorder. Generally, the results support the view that social phobia and avoidant personality disorder reflect different aspects of a social anxiety spectrum.     

A regulatory monoamine oxidase a promoter polymorphism and personality traits

Monoamine oxidase type A (MAOA) has been implicated to be part of mechanisms underlying human temperament and psychiatric disorders. We hypothesised that a functional polymorphism in the 5' untranslated region of the MAOA gene is associated with specific personality traits. In 371 healthy Caucasians, we estimated personality traits by the use of the Karolinska Scales of Personality (KSP), Scandinavian Universities Scales of Personality, Health-Relevant 5-Factor Personality inventory, Temperament and Character Inventory and the revised NEO Personality Inventory. In the same subjects, we analysed the genotype of a polymorphic region consisting of a variable number of a 30-bp repeat sequence located approximately 1.2 kb upstream of the MAOA gene. After correction for multiple testing, no statistically significant differences between MAOA genotype and personality were observed in men (n = 206) nor in women (n = 165). We conclude that the structure of this MAOA promoter region does not have a large impact on the expression of personality characteristics in the present Swedish population.     

Assessing needs for psychiatric treatment in prisoners: 1. Prevalence of disorder

Background

High levels of psychiatric morbidity in prisoners have important implications for services. Assessing Needs for Psychiatric Treatment in Prisoners is an evaluation of representative samples of prisoners in a male and a female prison in London. This paper reports on the prevalence of mental disorders. In a companion paper, we describe how this translates into mental health treatment needs and the extent to which they have been met.

Methods

Prisoners were randomly sampled in a sequential procedure based on the Local Inmate Data System. We interviewed roughly equal numbers from the following groups: male remand; male sentenced prisoners (Pentonville prison); and female remand; female sentenced prisoners (Holloway prison). Structured assessments were made of psychosis, common mental disorders, PTSD, personality disorder and substance abuse.

Results

We interviewed 197 male and 171 female prisoners. Psychiatric morbidity in male and female, sentenced and remand prisoners far exceeded in prevalence and severity than in equivalent general population surveys. In particular, 12% met criteria for psychosis; 53.8% for depressive disorders; 26.8% for anxiety disorders; 33.1% were dependent on alcohol and 57.1% on illegal drugs; 34.2% had some form of personality disorder; and 69.1% had two disorders or more. Moreover, in the year before imprisonment, 25.3% had used mental health services.

Conclusions

These rates of mental ill-health and their similarity in remand and sentenced prisoners indicate that diversion of people with mental health problems from the prison arm of the criminal justice system remains inadequate, with serious consequences for well-being and recidivism.

     

Adult psychopathic personality with childhood-onset hyperactivity and conduct disorder: a central problem constellation in forensic psychiatry

To describe lifetime mental disorders among perpetrators of severe inter-personal crimes and to identify the problem domains most closely associated with aggression and a history of repeated violent criminality, we used structured interviews, clinical assessments, analyses of intellectual functioning, medical and social files, and collateral interviews in 100 consecutive subjects of pretrial forensic psychiatric investigations. Childhood-onset neuropsychiatric disorders [attention-deficit/hyperactivity disorder (AD/HD), learning disability, tics and autism spectrum disorders] affected 55% of the subjects and formed complex comorbidity patterns with adult personality disorders [including psychopathic traits according to the Psychopathy Checklist (PCL-R)], mood disorders and substance abuse. The closest psychiatric covariates to high Lifetime History of Aggression (LHA) scores and violent recidivism were the PCL-R scores and childhood conduct disorder (CD). Behavioral and affective PCL-R factors were closely associated with childhood AD/HD, CD, and autistic traits. The results support the notion that childhood-onset social and behavioral problems form the most relevant psychiatric symptom cluster in relation to pervasive adult violent behavior, while late-onset mental disorders are more often associated with single acts of violent or sexual aggression.     

Personality traits and platelet monoamine oxidase activity in a Swedish male criminal population

BACKGROUND: A Swedish male criminal population was grouped into personality disorder subgroups and investigated with regard to personality traits and platelet monoamine oxidase (MAO) activity. The main aim of the study was to examine the possibility of a risk factor combination by having low platelet MAO activity as well as belonging to a certain diagnostic DSM-IV axis I (drug abuse in the present series) and/or II subgroup. METHODS: Personality disorders were grouped into clusters according to the cluster system used in DSM-IV axis II. The prisoners were grouped into five subgroups and each subject completed the Karolinska Scales of Personality self-report questionnaire. The comparison group for the personality data comprised 51 non-criminal males from a longitudinal Swedish project. Platelet MAO activity was assessed for the criminals as well as for a control group including 60 non-criminal healthy male Caucasians. For testing the existence of syndromes, a configuration frequency analysis (CFA) was used. RESULTS: The results showed low scores on the socialisation and high scores on the sensation seeking-related traits impulsiveness and monotony avoidance, and the somatic anxiety-related muscular tension in the criminals with any DSM-IV mental disorder, however most markedly in cluster AB and cluster B subjects. In addition, cluster AB subjects had significantly lower platelet MAO activity than controls. Two significant 'types' were found among the criminals: one was characterised by low platelet MAO activity, cluster B personality diagnosis as well as drug abuse disorder diagnosis; and the other by a pattern of normal platelet MAO activity, no cluster B personality disorder and no drug abuse disorder diagnosis. CONCLUSION: The aggregation of certain risk factors in the same individual has been shown to contribute to the development of criminal behaviour.     

Appearance of frontal midline theta rhythm and personality traits

The distinct theta rhythm in the frontal midline area during a performance of mental tasks has been called Fm theta. However, Fm theta shows individual differences in its appearance. The relationship between the appearance of Fm theta and the subject personality was investigated in the present study. Forty male university students performed an arithmetic addition test for 5 min daily during three consecutive days and their EEGs were recorded during the test. They also completed the Maudsley Personality Inventory (MPI) and the Taylor Manifest Anxiety Scale (MAS) after the EEG recording on the last day. The subjects who obtained low scores on the anxiety scale of MAS, high scores on the extraversion scale of MPI and low scores on the neuroticism scale of MPI showed larger amounts of Fm theta. On the other hand, those subjects who showed high scores on the anxiety scale, low scores on the extraversion scale and high scores on the neuroticism scale showed smaller amounts of Fm theta or none. These results suggest that the appearance of Fm theta is closely related to the subject personality traits.     

Personality traits in patients with idiopathic pain disorder

In the present study, patients with idiopathic pain syndromes have been compared to healthy volunteers, patients with neurogenic pain syndromes and depressed patients as concerns stable personality traits. The personality traits were assessed by means of the Karolinska Scales of Personality (KSP). Patients with idiopathic pain syndromes were found to have high scores on scales measuring Muscular tension, Social desirability, Psychasthenia and Socialization. They had also high scores on the Inhibition of aggression factor. They had low scores on Impulsivity, Monotony avoidance, Indirect aggression, Verbal aggression and Suspicion. As compared to depressed patients, the pain patients were much more controlled, with higher scores on Socialization and Social desirability scales and like depressed patients with a tendency to inhibit aggression. Thus, as compared to depressed patients, the pain patients had less open anxiety but the same degree of muscular tension.     

Diagnosing personality disorders in recent-onset schizophrenia

The present study aimed to determine the prevalence of personality disorders (PDs) and personality disorder traits in 40 recent-onset schizophrenic patients, to establish the degree of concordance between the Structured Interview for DSM-III Personality Disorders (SIDP) and the Million Multiaxial Clinical Inventory (MCMI-I), and to examine the interrater reliabilities for the diagnosis of SIDP disorders and traits. During their recovery phase, patients underwent the SIDP and completed the MCMI-I, a self-report inventory. Results showed that 57% of all patients had PDs according to the SIDP. The most common PDs were antisocial, borderline, and schizotypal, whereas the most common according to the MCMI-I were dependent, narcissistic, and avoidant. Both instruments indicated that multiple PD diagnoses were common. Paranoid and schizotypal traits were found to be ubiquitous across instruments. The level of agreements between the two instruments was poor on diagnostic assignment but better when trait scores were considered.