理工科一年级大学生人格障碍及其危险因素的现况调查

目的　调查理工科一年级大学生人格障碍的患病率并探讨人格障碍的危险因素。方法使用人格诊断问卷 (PDQ R)、国际人格障碍检查表等调查北京市某理工科重点大学一年级学生。结果　在 2 2 0 5名大学生中PDQ R总分为 (2 3 9± 8 4)分 ,阳性率为 6 30 % ;确诊人格障碍 5 5例 ,患病率为 2 49% ;强迫型人格障碍的患病率 (1 0 9% )和构成比 (37% )均为最高 ;人格障碍的危险因素有性别、父母关系不和睦、单亲家庭。结论　大学生中人格障碍患病率较高 ,家庭环境不良对人格障碍的形成具有重要作用。     

精神分裂症患者攻击行为的预测

试图对精神分裂症患者的攻击行为进行预测，采用病例对照研究方法，主要从人格特征、智力结构、脑电图、社会支持和早年不良家庭环境等方面，研究１５０例精神分裂症患者攻击行为的相关因素，并试图对患者的攻击行为进行预测。结果显示，既往攻击行为史、社会支持少、悲观抑郁、早年不良家庭环境、脑电图异常、明尼苏达多项人格调查表社会责任感量表分低，是本组精神分裂症患者攻击行为的主要预测因子。因此制定了一个有２１个条目的攻击行为预测表，其预测准确性达９０．３％，有一定预测效度。     

齐齐哈尔市高中学生人格障碍的流行病学研究

目的 描述齐齐哈尔市高中学生人格偏离和人格障碍的流行强度。方法 通过现况调查、病例对照研究、队列研究、社区干预试验的方法，按照ICD-10和DSM-Ⅳ的标准，采用人格诊断问卷第四版（PDQ-4）、国际人格障碍检查表（IPDE）、父母养育方式问卷（EMBU）和一般情况问卷，来调查齐齐哈尔市高中学生人格障碍的流行病学研究。结果 齐齐哈尔市高中学生人格偏离的现患率低于国外患病率，且随年龄增长而下降，有明显自愈趋势；人格障碍的患病率和发病率亦处于较低水平；高一出现人格偏离者高三时人格障碍发病率明显高于人格正常者。结论 证实对于人格障碍的发生，广义遗传因素的作用约占85%；人格障碍的家庭环境危险因素是父母关系不良和否认拒绝型及过度保护型养育方式，同时也证实了社区人群预防人格障碍发生的青春期心理健康教育的干预模式对青少年是行之有效的，可以促进高中学生群体精神卫生水平的提高。     

酒依赖脱瘾维持期患者复饮相关因素分析

目的:探讨酒依赖患者脱瘾维持期复饮的相关因素。方法:回顾分析在本院进行认知行为治疗(CBT)的188例酒依赖脱瘾维持期患者的临床资料,发现复饮酒113例(复饮酒组),未复饮酒75例(未复饮组)。将两组的临床资料进行对照分析,非条件二项Logistic回归分析复饮相关因素。结果:患者治疗后复饮率为60.1%。两组平均年龄、性别、饮酒年限、日均饮酒量、文化程度差异均无统计学意义(P0.05)。两组婚姻状况不良、家族饮酒史阳性、酒精依赖严重程度问卷(SADQ-C)评分、Zung焦虑自评量表(SAS)评分、Zung抑郁自评量表(SDS)评分、人格障碍、肝脏异常、CBT例数差异均有统计学意义(P0.05)。复饮与婚姻状况不良、家族饮酒史阳性、SADQ-C评分、SAS评分、SDS评分、人格障碍呈正相关,与肝脏异常、CBT治疗呈负相关(P均0.01)。结论:婚姻状况不良、家族饮酒史阳性、SADQ-C高评分、焦虑、抑郁、人格障碍是酒依赖患者脱瘾维持期复饮危险因素,肝脏异常以及接受CBT治疗患者复饮率相对较低。     

住院精神疾病患者攻击行为分析

目的：了解住院精神疾病患者攻击行为的相关因素，寻求防范措施。方法：观察住院患者223例，其中男103例，女120例，分别进行社会学资料统计和简明精神病评定量表(BPRS)评定，对住院期间发生攻击行为的59例进行相关因素的调查分析。结果：住院患者攻击行为的发生与文化程度、婚姻状况、既往暴力行为、住院方式等有明显的相关性，且BPRS总分及思维障碍、激活性、敌对猜疑3个因子分明显较高。结论：住院精神疾病患者发生攻击行为的占26．5％；并提出相应措施，最大限度地减少此类事件的发生。     

躯体形式障碍患者的人格障碍倾向调查

目的:探讨躯体形式障碍(SD)患者的人格障碍倾向。方法:对64例SD患者(SD组)和52名正常对照者(NC组)进行人格诊断问卷(PDQ-4)评估和比较。结果:SD组中,人格障碍筛查阳性为37例(57.81%),介于阳性与阴性间10例(15.6%);以C组人格障碍类型中的强迫型最常见。NC组中,人格障碍筛查阳性4例(7.7%),介于阳性与阴性间4例(7.7%)。SD组人格障碍筛查阳性率显著高于NC组(χ2=31.54,P0.001)。结论:SD患者人格障碍筛查阳性率较高,提示人格特质异常可能与SD的发病机制密切相关。     

精神分裂症患者攻击行为的相关因素分析

目的:探讨精神分裂症患者攻击行为的相关因素。方法:调查住院精神分裂症患者185例,分为攻击组(n=31)和非攻击组(n=154),采用SPSS13.0分析相关因素。结果:诊断分型、简明精神病评定量表(BPRS)总分及因子分、婚姻状态等两组差异有显著性。结论:诊断分型等是预测攻击行为的一个方法;家庭史、既往攻击史、入院态度是攻击行为的危险因素;婚姻是保护因素。     

独生子女情感障碍患者人格与父母教养方式的相关性

目的:探讨独生子女情感障碍患者人格与父母教养方式的相关性. 方法:采用艾森克个性问卷(EPQ)、人格诊断问卷(PDQ-4+)、父母教养方式评价量表(EMBU)对情感障碍独生子女患者90例(研究组)和正常独生子女90名(正常对照组)进行测评,其中研究组患者在自知力恢复以后测评.结果:研究组EPQ评分精神质、神经质、内外倾性显著高于正常对照组(t=5.63,6.11,11.13;P均＜0.01).研究组人格障碍的阳性率(44.44％)高于正常对照组(28.89％)(x2=4.69,P＜0.05).研究组EMBU评分父母惩罚、父母拒绝、父亲保护、母亲干涉因子分高于正常对照组(t=3.03 ～8.20,P均＜0.01),而父亲温暖因子低于正常对照组(t=4.46,P＜0.01). 结论:不良的父母教养方式可能造成独生子女人格障碍,人格障碍与情感障碍的发病有关.     

人格障碍属于精神疾病吗?

人格障碍属于精神疾病或精神障碍是历来争论的问题,迄今尚未阐明。早年大多数学者认为它并非精神疾病;近年来有的主张它是精神疾病,但一些研究者持谨慎态度,认为既不能肯定,也不能否定,需要继续探索。1 人格障碍不是精神疾病 人格障碍是继病态人格(psychopathic personality)或精神病态(psychopathy)后形成的术语。原本病态人格是广义,     

住院精神分裂症患者暴力行为危险因素研究

目的:探讨住院精神分裂症患者发生暴力行为的危险因素。方法:以外显行为攻击量表(MOAS)评分≥5分为界将220例住院精神分裂症患者分为暴力组(62例)和非暴力组(158例);对两组的人口学及临床资料进行收集、比较;采用多元Logitic回归分析探讨住院精神分裂症患者发生暴力行为的危险因素。结果:与非暴力组比较,暴力组患者更年轻、内向型人格比率低、既往有暴力行为史、有敌对情绪、被害妄想、兴奋易激惹的比率高(P<0.05或P<0.01);多元Logistic回归分析显示,既往暴力行为史(OR=2.169,95%CI:1.095～4.296)、有敌对情绪(OR=2.561,95%CI:1.117～5.869)、非内向人格特征(OR=1.496,95%CI:1.021～2.191)和被害妄想(OR=3.800,95%CI:1.592～9.070)进入方程。结论:既往暴力行为史、有敌对情绪、人格特征和被害妄想是住院精神分裂症患者发生暴力行为的危险因素。     

不同种类精神障碍患者暴力犯罪特征研究

目的：探讨各类精神障碍患者暴力犯罪行为的特征。方法：235例司法精神病鉴定暴力犯罪案例分成3组。A组135例,其中器质性精神障碍11例,精神分裂症85例,其他精神病性障碍25例,心境障碍14例;B组34例,其中精神活性物质所致精神障碍10例,神经症4例,轻度精神发育迟滞13例,人格障碍7例;C组66例,为无精神病或伪装精神病。分析3组被鉴定者人口学特点和犯罪行为学特征。结果：在人口学特点上,A、B及C组均以年轻无业男性、低教育水平者居多,但3组间差异无显著性。在犯罪特征上,C组有现实动机（X^2=128．87,P=0．00）、有预谋性（X^2=76．176,P=0．00）、有隐蔽性（X2=80．652,P=0．00）、有自我保护（x2=83．714,P=0．00）及完全责任能力（x^2=170．437,P=0．00）,与A组、B组存在显著差异（P〈0．01）。结论：不同种类精神障碍患者的犯罪行为学特征及司法精神病学鉴定特点不同。     

Frequency of DSM-III personality disorders in patients with panic disorder: comparison with psychiatric and normal control subjects

Three clinical populations--panic disorder (n = 88), randomly selected outpatients (n = 82), and normal control subjects (n = 40)--were compared on three standardized DSM-III personality disorder instruments, the Structured Interview for DSM-III Personality Disorders (SIDP), the Millon Clinical Multiaxial Inventory (MCMI), and the Personality Diagnostic Questionnaire (PDQ). Significant differences were consistently found in presence of "any" personality disorder and DSM-III Cluster C (there were always more disorders in the outpatients). Logistic regression analysis revealed the important determinants predicting personality disorders, and therefore of differences between groups, were state depression, age, lifetime history of alcohol abuse, and presence of panic disorder.     

Prevalence of mental disorders among 15-17-year-old male adolescent remand prisoners in Denmark

OBJECTIVE: To determine the past year prevalence of mental disorders of 15-17-year-old adolescent remand prisoners in east Denmark. METHOD: One hundred 15-17-year-old boys from east Denmark consecutively remanded during 1 year were interviewed with diagnostic instruments to obtain ICD-10 diagnoses. All were screened in The Danish Psychiatric Case Register and The Danish Criminal Register. RESULTS: Past year prevalence of 'any mental disorder' was 69%, substance use disorders 41%. Two per cent had schizophrenia and 2% schizotypal disorder. Thirty-six per cent had 'probable personality disorder'. Conduct disorder was found in 31% and 1% had a hyperkinetic disorder. Ten per cent had previous registered psychiatric contact. CONCLUSION: The prevalence of mental disorders was found substantially higher compared with literature of population-based samples. With an association between mental disorders and violence, early detection and treatment of mental disorders in adolescent delinquents is of importance in the prevention of violence.     

Mental disorders and violence in a total birth cohort: results from the Dunedin Study

BACKGROUND: We report on mental disorders and violence for a birth cohort of young adults, regardless of their contact with the health or justice systems. METHODS: We studied 961 young adults who constituted 94% of a total-city birth cohort in New Zealand, April 1, 1972, through March 31, 1973. Past-year prevalence of mental disorders was measured using standardized DSM-III-R interviews. Past-year violence was measured using self-reports of criminal offending and a search of official conviction records. We also tested whether substance use before the violent offense, adolescent excessive perceptions of threat, and a juvenile history of conduct disorder accounted for the link between mental disorders and violence. RESULTS: Individuals meeting diagnostic criteria for alcohol dependence, marijuana dependence, and schizophrenia-spectrum disorder were 1.9 (95% confidence interval [CI], 1.0-3.5), 3.8 (95% CI, 2.2-6.8), and 2.5 (95% CI, 1.1-5.7) times, respectively, more likely than control subjects to be violent. Persons with at least 1 of these 3 disorders constituted one fifth of the sample, but they accounted for half of the sample's violent crimes (10% of violence risk was uniquely attributable to schizophrenia-spectrum disorder). Among alcohol-dependent individuals, violence was best explained by substance use before the offense; among marijuana-dependent individuals, by a juvenile history of conduct disorder; and among individuals with schizophrenia-spectrum disorder, by excessive perceptions of threat and a history of conduct disorder. CONCLUSIONS: In the age group committing most violent incidents, individuals with mental disorders account for a considerable amount of violence in the community. Different mental disorders are linked to violence via different core explanations, suggesting multiple-targeted prevention strategies.     

Diagnosing personality disorders in the community. A comparison of self-report and interview measures

The rapidly expanding empirical study of personality disorders is the result of the publication of operational diagnostic criteria in DSM-III and the development of instruments to assess these criteria. Few researchers have examined the comparability of measures of personality disorders, and to our knowledge there are no studies of the factors associated with discordance between measures. In the present study, 697 relatives of psychiatric patients and healthy controls were interviewed with the Structured Interview for Personality Disorders (SIDP) and completed the Personality Disorders Questionnaire (PDQ). Significantly more individuals had a personality disorder according to the SIDP; however, multiple personality disorders were more frequently diagnosed on the PDQ. Schizotypal, compulsive, dependent, and borderline personality disorders were significantly more frequently diagnosed by the PDQ, whereas the SIDP more frequently diagnosed antisocial and passive-aggressive personality disorder. The corresponding dimensional scores of the two measures were all significantly correlated; however, the concordance for categorical diagnoses was poor. Discrepancies between the PDQ and the SIPD dimensional scores were significantly associated with current level of depressive symptoms and PDQ lie scale scores.     

Risque d’homicide et troubles mentaux graves : revue critique de la littérature

Introduction

Tragic and high profile killings by people with mental illness have been used to suggest that the community care model for mental health services has failed. It is also generally thought that schizophrenia predisposes subjects to homicidal behaviour.

Objective

The aim of the present paper was to estimate the rate of mental disorder in people convicted of homicide and to examine the relationship between definitions. We investigated the links between homicide and major mental disorders.

Methods

This paper reviews studies on the epidemiology of homicide committed by mentally disordered people, taken from recent international academic literature. The studies included were identified as part of a wider systematic review of the epidemiology of offending combined with mental disorder. The main databases searched were Medline. A comprehensive search was made for studies published since 1990.

Results

There is an association of homicide with mental disorder, most particularly with certain manifestations of schizophrenia, antisocial personality disorder and drug or alcohol abuse. However, it is not clear why some patients behave violently and others do not. Studies of people convicted of homicide have used different definitions of mental disorder. According to the definition of Hodgins, only 15% of murderers have a major mental disorder (schizophrenia, paranoia, melancholia). Mental disorder increases the risk of homicidal violence by two-fold in men and six-fold in women. Schizophrenia increases the risk of violence by six to 10-fold in men and eight to 10-fold in women. Schizophrenia without alcoholism increased the odds ratio more than seven-fold; schizophrenia with coexisting alcoholism more than 17-fold in men. We wish to emphasize that all patients with schizophrenia should not be considered to be violent, although there are minor subgroups of schizophrenic patients in whom the risk of violence may be remarkably high. According to studies, we estimated that this increase in risk could be associated with a paranoid form of schizophrenia and coexisting substance abuse. The prevalence of schizophrenia in the homicide offenders is around 6%. Despite this, the prevalence of personality disorder or of alcohol abuse/dependence is higher: 10% to 38% respectively. The disorders with the most substantially higher odds ratios were alcohol abuse/dependence and antisocial personality disorder. Antisocial personality disorder increases the risk over 10-fold in men and over 50-fold in women. Affective disorders, anxiety disorders, dysthymia and mental retardation do not elevate the risk. Hence, according to the DMS-IV, 30 to 70% of murderers have a mental disorder of grade I or a personality disorder of grade II. However, many studies have suffered from methodological weaknesses notably since obtaining comprehensive study groups of homicide offenders has been difficult.

Conclusions

There is an association of homicide with mental disorder, particularly with certain manifestations of schizophrenia, antisocial personality disorder and drug or alcohol abuse. Most perpetrators with a history of mental disorder were not acutely ill or under mental healthcare at the time of the offence. Homicidal behaviour in a country with a relatively low crime rate appears to be statistically associated with some specific mental disorders, classified according to the DSM-IV-TR classifications.     

The prevalence of personality disorder among UK primary care attenders

OBJECTIVE: To determine the prevalence rate of personality disorder among a consecutive sample of UK primary care attenders. Associations between a diagnosis of personality disorder, sociodemographic background and common mental disorder were examined. METHOD: Three hundred and three consecutive primary care attenders were examined for the presence of ICD-10 and DSM-4 personality disorders using an informant-based interview. RESULTS: Personality disorder was diagnosed in 24% (95% CI: 19-29) of the sample. Personality-disordered subjects were more likely to have psychiatric morbidity as indicated by GHQ-12, to report previous psychological morbidity, to be single and to attend the surgery on an emergency basis. 'Cluster B' personality disorders were particularly associated with psychiatric morbidity. CONCLUSION: There is a high prevalence rate of personality disorders among primary care attenders. These disorders are associated with the presence of common mental disorder and unplanned surgery attendance. Personality disorders may represent a significant source of burden in primary care.     

Criminal conviction, impulsivity, and course of illness in bipolar disorder

Swann AC, Lijffijt M, Lane SD, Kjome KL, Steinberg JL, Moeller FG. Criminal conviction, impulsivity, and course of illness in bipolar disorder.
Bipolar Disord 2011: 13: 173–181. © 2011 The Authors.
Journal compilation © 2011 John Wiley & Sons A/S. Objective: Criminal behavior in bipolar disorder may be related to substance use disorders, personality disorders, or other comorbidities potentially related to impulsivity. We investigated relationships among impulsivity, antisocial personality disorder (ASPD) or borderline personality disorder symptoms, substance use disorder, course of illness, and history of criminal behavior in bipolar disorder. Methods: A total of 112 subjects with bipolar disorder were recruited from the community. Diagnosis was by Structured Clinical Interview for DSM‐IV (SCID‐I and SCID‐II); psychiatric symptom assessment by the Change version of the Schedule for Affective Disorders and Schizophrenia (SADS‐C); severity of Axis II symptoms by ASPD and borderline personality disorder SCID‐II symptoms; and impulsivity by questionnaire and response inhibition measures. Results: A total of 29 subjects self‐reported histories of criminal conviction. Compared to other subjects, those with convictions had more ASPD symptoms, less education, more substance use disorder, more suicide attempt history, and a more recurrent course with propensity toward mania. They had increased impulsivity as reflected by impaired response inhibition, but did not differ in questionnaire‐measured impulsivity. On logit analysis, impaired response inhibition and ASPD symptoms, but not substance use disorder, were significantly associated with criminal history. Subjects convicted for violent crimes were not more impulsive than those convicted for nonviolent crimes. Conclusions: In this community sample, a self‐reported history of criminal behavior is related to ASPD symptoms, a recurrent and predominately manic course of illness, and impaired response inhibition in bipolar disorder, independent of current clinical state.     

Suicide attempts and clinical risk factors in patients with bipolar and unipolar affective disorders

Background

Suicide is an important clinical problem in psychiatric patients. The highest risk of suicide attempts is noted in affective disorders.

Objective

The aim of the study was to look for suicide risk factors among sociodemographic and clinical factors, family history and stressful life events in patients with diagnosis of unipolar and bipolar affective disorder (597 patients, 563 controls).

Method

In the study, the Structured Clinical Interview for DSM-IV Axis I Disorders and the Operational Criteria Diagnostic Checklist questionnaires, a questionnaire of family history, and a questionnaire of personality disorders and life events were used.

Results

In the bipolar and unipolar affective disorders sample, we observed an association between suicidal attempts and the following: family history of psychiatric disorders, affective disorders and psychoactive substance abuse/dependence; inappropriate guilt in depression; chronic insomnia and early onset of unipolar disorder. The risk of suicide attempt differs in separate age brackets (it is greater in patients under 45 years old). No difference in family history of suicide and suicide attempts; marital status; offspring; living with family; psychotic symptoms and irritability; and coexistence of personality disorder, anxiety disorder or substance abuse/dependence with affective disorder was observed in the groups of patients with and without suicide attempt in lifetime history.