A study of patients with personality disorder not otherwise specified

Background

Personality disorder not otherwise specified (PD NOS) is a frequently applied diagnosis, but we lack knowledge of the clinical appearance of patients receiving the diagnosis. This study applied a large clinical sample (N = 1516) to investigate (1) the prevalence and diagnostic and clinical characteristics of patients with PD NOS defined according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and (2) the prevalence and psychosocial impairment associated with different definitions of PD NOS.

Method

Patients from the Norwegian Network of Psychotherapeutic Day Hospitals diagnosed in accordance with the LEAD standard (Longitudinal, Expert, All Data) were evaluated on several clinical measures at admission and discharge from short-term treatment.

Results

The DSM-IV PD NOS category was the third most frequent PD diagnosis. Seventeen percent of the total sample and 22% of those with PDs had a PD NOS diagnosis, with an average of 9 PD criteria. Patients with PD NOS were heterogeneous with respect to types of PD criteria, 41% were not subthreshold on any specific PD. The PD NOS patients were intermediate between patients with specific PDs and those with no PD regarding number of fulfilled PD criteria and several social and clinical variables. Alternative operationalizations of PD NOS, that is, subthreshold on at least 2 specific PDs or meeting a minimum of 10 PD criteria, resulted in lower prevalence rates and defined clinically more impaired patients.

Conclusion

The PD NOS defined according to DSM-IV has a high prevalence and seems to capture a group of patients with fewer PD criteria and less severe psychosocial impairment compared to patients with specific PDs. The findings indicate that the operational definition of PD NOS may have a strong impact on the prevalence and clinical appearance of patient receiving this diagnosis.     

Eating disorder not otherwise specified in adolescents

OBJECTIVE: To examine the frequency, type, and clinical severity of eating disorder not otherwise specified (EDNOS) in adolescents seeking treatment through an outpatient eating disorders service. METHOD: Two hundred eighty-one consecutive referrals to an eating disorders program were assessed using the Eating Disorder Examination (EDE) and self-report measures of depression and self-esteem. RESULTS: The majority of adolescents presented with EDNOS (59.1%; n = 166) relative to anorexia nervosa (AN; 20.3%; n = 57) and bulimia nervosa (BN; 20.6%; n = 58). Most EDNOS youths could be described as subthreshold AN (SAN; 27.7%; n = 46), subthreshold BN (SBN; 19.9%; n = 33), EDNOS purging (27.7%; n = 46), or EDNOS bingeing (6.0%; n = 10); yet 31 (18.7%) could not be categorized as such (EDNOS "other"). Overall differences in eating disorder pathology, depressive symptoms, and self-esteem emerged between the EDNOS types, wherein adolescents with EDNOS bulimic variants (SBN, EDNOS purging, and EDNOS bingeing) had more pathology than youths with SAN or EDNOS "other." There were no differences in these variables between AN and SAN; in contrast, compared with BN, youths with EDNOS bulimic variants reported lower EDE scores and higher self-esteem, although there were no between-group differences in depression. CONCLUSIONS: As in adults with eating disorders, EDNOS predominates and is heterogeneous with regard to eating disorder pathology and associated features in an adolescent clinical sample. Lack of differences between AN and SAN suggests that the strict criteria for AN could be relaxed; differences between BN and EDNOS bulimic variants do not support their combination.     

Face recognition in children with a pervasive developmental disorder not otherwise specified

This study investigates the accuracy and speed of face recognition in children with a Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS; DSM-IV, American – Psychiatric Association [APA], 1994). The study includes a clinical group of 26 nonretarded 7- to 10-year-old children with PDDNOS and a control group of 65 normally developing children of the same age. Two computerized reaction time tasks were administered: a face recognition task and a control task designed to measure the recognition of abstract visuospatial patterns. The latter were either easy or difficult to distinguish from a set of alternative patterns. The normally developing children recognized the faces much faster than the hardly distinguishable abstract patterns. The children in the PDDNOS group needed an amount of time to recognize the faces that almost equalled the time they needed to recognize the abstract patterns that were difficult to distinguish. The results suggest that, when processing faces, children with PDDNOS use a strategy that is more attention-demanding and, hence, less automatic or Gestalt-like than the one used by the control children. The results are discussed in the light of a theory that explains the development of coherent mental representations.     

Epilepsy in patients with pervasive developmental disorder not otherwise specified

Data on epilepsy in pervasive developmental disorder not otherwise specified are few and scanty. Seventy-seven patients with pervasive developmental disorder not otherwise specified were compared with 77 with autistic disorder, matched for age and sex. The 2 groups were divided into 3 subgroups each: A, without electroencephalography (EEG) paroxysmal abnormalities or epilepsy; B, with EEG paroxysmal abnormalities without epilepsy; and C, with epilepsy. Mild mental retardation (P < .01), pathological neurological examination (P < .05), cerebral lesions (P < .01), abnormal EEG background activity (P < .001), and associated genetic pathologies (P < .01) were more common in pervasive developmental disorder not otherwise specified. Familial antecedents for epilepsy prevailed in subgroup C (P < .01). Epilepsy occurred in 35.1% of patients with pervasive developmental disorder not otherwise specified, with no statistically significant difference compared with autistic disorder. The mean age of seizure onset was earlier (2 years 8 months) in pervasive developmental disorder not otherwise specified (P < .000). Seizure outcome was better in autistic disorder. Genetic diseases and cerebral lesions should be investigated in pervasive developmental disorder not otherwise specified to clarify the etiological and clinical features.     

An outpatient clinical study of dissociative disorder not otherwise specified

The relatively high prevalence of the diagnosis of dissociative disorder not otherwise specified is frequently considered to be disproportionate. The disproportionate rate of this diagnosis is thought to be related to nosologic and/or diagnostic issues in dissociative identity disorder. We sought to investigate and compare the symptom patterns of these two clinical entities. We conducted a cross-sectional study involving 1314 participants who were screened with the Dissociative Experience Scale (DES) and the Somatoform Dissociation Questionnaire (SDQ). Of the participants, 272 who scored above the cut-off points for the screening questionnaires (DES score > 30 and/or SDQ score > 40 points) were invited to complete a structured interview using the Dissociative Disorders Interview Schedule (DDIS); of this subsample, only 190 participants agreed to participate in the second phase of the study. The mean score for the DES was 18.55 ± 17.23, and the mean score for the SDQ was 30.19 ± 13.32. Of the 190 participants, 167 patients were diagnosed as having a dissociative disorder (87.8%). We found that DD-NOS was the most prevalent category of dissociative disorder.     

Bipolar disorder not otherwise specified in relation to the bipolar spectrum

BACKGROUND: The purpose of this study was to determine the clinical characteristics of patients who are diagnosed with bipolar disorder not otherwise specified (BPD NOS) and who are considered to represent part of the bipolar spectrum. The lifetime prevalence of BPD in the general population may be as high as 6% when the full spectrum of bipolar disorders is accounted for. Correct identification of true bipolar patients in clinical settings may result in more appropriate treatment. Our hypothesis was that patients with BPD NOS would be more similar to other bipolar patients than major depressive disorder (MDD) patients in terms of age of onset, history of suicidal behavior and family history of BPD. METHODS: We conducted a retrospective chart review to extract and analyze data on the family history, disease course and clinical characteristics of 305 bipolar disorder I (BPD I), bipolar disorder II (BPD II), bipolar disorder not otherwise specified (BPD NOS) or major depressive disorder (MDD) patients who were then grouped by diagnosis for analysis. Nominal variables were compared between groups using chi-square tests and ANOVA was used to compare means between groups for continuous variables. Significant F values were followed by independent-samples t-tests. RESULTS: Patients with BPD I, BPD II and BPD NOS were all found to have a significantly earlier mean age of onset of depression than MDD patients. A significantly higher incidence of bipolar illness in a first-degree relative was found in all BPD groups (27-32%) compared with MDD patients (11%). Only the BPD I group had a significantly higher rate of suicide attempts (42%), compared with the BPD NOS (17%) and MDD recurrent (16%) groups. CONCLUSIONS: Our data support the conclusions of others that an early age of onset and a positive family history of bipolar illness are associated not only with BPD I and II but also with 'softer' forms of bipolar illness, which DSM-IV classifies as BPD NOS and the current literature refers to as a category of 'bipolar spectrum disorder', albeit with varying proposed definitions and diagnostic criteria. Suicide attempt history may be more useful in identifying the severity of illness than distinguishing the bipolar spectrum from depressive disorders. Further research is needed to clearly define the boundaries of the bipolar spectrum.     

Axis-I comorbidity in female patients with dissociative identity disorder and dissociative identity disorder not otherwise specified

The aim of this study was to investigate axis-I comorbidity in patients with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS). Using the Diagnostic Interview for Psychiatric Disorders, results from patients with DID (n = 44) and DDNOS (n = 22) were compared with those of patients with posttraumatic stress disorder (PTSD) (n = 13), other anxiety disorders (n = 14), depression (n = 17), and nonclinical controls (n = 30). No comorbid disorders were found in nonclinical controls. The average number of comorbid disorders in patients with depression or anxiety was 0 to 2. Patients with dissociative disorders averagely suffered from 5 comorbid disorders. The most prevalent comorbidity in DDNOS and DID was PTSD. Comorbidity profiles of patients with DID and DDNOS were very similar to those in PTSD (high prevalence of anxiety, somatoform disorders, and depression), but differed significantly from those of patients with depression and anxiety disorders. These findings confirm the hypothesis that PTSD, DID, and DDNOS are phenomenologically related syndromes that should be summarized within a new diagnostic category.     

Neuropsychological deficits in pediatric patients with childhood-onset schizophrenia and psychotic disorder not otherwise specified

OBJECTIVE: Children with transient psychotic symptoms and serious emotional disturbances who do not meet current criteria for schizophrenia or other presently recognized diagnostic categories commonly present diagnostic and treatment problems. Clarifying the connections between children with narrowly defined schizophrenia and children with a more broadly defined phenotype (i.e., Psychotic Disorder Not Otherwise Specified, PD-NOS) has implications for understanding the pathophysiology of schizophrenia. In this study, the neuropsychological test performance of a subgroup of children with atypical psychosis was compared with that of patients with childhood-onset schizophrenia (COS). METHOD: Cognitive function was assessed with neuropsychological test battery regimens in 51 neuroleptic-nonresponsive patients within the first 270 at NIMH testing (24 PD-NOS, 27 COS) were included in this analysis. Seventeen (39%) of 44 COS subjects were unavailable for this study as their IQ tested <70. The PD-NOS patients were younger than the COS patients at the time of testing (12.0+/-2.8 vs 14.4+/-1.8years, respectively, p<0.004). The test levels of these groups were compared with each other. RESULTS: The neuropsychological test results for the PD-NOS and COS patients were 1-2standard deviations below normative data across a broad array of cognitive functions. There were no overall differences in the test levels for the six summary scales (F=2.82, df=1, 36, p=0.10) or in the profile shape (F=1.70, df=5, 180, p=0.14) between the PD-NOS and COS groups. For the COS patients, there was a significant difference between their mean full-scale WISC IQ (84.7+/-16.2) and their average standard scores for both the spelling (97.7+/-16.1, n=23, t=4.0, p=0.001) and reading decoding subtests (97.7+/-13.7, n=23, t=3.7, p=0.001) of the Kaufman Test of Educational Achievement. CONCLUSIONS: Treatment-refractory PD-NOS and COS patients share a similar pattern of generalized cognitive deficits, including deficits in attention, learning and abstraction which are commonly observed in adult patients with schizophrenia. These data support a hypothesis that at least some of the PD-NOS cases belong within the schizophrenic spectrum, which is of importance for future genetic studies planned for this cohort.     

Bipolar disorder not otherwise specified: comparison with bipolar disorder I/II and major depression

OBJECTIVE: To compare the personality, clinical and comorbidity characteristics of subjects meeting diagnostic criteria for bipolar disorder not otherwise specified (BDNOS) to those with major depression and bipolar I or II disorder. METHODS: A family-based study was undertaken on the molecular genetics of depression and personality, in which the proband had been treated for depression, regardless of history, of hypomania or mania. RESULTS: The 25 subjects with BDNOS were different to the 297 subjects with major depression and similar to 75 subjects with bipolar I or II disorder on social phobia, obsessive-compulsive disorder and substance dependence comorbidity. The BDNOS subjects also had personality traits more akin to the bipolar I or II disorder subjects, especially borderline personality traits and self transcendence. CONCLUSIONS: Subjects with BDNOS, based on a history of 1-3 day recurrent hypomanias, should be included within a broader bipolar spectrum.     

Differentiating pervasive developmental disorder not otherwise specified from autism and language disorders

Features useful in distinguishing choldren with pervasive developmental disorder (PDD) from those with autism or language disorder were developed from a retrospective chart review using groups of children with PDD-NOS and MA-and sex-matched autistic and language-disordered groups. Charts were reviewed using a list of 80 items compiled from various sources. Items that had adequate interrater reliability and significantly discriminated the PDD-NOS cases from the language-disordered or autistic cases were then evaluated using a second set of cases and signal detection methods. Fewer items significantly discriminated cases with autism from those with PDD-NOS as compared to cases with language disorder. Clinical implications are discussed.From the Yale Child Study Center (Mayes, Volkmar, and Hooks) and the Veterans Administration Medical Center, West Haven, Connecticut (Cicchetti). Marla Hooks is currently affiliated with the University of Washington. This study was supported by grant M846961 from the National Institute of Mental Health, by grant HD-03008 from the National Institute of Child Health and Human Development, by NIMH grant MH-30929 to the Mental Health Clinical Research Center, and grant MRIS-1416 to the Veterans Administration. The authors thank Helena Kraemer for her provision of the QROC program.     

大一女生非典型摄食障碍的初步调查

目的 了解非典型摄食障碍(EDNOS)的特征表现.方法 采用进食情况调查表(EDI)进行自评问卷调查、摄食障碍检查问卷( EDE)和SCID —I的H部分进行访谈的方法,对8 600名大一女生筛选和确诊摄食障碍,并获取各类摄食障碍的心理行为特征.结果 EDNOS的发病率最高,为7.277‰.EDNOS的代偿行为基本少于神经性厌食症和神经性贪食症;EDNOS群体中,选择剧烈运动和采取一种代偿行为所占的比例相对较高,分别为38.7％和43.5％.三类摄食障碍的EDI与EDE所有因子分的差异均无统计学意义;EDE的条目中,EDNOS的空腹和体重重要性分值低于神经性厌食症,而秘密进食分值低于神经性贪食症.结论 EDNOS总体上具有摄食障碍的所有临床特征,在某些症状上表现较轻,需要鉴别和引起重视.     

Cardiac adaptivity to attention-demanding tasks in children with a pervasive developmental disorder not otherwise specified (PDD-NOS).

BACKGROUND: Decreases in heart rate variability (HRV) have been repeatedly demonstrated to be an index of effort allocation to attention-demanding tasks. Children with autistic-type problems in social interaction and in adapting to unfamiliar situations (DSM-IV: PDD-NOS) have been shown to have specific attention deficits. These children were hypothesized to exhibit less cardiac adaptivity to attention-demanding tasks. METHODS: Two groups of 18 children with PDD-NOS, judged to be hyperactive and nonhyperactive, were compared to 18 healthy children with respect to their performances on a visual attention task and the differences in HRV measured during periods of task performance and periods of rest. RESULTS: Compared to the control group, both clinical groups were found to have a stronger capacity limitation in processing high loads of information, and to be less capable of maintaining a stable task performance throughout the whole task. Both clinical groups showed significantly less decreases in HRV during the periods of task performance. The magnitude of rest-task differences in HRV was found to correlate significantly with a behavioral measure of resistance to unexpected changes in daily routines. CONCLUSIONS: Children with PDD-NOS are significantly less flexible in their autonomic adaptation to attention-demanding tasks. The findings are interpreted as reflecting a deficiency in the functional organization of those neural pathways that provide cortical control of the visceral efferents.     

Relationship between motor and executive functioning in school-age children with pervasive developmental disorder not otherwise specified

This study examines the motor skills and executive functioning (EF) of 28 children diagnosed with pervasive developmental disorder-not otherwise specified (PDD-NOS; mean age: 10 years 6 months, range: 7-12 years; 19 boys, 9 girls) in comparison with age- and gender-matched typically developing children. The potential relationship between motor performance and EF in children with PDD-NOS is investigated as well. The children's motor skills were evaluated with the Movement ABC. EF, in terms of planning ability, strategic decision making, and problem solving, was gauged with the Tower of London (TOL) task. Compared with their typically developing peers, the children with PDD-NOS scored poor on the Movement ABC (p < 0.01) and the TOL (p < 0.05). They had significantly more definite motor problems than the normative sample of the Movement ABC: 43% (manual dexterity, p < 0.001), 25% (ball skills, p < 0.001), and 25% (balance skills, p < 0.001). There were significant inverse relationships between manual dexterity and the TOL score (r = −0.46, p < 0.01), and balance and the TOL score (r = −0.41, p < 0.05), indicating that children with a better performance on the manual dexterity subtest and the balance subtest had a better TOL score than children with a worse performance. Children with PDD-NOS have inferior motor skills, and these deficits are interrelated with planning ability, strategic decision making, and problem solving.     

Cognitive profile difference between normally intelligent children with Asperger's disorder and those with pervasive developmental disorder not otherwise specified

Aim: Asperger's disorder (Asperger syndrome, AS) and pervasive developmental disorder not otherwise specified (PDD‐NOS) are different subtypes of mild pervasive developmental disorders (PDD). Methods: Using the Japanese version of the Wechsler Intelligence Scale for Children–Third Edition (WISC‐III), 28 AS children (mean age, 9.3 years, 24 male) were compared with 78 PDD‐NOS children (mean age, 7.6 years, 64 male) with normal intelligence (IQ ≥ 85), using analysis of covariance (ancova ) with the chronological age of a child as a covariate. Results: Verbal IQ tended to be higher in the AS children than in the PDD‐NOS children (mean raw scores, AS vs PDD‐NOS: 103.9 vs 99.6; P < 0.10), although full‐scale and performance IQ did not differ significantly. Compared with the PDD‐NOS children, the AS children scored significantly higher on Freedom from Distractibility index (110.1 vs 104.5; P < 0.05) consisting of Arithmetic (11.0 vs 9.9, P = 0.04) and Digit Span (12.4 vs 11.6, P = 0.051), but tended to score lower on Coding (8.5 vs 9.8, P = 0.08). Conclusion: The typical cognitive profile of PDD (i.e. low score on Comprehension and high score on Block Design) was shared by both groups, which may support the validity of the current diagnostic classification of PDD. Relatively better verbal ability in AS children seems to reflect their normal language acquisition in infancy, and strong numeric interest may produce the AS children's mathematical excellence over PDD‐NOS children. A low score on Coding in AS children might reflect their extreme slowness, circumstantiality and/or drive for perfection.