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Comorbid Personality Disorders in Individuals With an At-Risk Mental State for Psychosis: A Meta-Analytic Review.

ABSTRACT: Increasing evidence shows that personality pathology is common among patients at clinical high risk (CHR) for psychosis. Despite the important impact that this comorbidity might have on presenting high-risk psychopathology, psychological functioning, and transition to full psychotic disorders, the relationship between personality syndromes and CHR state has received relatively little empirical attention. The present meta-analytic review aimed at 1) estimating the prevalence rates of personality disorders (PDs) in CHR individuals and 2) examining the potential role of PDs in predicting transition from CHR state to a full-blown psychotic disorder. The systematic search of the empirical literature identified 17 relevant studies, including a total of 1,868 CHR individuals. Three distinct meta-analyses were performed to provide prevalence estimates of PDs in the CHR population. The first and more comprehensive meta-analysis focused on any comorbid PD (at least one diagnosis), the second one focused on schizotypal personality disorder (SPD), and the last one focused on borderline personality disorder (BPD). Moreover, a narrative review was presented to define the predictive role of personality disorders in promoting more severe outcomes in CHR patients. The findings showed that the prevalence rate of personality disorders in CHR patients was 39.4% (95% CI [26.5%-52.3%]). More specifically, 13.4% (95% CI [8.2%-18.5%]) and 11.9% (95% CI [0.73%-16.6%]) of this clinical population presented with SPD and BPD, respectively. Finally, the studies examining the effects of baseline personality diagnoses on conversion to psychotic disorders showed contradictory and insufficient results concerning the potential significant impact of SPD. Conversely, no effect of BPD was found. This meta-analytic review indicated that the CHR population includes a large subgroup with serious personality pathology, that may present with attenuated psychotic symptoms conjointly with distinct and very heterogeneous personality features. These findings support the need for improved understanding of both core psychological characteristics of CHR patients and differentiating aspects of personality that could have relevant clinical implications in promoting individualized preventive interventions and enhancing treatment effectiveness.

SUBMITTER: Boldrini T

PROVIDER: S-EPMC6625011 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Comorbid Personality Disorders in Individuals With an At-Risk Mental State for Psychosis: A Meta-Analytic Review.

Boldrini Tommaso T Tanzilli Annalisa A Pontillo Maria M Chirumbolo Antonio A Vicari Stefano S Lingiardi Vittorio V

Frontiers in psychiatry 20190705

Increasing evidence shows that personality pathology is common among patients at clinical high risk (CHR) for psychosis. Despite the important impact that this comorbidity might have on presenting high-risk psychopathology, psychological functioning, and transition to full psychotic disorders, the relationship between personality syndromes and CHR state has received relatively little empirical attention. The present meta-analytic review aimed at 1) estimating the prevalence rates of personality ...[more]

PMID: 31333509

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Project description:PURPOSE:Prevalence rates of PTSD are higher in the prison population than in the community. We sought to systematically review the extent to which this disorder is associated with other mental health disorders and problematic suicidal or aggressive behaviours in the prison population. METHODS:Studies reporting a relationship between PTSD and comorbid mental disorders and/or problematic behaviours in imprisoned adolescent and adult populations were identified from four bibliographic indexes. Primary studies involving clinical interviews, validated instruments leading to DSM or ICD diagnoses, or validated self-report questionnaires such as the PTSD checklist were included. Random-effects meta-analysis was conducted where possible. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS:This review identified 36 studies, with a combined sample of 9594 participants, (6478 male and 2847 female prisoners) from 11 countries. Thirty-four of the identified studies employed a cross-sectional design. We identified significant associations between PTSD and comorbid mental disorders including depression (OR = 3.4, 95% confidence interval (CI): 2.3-4.9), anxiety (OR = 2.9, 95% confidence interval (CI): 1.8-4.7) and substance use (OR = 1.9, 95% confidence interval (CI): 1.5-2.4). We also identified significant associations between PTSD and suicidality (OR = 3, 95% confidence interval (CI): 2.4-3.8) and aggressive behaviours (this latter finding was not subject to meta-analysis). Significant methodological heterogeneity was identified between studies. CONCLUSIONS:High rates of psychiatric comorbidity among prisoners with PTSD, and links to suicidal behaviour, self-harm and aggressive behaviour, provide further support for the need for trauma-informed treatment approaches in prisons. However, significant gaps in the current evidence were apparent. In particular, a lack of large, longitudinal studies meant that the temporal relationships between PTSD and relevant outcomes cannot currently be determined.

Project description:Identity concealment affects all sexual minority individuals, with potentially complex mental health implications. Concealing a sexual minority identity can simultaneously generate the stress of hiding, protect against the stress of discrimination, and keep one apart from sexual minority communities and their norms and supports. Not surprisingly, existing studies of the association between sexual orientation concealment and mental health problems show contradictory associations-from positive to negative to null. This meta-analysis attempts to resolve these contradictions. Across 193 studies (n = 92,236) we find a small positive association between sexual orientation concealment and internalizing mental health problems (i.e., depression, anxiety, distress, problematic eating; ESr = 0.126; 95% CI [0.102, 0.151]) and a small negative association between concealment and substance use problems (ESr = -0.061; 95% CI [-0.096, -0.026]). The association between concealment and internalizing mental health problems was larger for those studies that assessed concealment as lack of open behavior, those conducted recently, and those with younger samples; it was smaller in exclusively bisexual samples. Year of data collection, study location, and sample gender, education, and racial/ethnic composition did not explain between-study heterogeneity. Results extend existing theories of stigma and sexual minority mental health, suggesting potentially distinct stress processes for internalizing problems versus substance use problems, life course fluctuations in the experience of concealment, distinct experiences of concealment for bisexual individuals, and measurement recommendations for future studies. Small overall effects, heavy reliance on cross-sectional designs, relatively few effects for substance use problems, and the necessarily coarse classification of effect moderators in this meta-analysis suggest future needed methodological advances to further understand the mental health of this still-increasingly visible population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Project description:ImportancePremature mortality has been observed among people with mental disorders. Comorbid general medical conditions contribute substantially to this reduction in life expectancy.ObjectiveTo provide an analysis of mortality associated with comorbidity between a broad range of mental disorders and general medical conditions.Design, setting, and participantsPopulation-based cohort study of 5 946 800 individuals born in Denmark from 1900 to 2015 and residing in the country at the start of follow-up (January 1, 2000, or their date of birth, whichever occurred later).ExposuresDanish health registers were used to identify people with mental disorders and general medical conditions.Main outcomes and measuresConsidering pairs of mental disorders and general medical conditions, we calculated mortality rate ratios (MRRs) and differences in life expectancy (ie, life-years lost) to assess the association of mortality with both disorders of interest compared with the mental disorder of interest, the general medical condition of interest, and neither disorder of interest.ResultsThe study population comprised 2 961 397 males and 2 985 403 females, with a median (IQR) age of 32.0 years (7.3-52.9) at start of follow-up and 48.9 years (42.5-68.8) at the end. Based on all pairs of comorbid mental disorders and general medical conditions, the mean MRR compared with people without these conditions was 5.90 (median, 4.94; IQR, 3.80-7.30), and the mean reduction of life expectancy compared with the general population was 11.35 years (median, 11.08; range, 5.27-23.53; IQR, 8.22-13.72). The association with general medical condition comorbidity in those with mental disorders varied by general medical condition; for example, the addition of a neurological condition for each of the mental disorders was associated with a mean MRR of 1.22, whereas for cancer, the mean MRR for all mental disorders was 4.07.Conclusions and relevanceIn this study, shorter life expectancy was associated with comorbid mental disorders and general medical conditions compared with the entire population and also when compared with patients who had either mental disorders only or general medical conditions only. Prevention and early detection of comorbidities could reduce premature mortality in patients with mental disorders.

Dataset Information

Comorbid Personality Disorders in Individuals With an At-Risk Mental State for Psychosis: A Meta-Analytic Review.

Publications

Comorbid Personality Disorders in Individuals With an At-Risk Mental State for Psychosis: A Meta-Analytic Review.

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