BackgroundSubstance use disorders (SUDs) constitute a major health problem and are associated with an extensive psychiatric comorbidity. Personality disorders (PDs) and SUDs commonly co-occur. Comorbid PD is characterized by more severe addiction problems and by an unfavorable clinical outcome. The present study investigated the prevalence of SUDs, PDs and common Axis I disorders in a sample of adolescent outpatients. We also investigated the association between PDs and SUDs, and how this association was influenced by adjustment for other Axis I disorders, age and gender.MethodsThe sample consisted of 153 adolescents, aged 14–17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. SUDs and other Axis I conditions were assessed using the mini international neuropsychiatric interview. PDs were assessed using the structured interview for DSM-IV personality.Results18.3 % of the adolescents screened positive for a SUD, with no significant gender difference. There was a highly significant association between number of PD symptoms and having one or more SUDs; this relationship was practically unchanged by adjustment for gender, age and presence of Axis I disorders. For boys, no significant associations between SUDs and specific PDs, conduct disorder (CD) or attention deficit hyperactivity disorder (ADHD) were found. For girls, there were significant associations between SUD and BPD, negativistic PD, more than one PD, CD and ADHD.ConclusionsWe found no significant gender difference in the prevalence of SUD in a sample of adolescents referred to a general mental health outpatient clinic. The association between number of PD symptoms and having one or more SUDs was practically unchanged by adjustment for gender, age and presence of one or more Axis I disorders, which suggested that having an increased number of PD symptoms in itself may constitute a risk factor for developing SUDs in adolescence. The association in girls between SUDs and PDs, CD and ADHD raises the question if adolescent girls suffering from these conditions may be especially at risk for developing SUDs. In clinical settings, they should therefore be monitored with particular diligence with regard to their use of psychoactive substances.Trial registration The regional committee for medical research ethics for eastern Norway approved the study protocol in October 2004 (REK: 11395). Address correspondence and reprint requests to: Hans Ole Korsgaard, The Nic Waal Institute, Lovisenberg Diakonale Hospital, P.O. Box 2970 Nydalen, N-0440 Oslo, Norway; E-mail hansole.korsgaard@tele5.no

BackgroundAttention deficit hyperactivity disorder (ADHD) is a lifelong condition which carries great cost to society and has an extensive comorbidity. It has been assumed that ADHD is 2 to 5 times more frequent in boys than in girls. Several studies have suggested developmental trajectories that link ADHD and certain personality disorders. The present study investigated the prevalence of ADHD, common Axis I disorders, and their gender differences in a sample of adolescent outpatients. We also wanted to investigate the relationship between ADHD and personality disorders (PDs), as well as how this relationship was influenced by adjustment for Axis I disorders, age and gender.MethodsWe used a sample consisting of 153 adolescents, aged 14 to 17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. ADHD, conduct disorder (CD) and other Axis I conditions were assessed using the Mini International Neuropsychiatric Interview (MINI). PDs were assessed using the Structured Interview for DSM-IV Personality (SIDP-IV).Results13.7 % of the adolescents met diagnostic criteria for ADHD, with no significant gender difference. 21.6 % had at least one PD, 17.6 % had CD, and 4.6 % had both ADHD and a PD. There was a significantly elevated number of PD symptoms in adolescents with an ADHD diagnosis (p = 0.001), and this relationship was not significantly weakened when adjusted for age, gender and other Axis I disorders (p = 0.026). Antisocial (χ2 = 21.18, p = 0.002) and borderline (χ2 = 6.15, p = 0.042) PDs were significantly more frequent in girls than in boys with ADHD.ConclusionsWe found no significant gender difference in the prevalence of ADHD in a sample of adolescents referred to a general mental health outpatient clinic. Adolescent girls with ADHD had more PDs than boys, with antisocial and borderline PDs significantly different. The present study suggests that ADHD in girls in a general outpatient population may be more prevalent than previously assumed. It especially highlights the importance of assessing antisocial and borderline personality pathology in adolescent girls presenting with ADHD symptoms.

Background: During recent years, there has been an increasing focus on the benefits of the early detection and treatment of personality disorders in adolescents. Previous studies of adults have shown that the number of personality disorder criteria met is negatively correlated with a patient's quality of life and general functioning. Objective: The aim of the present study was to investigate the prevalence of personality disorders, particularly with regard to the correlation between the number of personality disorder criteria fulfilled and self-perceived quality of life. Distribution according to gender and age in a clinical sample of adolescent outpatients were also considered. Method: This study included 153 adolescents between the ages of 14 and 17 years who were referred to a mental health outpatient clinic. Personality disorders were assessed using the Structured Interview for DSM-IV Personality. Quality of life was assessed using the Youth Quality of Life Instrument -Research Version, which is a 41-item questionnaire that covers broad aspects of quality of life. Axis I disorders were assessed using the Mini International Neuropsychiatric Interview. Results: Results demonstrated that 21.6% of the adolescents met the diagnostic criteria for at least one personality disorder. A relationship between the number of personality disorder criteria met and reduced quality of life was found. No significant gender differences with regard to the prevalence of each of the personality disorders were revealed. Adjustment for the presence of Axis I disorders did not appreciably affect these findings Conclusion: The present study indicates that reduced quality of life as a result of the number of personality disorder criteria met affects adolescents in much the same way that it does adults. This further emphasizes the clinical importance of including quality of life assessment as part of the general diagnostic procedures used with adolescents.

A significant proportion of adolescents suffering from major depressive disorder (MDD) are likely to have a co-morbid personality disorder (PD). Short-term psychoanalytic psychotherapy (STPP) was found to be one treatment of choice for adolescents suffering from MDD. Background: The first experimental study of transference work-in teenagers (FEST-IT) demonstrated the efficaciousness of transference work in STPP with adolescents suffering from MDD. The usefulness of STPP may be enhanced by exploring possible moderators. Methods: Depressed adolescents (N = 69), aged 16–18 years, were diagnosed with the structured interview for DSM-IV PDs and randomized to 28 weeks of STPP with or without transference work. A mixed linear model was applied. The moderator effect was investigated by a three-way interaction including “time”, “treatment group” and “number of PD criteria”. Results: A small but significant moderator effect was found for cluster B personality pathology. Patients with a higher number of cluster B PD criteria at baseline did better up to one-year post-treatment where therapists encouraged patients to explore the patient–therapist relationship in the here and now. Conclusion: When treated with psychoanalytic psychotherapy for MDD, adolescents with cluster B PD symptoms seem to profit more from transference work than adolescents without such pathology.

Personality disorders (PDs) are a class of mental disorders which are associated with subjective distress, decreased quality of life and broad functional impairment. The presence of one or several PDs may also complicate the course and treatment of symptom disorders such as anxiety and depression. Accurate and reliable means of diagnosing personality disorders are thus crucial to ensuring efficient treatment planning and resource allocation, a fact which is widely acknowledged within the adult mental health field. In adolescents, on the other hand, the consensus view has been that the rapid and discontinuous processes of normal personality development render the construct of PD in adolescents clinically unhelpful and conceptually dubious. However, recent research has established the reliability and validity of the construct, heralding an increased interest in the field, with important conceptual and clinical implications. The present article presents reliability data for the Structured Interview of DSM-IV Personality (SIDP-IV) in an adolescent outpatient population. For this study, 25 interviews conducted by experienced clinicians were blindly re-scored based on sound recordings, which allowed for the calculation of intra-class correlation metrics. The intra-class correlation coefficient for categorical diagnosis of specific personality disorders was found to be 0.876 (95% CI 0.718–0.945); Cohen’s kappa for presence/absence of personality diagnosis was found to be 0.896. The present study found excellent intra-rater reliability for the sample, which suggests that the SIDP-IV is a suitable instrument for assessing personality pathology in adolescent populations.

Personlighetsforstyrrelser kan diagnostiseres hos ungdom, og langtidsprognosen kan bedres gjennom tidlig intervensjon og forebygging av komorbide lidelser. Hans Ole Korsgaard. Foto: Gudbrand KorsgaardPersonlighetsforstyrrelser er blant våre vanligste psykiske lidelser, med en forekomst på 10-15 % i voksen normalbefolkning. Forekomsten blant ungdom er ikke så godt kartlagt.I mitt doktorgradsarbeid har jeg undersøkt forekomsten av personlighetsforstyrrelser hos ungdom (14-17 år) henvist til poliklinisk behandling i barne-og ungdomspsykiatrien.21,6 % av ungdommene hadde minst én personlighetsforstyrrelse. Jeg fant samme fordeling mellom ulike typer personlighetsforstyrrelser som hos voksne, og det var samme forhold mellom opplevd livskvalitet og grad av symptombelastning. Det var sterk korrelasjon mellom personlighetsforstyrrelser og rus, og dette forholdet var uavhengig av kjønn, alder og samtidig forekomst av andre lidelser. Det var også sterk korrelasjon mellom personlighetsforstyrrelser og AD/HD, uavhengig av kjønn. For jenter var det dessuten en signifikant sammenheng mellom rus og emosjonelt ustabil personlighetsforstyrrelse, atferdsforstyrrelse og AD/HD. Funnene impliserer at det kan vaere viktig å kartlegge livskvaliteten når man utreder personlighetsproblematikk hos ungdom, og at det å ha en personlighetsforstyrrelse kan utgjøre en selvstendig risikofaktor for å utvikle en ruslidelse i ungdomsalderen, kanskje spesielt for jenter.Resultatene fra studien kan få betydning for diagnostisk praksis for ungdom som har behov for langvarig oppfølging. Riktig diagnostikk er viktig for å få en god overgang til voksenpsykiatrien, for å gi pårørende realistiske forventninger til sykdomsforløpet og for å forebygge utviklingen av alvorlig tilleggsproblematikk som angst, depresjon og rusmisbruk.

Personlighet 239 s, tab, ill. Oslo: Gyldendal Akademisk, 2017. Pris NOK 399. ISBN 978-82-05-50099-0 I forordet definerer forfatteren sitt prosjekt på følgende måte: «Formålet med denne boken er å utlegge en moderne og overordnet personlighetsteori som kan reorganisere mye av den kunnskapen vi allerede har og formulere dette i et språk som er forståelig og anvendelig for den opplyste allmennhet.» Det er således ingen liten oppgave han tar på seg.Forfatteren presenterer en aktuell og relevant personlighetsteori som bygger på de tre hovedkomponentene temperament (primaere emosjoner), tilknytning og mentalisering (selvbevissthet). Dette er en forståelse av personlighetsbegrepet som ligger i tiden, og som er godt forskningsmessig dokumentert.Saerlig interessant er det at det også anlegges et evolusjonaert perspektiv, hvilket betyr at det presenteres hypoteser for hvorfor og hvordan de høyere psykiske funksjonene, som er grunnlaget for menneskelig personlighet, har utviklet seg.De 14 kapitlene er fordelt på fem deler. Første del omhandler personlighetsbegrepet, og i annen del går forfatteren systematisk gjennom personlighetens tre grunnpilarer temperament, tilknytning og mentaliseringsevne. Her er kapitlet om temperament relativt langt og kanskje det vanskeligst tilgjengelige for bokens definerte målgruppe. Tredje del dreier seg om personlighetstrekk med saerlig søkelys på femfaktormodellen, mens fjerde del handler om ulike personlighetstyper. I den femte delen konsentrerer forfatteren seg om personlighet i et livsløpsperspektiv og spesielt spørsmålet om personligheten kan endres gjennom psykoterapi.Boken er gjennomarbeidet og preges av et godt, lettlest språk. Fagterminologi og vanskelige