Cluster a personality disorder: A marker of worse treatment outcome of major depression?

Sato, Tetsuya; Sakado, Kaoru; Sato, Satoshi; Morikawa, Tatsuya

doi:10.1016/0165-1781(94)90106-6

Cited by 45 publications

(34 citation statements)

References 10 publications

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“…In contrast to the review by Reich and Green [4]and research during the last decade [5, 6, 7, 8, 9, 10, 11], we did not find treatment resistance to be associated with increased rates of personality disturbance. In fact, the only statistically significant difference found was that non-TRD patients have a higher rate of obsessive-compulsive personality disorder when compared with matched TRD patients.…”

Section: Discussioncontrasting

confidence: 56%

“…At the same time, such exclusion criteria also limit generalizability of our findings to the non-TRD population. However, our findings can be compared with the studies of non-TRD patients [5, 6, 7, 8, 9, 10, 11], since, similar to our study, these studies also employed similar exclusion criteria typical of clinical trials. Furthermore, one may argue that depressed outpatients with no substance abuse, psychosis or significant comorbidity are more representative of patients seen in a general clinical practice, as opposed to the more severely ill patients seen in tertiary care settings, academic or national health centers.…”

Section: Discussionmentioning

confidence: 58%

“…The studies we reviewed revealed the following factors as all being associated with poorer treatment outcome: dysfunctional attitudes, reward dependence, dependent personality traits, borderline personality traits, and symptoms of cluster A and C personality [5, 6, 7, 8, 9, 10]. In addition, depressed patients with personality disturbance have been shown to have lower levels of social functioning and a greater frequency of suicide attempts [8, 11].…”

Section: Introductionmentioning

confidence: 99%

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Treatment-Resistant Depression and Axis II Comorbidity

Petersen

Hughes

Papakostas

et al. 2002

Psychother Psychosom

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Background: Researchers of unipolar depression have speculated that personality disturbance is a contributing factor in the development of treatment resistance. The purpose of this study was to compare the prevalence of Axis II disorders between a sample of rigorously defined, treatment-resistant depressed outpatients and a sample of depressed outpatients not having experienced treatment resistance. Methods: 53 patients with treatment-resistant depression (TRD) and 105 patients with non-treatment-resistant depression (non-TRD) were recruited through respective outpatient clinical trials at the Massachusetts General Hospital’s Depression Clinical and Research Program. Diagnosis of Major Depressive Disorder was made using the Structured Clinical Interview for the DSM-III-R, personality disorders were assessed using the Structured Clinical Interview for DSM-III-R Personality Disorders, and antidepressant treatment resistance was defined using the McLean Hospital Antidepressant Treatment Record. Participants from both studies were matched for baseline HAM-D-17 total score and gender. Multiple chi-square analysis was used to compare frequencies of Axis II disorders between TRD and non-TRD patients as well as to compare categorical baseline demographic variables. Unpaired t tests were used to compare baseline demographic and clinical variables measured in a continuous manner. Results: Non-TRD patients had a higher rate of obsessive-compulsive personality disorder than TRD patients, but this difference was not statistically significant after adjusting for multiple comparisons. No other differences were found to be statistically significant. Range of Axis II comorbidity was 0.0–30.2% for TRD patients and 2.9–37.1% for non-TRD patients. Conclusions: In this sample, treatment resistance in a current major depressive episode was not associated with an increased rate of Axis II disorders. Strengths of this study include the use of structured interview instruments to assess Axis I and II conditions, and having the two study groups matched for gender and baseline severity of depression. Limitations of this study include a modest sample size and reliance on DSM personality constructs.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

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Treatment-Resistant Depression and Axis II Comorbidity

Petersen

Hughes

Papakostas

et al. 2002

Psychother Psychosom

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“…What's more, only Mr. F manifests a significant and constant presence of Schizoid personality traits: in particular, whilst PD scores sink under threshold in T2, the Q scores remain elevated in T2 (60.44 in T1; 60.22 in T2). Part of existing literature attests to the possibility of relationships between Depressive Disorders and specific Personality Disordersand more in detail, Schizoid or Cluster A Personality Disorders and Avoidant or Cluster C Personality Disorders (Sato et al, 1994;Johnson et al, 2005;Hirschfeld, 1999). …”

Section: Discussionmentioning

confidence: 99%

Assessing personality change with Blatt's anaclitic and introjective configurations and Shedler-Westen Assessment Procedure profiles: two case studies in psychodynamic treatment

Oasi

Buonarrivo

Codazzi³

et al. 2017

ResPsy

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A growing body of empirical and clinical research attests to the influence of personality features on the development, course and outcome of psychotherapy. Over the last four decades, Blatt adopted a psychoanalytic and cognitive developmental approach in developing a theoretically and empirically grounded two-configurations model of personality. The main aim of this study was to evaluate possible changes in anaclitic and introjective configurations – as measured by the Depressive Experience Questionnaire (DEQ) (Blatt, D’Afflitti, & Quinlan, 1976) – set against simultaneous changes in personality profile measured by Shedler-Westen Assessment Procedure (SWAP-200). Two young patients, a man and a woman, characterized by different personality profiles – introjective and anaclitic, respectively – were assessed for one year in the context of a psychodynamic psychotherapy. A battery of instruments – Beck Depression Inventory II (BDI-II), Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders I and II, Defense Mechanism Rating Scale, DEQ and SWAP-200 – were administered at the beginning, during the assessment process, and after one year. Both patients displayed lower BDI-II scores, along with evident clinical progress. Defence profiles and Core Conflict Relationship Themes showed interesting developments, in keeping with the evolution of the psychotherapy process. Lastly, while DEQ profiles outlined substantial stability after one year, some important changes in SWAP-200 profiles – in particular with regard to Q factors – were observed. Although these findings should be considered as preliminary, these results appear to be consistent with the description of Self-criticism and Dependency as relatively stable personality dimensions. The potential influence of profile diversity – introjective vs anaclitic – on other key variables of the psychotherapy process is also discussed.

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“…Most existing studies investigate the impact of cluster A PD on treatment effects of axis I treatments or focus on the effectiveness of psychopharmacological treatment of schizotypal PD. It has been shown in these studies that the presence of cluster A PD, especially schizotypal PD, has a negative influence on the outcome of axis I treatments of both medical and psychotherapeutic kind [15,16,17,18,19]. Medication studies of schizotypal PD have shown that typical and atypical antipsychotics, and possibly antidepressants, can have a positive influence on distinguished symptoms , such as cognitive disturbance, derealisation, ideas of reference, anxiety, self-image, social and overall functioning, odd communication, obsessive-compulsive symptoms and self-injury [20,21,22,23,24,25,26,27,28,29].…”

Section: Introductionmentioning

confidence: 99%

Patients with Cluster A Personality Disorders in Psychotherapy: An Effectiveness Study

Bartak

Andrea²,

Spreeuwenberg

et al. 2010

Psychother Psychosom

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Background: While psychopharmacological studies are common in patients with cluster A personality disorders, the effects of psychotherapy have received little attention. The aim of this study is to explore whether psychotherapeutic treatment yields health gains for these patients. Methods: The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherlands, with a sample of 57 patients with a DSM-IV-TR axis II cluster A diagnosis. Patients were assigned to 3 settings of psychotherapeutic treatment (outpatient, day hospital, inpatient), and effectiveness was assessed at 18 months after baseline. An intention-to-treat analysis was conducted for psychiatric symptoms (Brief Symptom Inventory), psychosocial functioning (Outcome Questionnaire-45) and quality of life (EQ-5D), using multilevel statistical modelling. As the study was non-randomised, the propensity score method was used to control for initial differences. Results: Patients in the day hospital and inpatient group improved substantially in terms of psychiatric symptoms, social and interpersonal functioning, and quality of life. Patients in the outpatient group showed less improvement. Direct comparison of the improvement of psychiatric symptoms showed significant results in favour of day hospital (p = 0.046) and inpatient (p = 0.01) treatment, as compared to outpatient treatment. However, due to substantial baseline differences, this direct comparison should be judged carefully. Conclusions: Cluster A psychopathology is not a contraindication to benefit from psychotherapy. This is especially true for more intensive forms like inpatient and day hospital treatment. Future research should focus more on psychotherapeutic treatment to gain further insight into effective treatment options for this patient group.

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Cluster a personality disorder: A marker of worse treatment outcome of major depression?

Cited by 45 publications

References 10 publications

Treatment-Resistant Depression and Axis II Comorbidity

Treatment-Resistant Depression and Axis II Comorbidity

Assessing personality change with Blatt's anaclitic and introjective configurations and Shedler-Westen Assessment Procedure profiles: two case studies in psychodynamic treatment

Patients with Cluster A Personality Disorders in Psychotherapy: An Effectiveness Study

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