What we do, do not, and need to know about comorbid depression and personality disorders

Van, Henricus L.; Kool, Marit

doi:10.1016/s2215-0366(18)30260-8

Cited by 19 publications

(12 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These individuals may need more inpatient resources later when depression becomes severe and they experience much lower QoL. Individuals with depression often fail to seek treatment from primary care professionals [30], which may result in more intensive treatment that is needed later – for example, hospitalisations due to relapse and for suicide risk management [31,32].…”

Section: Discussionmentioning

confidence: 99%

Implications of multimorbidity patterns on health care utilisation and quality of life in middle-income countries: cross-sectional analysis

Sum¹,

Salisbury²,

Koh³

et al. 2019

Journal of Global Health

View full text Add to dashboard Cite

Background Past studies have demonstrated how single non-communicable diseases (NCDs) affect health care utilisation and quality of life (QoL), but not how different NCD combinations interact to affect these. Our study aims to investigate the prevalence of NCD dyad and triad combinations, and the implications of different NCD dyad combinations on health care utilisation and QoL. Methods Our study utilised cross-sectional data from the WHO SAGE study to examine the most prevalent NCD combinations in six large middle-income countries (MICs). Subjects were mostly aged 50 years and above, with a smaller proportion aged 18 to 49 years. Multivariable linear regression was applied to investigate which NCD dyads increased or decreased health care utilisation and QoL, compared with subjects with only one NCD. Results The study included 41 557 subjects. Most prevalent NCD combinations differed by subgroups, including age, gender, income, and residence (urban vs rural). Diabetes, stroke, and depression had the largest effect on increasing mean number of outpatient visits, increasing mean number of hospitalisation days, and decreasing mean QoL scores, respectively. Out of the 36 NCD dyads in our study, thirteen, four, and five dyad combinations were associated with higher or lower mean number of outpatient visits, mean number of hospitalisations, or mean QoL scores, respectively, compared with treating separate patients with one NCD each. Dyads of depression were associated with fewer mean outpatient visits, more hospitalisations, and lower mean QoL scores, compared to patients with one NCD. Dyads of hypertension and diabetes were also associated with a reduced mean number of outpatient visits. Conclusions Certain NCD combinations increase or decrease health care utilisation and QoL substantially more than treating separate patients with one NCD each. Health systems should consider the needs of patients with different multimorbidity patterns to effectively respond to the demands on health care utilisation and to mitigate adverse effects on QoL.

show abstract

Section: Discussionmentioning

confidence: 99%

Implications of multimorbidity patterns on health care utilisation and quality of life in middle-income countries: cross-sectional analysis

Sum¹,

Salisbury²,

Koh³

et al. 2019

Journal of Global Health

View full text Add to dashboard Cite

show abstract

“…Second, the high prevalence of medical comorbidities in persons with psychiatric disorders may lead physicians to treat the patients predominantly as ‘medical’ patients. This might be influenced by clinicians’ general tendency to consider personality disorders as coincidental rather than as a true diagnosis (Tyrer et al ., 2015; Van and Kool, 2018). It is notable that over a third (36%) did not have a treating psychiatrist at the time of their EAS request, only 30% of the EAS physicians were psychiatrists, and half of the EAS evaluations were managed by physicians new to the patient.…”

Section: Discussionmentioning

confidence: 99%

“…Whether these results would be generalizable to some of the more complex cases in our study – with multiple psychiatric and somatic comorbidities – is an open question. However, it is important to note that treatment studies targeting personality disorders and psychiatric comorbidity such as depression are still lacking (Van and Kool, 2018). Similarly, the complex interplay between psychiatric and somatic comorbidity, in particular in female patients, needs further study (WHO, 2001).…”

Section: Discussionmentioning

confidence: 99%

Euthanasia and assisted suicide of persons with psychiatric disorders: the challenge of personality disorders

et al. 2019

View full text Add to dashboard Cite

BackgroundEuthanasia or assisted suicide (EAS) for psychiatric disorders, legal in some countries, remains controversial. Personality disorders are common in psychiatric EAS. They often cause a sense of irremediable suffering and engender complex patient–clinician interactions, both of which could complicate EAS evaluations.MethodsWe conducted a directed-content analysis of all psychiatric EAS cases involving personality and related disorders published by the Dutch regional euthanasia review committees (N = 74, from 2011 to October 2017).ResultsMost patients were women (76%, n = 52), often with long, complex clinical histories: 62% had physical comorbidities, 97% had at least one, and 70% had two or more psychiatric comorbidities. They often had a history of suicide attempts (47%), self-harming behavior (27%), and trauma (36%). In 46%, a previous EAS request had been refused. Past psychiatric treatments varied: e.g. hospitalization and psychotherapy were not tried in 27% and 28%, respectively. In 50%, the physician managing their EAS were new to them, a third (36%) did not have a treating psychiatrist at the time of EAS request, and most physicians performing EAS were non-psychiatrists (70%) relying on cross-sectional psychiatric evaluations focusing on EAS eligibility, not treatment. Physicians evaluating such patients appear to be especially emotionally affected compared with when personality disorders are not present.ConclusionsThe EAS evaluation of persons with personality disorders may be challenging and emotionally complex for their evaluators who are often non-psychiatrists. These factors could influence the interpretation of EAS requirements of irremediability, raising issues that merit further discussion and research.

show abstract

“…Personality disorders continue to challenge clinicians and researchers. These diagnoses are still stigmatised and often present as complex mental states that include comorbid alcohol or substance misuse, depression, dissociative experiences and other mental disorders; cultural factors also complicate the assessment and therapeutic process 1 – 5 . In addition, people diagnosed with personality disorders may face social adversity, loss of social support, interpersonal distress and higher mortality 6 – 8 .…”

Section: Personality Disorders: Still Neglected?mentioning

confidence: 99%

Complex personality disorders

Bhui¹

2018

Br J Psychiatry

View full text Add to dashboard Cite

Personality disorders continue to challenge clinicians and researchers. These diagnoses are still stigmatised and often present as complex mental states that include comorbid alcohol or substance misuse, depression, dissociative experiences and other mental disorders; cultural factors also complicate the assessment and therapeutic process. 1-5 In addition, people diagnosed with personality disorders may face social adversity, loss of social support, interpersonal distress and higher mortality. 6-8 Personality disorders are still underrecognised, especially among minorities, and in some socially excluded groups and service settings. 8-10 Volkert et al (pp. 709-715) provide an updated meta-analysis of the prevalence of categories of personality disorders, showing these to be common; they find that expert ratings produce a lower prevalence estimate than self-ratings.

show abstract

What we do, do not, and need to know about comorbid depression and personality disorders

Cited by 19 publications

References 11 publications

Implications of multimorbidity patterns on health care utilisation and quality of life in middle-income countries: cross-sectional analysis

Implications of multimorbidity patterns on health care utilisation and quality of life in middle-income countries: cross-sectional analysis

Euthanasia and assisted suicide of persons with psychiatric disorders: the challenge of personality disorders

Complex personality disorders

Contact Info

Product

Resources

About