Recognition of personality disorder and anxiety disorder comorbidity in patients treated for depression in secondary psychiatric care


Autoři: Marie Asp aff001;  Daniel Lindqvist aff001;  Johan Fernström aff001;  Livia Ambrus aff001;  Eva Tuninger aff001;  Margareta Reis aff003;  Åsa Westrin aff001
Působiště autorů: Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden aff001;  Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden aff002;  Department of Clinical Pharmacology, Linköping University, Linköping, Sweden aff003
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227364

Souhrn

Objectives

Depression is a common illness with substantial economic consequences for society and a great burden for affected individuals. About 30% of patients with depression do not respond to repeated treatments. Psychiatric comorbidity is known to affect duration, recurrence and treatment outcome of depression. However, there is a lack of knowledge on the extent to which psychiatric comorbidity is identified in the clinical setting for depressed patients in secondary psychiatric care. Therefore, the aim of this study was to compare the agreement between traditional diagnostic assessment (TDA) and a structured and comprehensive diagnostic procedure (SCDP) for identification of personality and anxiety disorder comorbidity in depressed patients in secondary psychiatric care.

Methods

274 patients aged 18–77 were referred from four secondary psychiatric care clinics in Sweden during 2012–2017. ICD-10 diagnoses according to TDA (mostly unstructured by psychiatric specialist and residents in psychiatry), were retrieved from medical records and compared to diagnoses resulting from the SCDP in the study. This included the Mini International Neuropsychiatric Interview, the Structured Interview for DSM Axis II Personality Disorders and semi-structured questions on psychosocial circumstances, life-events, psychiatric symptoms, psychiatric treatments, substance use, and suicidal and self-harm behaviour. The assessment was carried out by psychiatric specialists or by residents in psychiatry with at least three years of psychiatric training.

Results

SCDP identified personality disorder comorbidity in 43% of the patients compared to 11% in TDA (p<0,0001). Anxiety disorder comorbidity was identified in 58% with SCDP compared to 12% with TDA (p<0,0001).

Conclusions

Important psychiatric comorbidity seems to be unrecognized in depressive patients when using TDA, which is routine in secondary psychiatric care. Comorbidities are better identified using the proposed model involving structured and semi-structured interviews together with clinical evaluations by clinical experts.

Klíčová slova:

Anxiety disorders – Depression – Diagnostic medicine – Mental health and psychiatry – Neuropsychological testing – Personality disorders – Personality tests – Suicide


Zdroje

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