Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Schizotypal Personality Disorder

Autor: Tulshi D. Saha, S. Patricia Chou, Sharon M. Smith, Bridget F. Grant, W. June Ruan, Roger P. Pickering, Frederick S. Stinson, Boji Huang, Deborah A. Dawson, Deborah S. Hasin, Attila J. Pulay, Risë B. Goldstein
Rok vydání: 2009
Předmět:
Zdroj: The Primary Care Companion to The Journal of Clinical Psychiatry. 11:53-67
ISSN: 1523-5998
DOI: 10.4088/pcc.08m00679
Popis: Schizotypal personality disorder (SPD) is a serious psychiatric disorder, the essential feature of which is a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships and cognitive or perceptual distortions and eccentricities.1 Schizotypal personality disorder has been associated with severe reductions in quality of life,2 functional impairment,3,4 and high rates of comorbidity with many substance use, mood, anxiety, psychotic, and other personality disorders.5–14 For Clinical Use ♦ Although schizotypal personality disorder (SPD) is more prevalent among men than women, it is associated with significant disability and is highly comorbid with Axis I and II disorders in both sexes. ♦ Managing male and female patients with SPD may require different treatment strategies due to the sex-specific pattern of co-occurring psychiatric disorders. ♦ Patients with SPD, as well as those with borderline, dependent, and avoidant personality disorders, should be carefully monitored for psychotic episodes and for development of schizophrenia. Schizotypal personality disorder is becoming increasingly important in its own right as a significant personality disorder and as a disorder that may provide important insights into the origins of schizophrenia.15,16 The cognitive-perceptual and interpersonal disturbances, together with disorganized speech and behavior, of SPD have been viewed as a premorbid or prodromal stage of this major psychotic disorder.17–19 This view is supported by the increased frequency of SPD in families of patients diagnosed with schizophrenia and in the adopted-away offspring of mothers with schizophrenia spectrum disorder20–25 and by an increasing use of SPD criteria in the development of structured prodromal screening criteria for schizophrenia.26–28 Despite considerable research devoted to identifying individuals predisposed to schizophrenia, very little is known about the prevalence, correlates, disability, and comorbidity of SPD in large general population samples. Earlier community surveys were geographically restricted to states, and usually cities, in addition to being limited by small sample sizes (N = 133 to 799).3,29–39 Others preselected individuals from larger general population samples based on responses to personality disorder screening scales or psychopathology in general, further limiting the sample sizes on which the prevalence estimates were based.34,40–42 Although 1 larger general population survey (N = 2053),43 compromised by a low response rate (57%), together with 4 other smaller studies34,35,39,40 have provided basic sociodemographic data on SPD (sex, age, marital status, urbanicity), none were large enough to provide detailed information on characteristics such as race-ethnicity or socioeconomic status. Moreover, only 1 prior epidemiologic study39 has examined disability and comorbidity of SPD with other Axis I and II disorders. To fill this gap in the personality disorder literature, the major objective of this study was to present current, comprehensive, and detailed information on the prevalence, correlates, disability, and comorbidity of SPD in the United States using the 2004–2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).44 The Wave 2 NESARC covered DSM-IV alcohol and specific drug use disorders as well as mood and anxiety disorders assessed in the 2001–2002 Wave 1 NESARC,45,46 in addition to SPD and borderline and narcissistic personality disorders, and posttraumatic stress disorder. The remaining DSM-IV personality disorders (avoidant, dependent, obsessive-compulsive, paranoid, schizoid, histrionic, and antisocial) were assessed in the Wave 1 NESARC. The sample size and high response rate of the Wave 2 NESARC allow for reliable and precise estimation of lifetime prevalence of SPD, especially among important sociodemographic subgroups of the population. The sample size also enabled the examination of comorbidity of SPD with specific Axis I and II disorders with control for both sociodemographic characteristics and additional psychiatric disorders, thereby allowing the determination of the unique relationship of each specific disorder to SPD. The importance of controlling for other disorders that are highly comorbid with one another represents an advance in our understanding of comorbidity recently highlighted in the epidemiologic literature.47,48 This study also provides information on mental disability associated with SPD. All analyses of prevalences, correlates, disability, and comorbidity were conducted separately for men and women. Because so little is known about the relationship between SPD and schizophrenia in large general population samples, the association of SPD with the occurrence of schizophrenia or psychotic episode was examined. If SPD reflects the phenotypic expression of a genetic predisposition to schizophrenia, it would be expected that SPD would be highly and significantly associated with this diagnosis. Associations of other DSM-IV personality disorders with schizophrenia or psychotic episode, some of which have been shown to have greater prevalences in relatives of probands with schizophrenia compared with relatives of controls, are also assessed in this study.
Databáze: OpenAIRE
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