Treatment outlines for paranoid, schizotypal and schizoid personality disorders. The Quality Assurance Project

Childhood adversity, mental disorder comorbidity, and suicidal behavior in schizotypal personality disorder

Schizotypal personality disorder (SPD) is a serious and relatively common psychiatric disorder, yet remains understudied among the personality disorders. The current study examines the psychiatric correlates of SPD in a representative epidemiologic sample, utilizing data from the National Epidemiological Survey on Alcohol and Related Conditions (N = 34,653). Multiple logistic regression compared people with SPD to the general population across a broad range of childhood adversities, comorbid psychiatric disorders, and suicidal behavior. SPD was strongly associated with many adverse childhood experiences. After adjusting for confounding factors, SPD was independently associated with major depression and several anxiety disorders, including post-traumatic stress disorder. Interestingly, SPD was more strongly associated with borderline and narcissistic personality disorders than cluster A personality disorders. Individuals with SPD were also more likely to attempt suicide. As a whole, these results suggest that individuals with SPD experience significant morbidity and may be at increased risk of mortality.

Cluster A personality disorders: considering the 'odd-eccentric' in psychiatric nursing

Psychiatric nurses are familiar with the concept of personality disorder because of their contact with persons with the most common personality disorder in clinical settings - borderline type, who frequently engage mental health services. Perhaps it is this familiarity that has focused research and clinical attention on borderline personality disorder compared with the other personality disorders. The significance of cluster A personality disorders for nursing is multifaceted because of their severity, prevalence, inaccurate diagnosis, poor response to treatment, and similarities to axis I diagnoses. Despite this, literature reviews have established that relatively few studies have focused on the treatment of the cluster A personality disorders - paranoid, schizotypal, and schizoid - resulting in a dearth of evidence-based interventions for this group of clients. A discussion of these disorders in the context of personality disorder and their individual characteristics demonstrates the distinctive and challenging engagement techniques required by psychiatric nurses to provide effective treatment and care. It is also strongly indicated that the discipline of psychiatric nursing has not yet begun to address the care of persons with cluster A personality disorders.

[Psychotherapeutic treatment of personality disorders]

Treating patients with personality disorders presents a major challenge due to their maladaptive interpersonal styles which affect the therapeutic relationship. A number of therapeutic approaches using psychodynamic, behavioural, and other origins have been developed to treat patients with personality disorders, most of them dealing with borderline personality disorder. Overall, only a few controlled therapy studies have been carried out to document therapy effectiveness. However, available research indicates that psychotherapy has substantial effects even in personality disorders. From a vast literature based on case reports, therapeutic recommendations are presented for specific personality disorders.

Schizophrenia: family studies and treatment of spectrum disorders

A substantial part of the contribution of genetic studies to the treatment of schizophrenia involves its emphasis on reliable and valid diagnoses. One consequence of this focus is the recognition that schizophrenic illness is broader than the diagnostic entity of schizophrenia itself, and instead consists of a “spectrum” of related disorders. Because some of the symptoms in these disorders differ from each other, they provide an opportunity to determine which ones reflect a common etiology. To the extent that such symptoms are identifiable, they may provide a foundation for treatment and even prevention strategies. In this paper, we focus on a clinical condition - “schizotaxia” - that may reflect the liability for schizophrenia. To characterize the nature and extent of this proposed syndrome, we will review results from family studies in our laboratory, and consider conceptual foundations and criteria for assessment. A more general consideration of treatment strategies for schizophrenia spectrum disorders follows, along with suggestions for future research. Our initial attempts to treat and validate schizotaxia are encouraging, and raise the possibility that early treatment might eventually prevent or attenuate the development of other, more severe disorders in the schizophrenia spectrum, including schizophrenia itself.

Structural characteristics of Australasian psychiatric practice

A questionnaire examining structural and basic process characteristics of psychiatric practice was prepared by the RANZCP Quality Assurance Committee and circulated to all Fellows of the College in 1991. There were 830 replies (48%). A one in two sample of the replies was analysed and forms the basis of the descriptive report presented in this paper.

Treatment outlines for antisocial personality disorder. The Quality Assurance Project

The notion of antisocial behaviour as mental disorder is reviewed and criteria to distinguish it from criminality described. The natural history and familial nature of the disorder are emphasised. The literature was searched unsuccessfully for accounts of effective treatments. The sample of practising psychiatrists and the nominated experts were agreed, in the absence of any specific remedy, about the management of such patients. There are three principles. Clarify the real reason help is being sought, treat intercurrent conditions energetically, and remember that as remission is common by mid-life what happens to the patient before then may materially affect their ability to manage later.

The changing nature of psychiatry

The traditional role of psychiatrist as the central figure in the delivery of mental health services is changing. First, the advent of structured diagnostic interviews means that the diagnosis of mental disorders is no longer the exclusive preserve of psychiatrists; second, the growth of community mental health services staffed by non-psychiatrists means that psychiatrists now treat a minority of the patients with mental disorders; and third, the psychiatrists' continued endorsement of dynamic psychotherapy means they are becoming identified with an unproven and very expensive treatment. These changes should be seen against the broader background of a profession that is well-trained, active in evaluating performance, supported by a burgeoning research base in cognitive science and neuroscience, and delivering services efficiently and inexpensively.

Treatment outlines for avoidant, dependent and passive-aggressive personality disorders. The Quality Assurance Project

Treatment outlines for avoidant, dependent and passive-aggressive personality disorders were developed by having nominated experts consider their own views in the light of the treatment literature and the responses of practising psychiatrists. The experts recommend that long-term psychotherapy is the treatment of choice and that a considerable component of the outcome will be related to the therapeutic relationship. Assessment, general approaches to treatment, and strategies in psychodynamic management are outlined in some detail. For those individuals for whom long-term therapy is not available or appropriate, other therapies, such as cognitive behavioural therapy, can be promising.