Maladaptive personality traits in depressive and substance use disorders: A study with the PID-5.

Studies on the relationship between personality and depressive disorders (DD) or substance use disorders (SUD) often refer to the normal personality model and focus mainly on the "big" factors. Domain level results with the Personality Inventory for DSM-5 (PID-5) tend to be consistent with NEO-PI-R or NEO-FFI results, however facet level results in the specific characteristics of these disorders are scarce. The main objective of this study was to characterize DD and SUD's maladaptive personality traits through the PID-5. A sample of DD was compared with a sample of SUD, with a sample of other disorders, and with a community sample. A sample of the general Portuguese population (N = 693) and a heterogeneous clinical sample (N = 310) were studied. Participants responded to the PID-5 and to the Brief Symptom Inventory (BSI). Depressivity, Irresponsibility and Anhedonia were the main characteristics of DD. However, high values in Depressivity and in depressive symptomatology were present in all the clinical subsamples. Irresponsibility, Deceitfulness and Callousness were the main characteristics of SUD. The occurrence of DD, SUD or Other disorders could be predicted using multinonomial logisitic regression analysis, and PID-5 facets as independent variables. These results are in line with comorbidity data and tend to confirm the PID-5 validity.

The Portuguese version of the self-report form of the DSM-5 Level of Personality Functioning Scale (LPFS-SR) in a community and clinical sample.

The Level of Personality Functioning Scale-Self-Report (LPFS-SR) operationalizes Criterion A of the DSM-5 Alternative Model for Personality Disorders. The current study aimed 1) to examine the internal consistency of the Portuguese version of the LPFS-SR in a community sample and a clinical sample, 2) to compare non-clinical participants (N = 282, Mage = 48.01, SD = 10.87) with two samples of clinical participants, one composed of patients with a personality disorder diagnosis (PD sample, n = 40, Mage = 46.18, SD = 13.59) and the other of patients with other psychiatric diagnoses (OD sample, n = 148, Mage = 49.49, SD = 11.88), with respect to LPFS-SR dimensions and total score, 3) to examine the capacity of the LPFS-SR to discriminate between samples through the ROC curve analyses, and 4) to examine the factor structure of the Portuguese version of the LPFS-SR. The Portuguese version of the LPFS-SR revealed adequate internal consistency results, akin to the original data, in the community and clinical samples. The community sample differed significantly from both clinical samples in all the LPFS-SR dimensions and total score. The ROC curve analysis indicated an optimal cut-off for the total score of 272.00, corresponding to a sensitivity of 75% and a specificity of 89%, in the PD vs. community samples. The LPFS-SR total score discriminative capacity between the PD and OD samples was lower, albeit also significant (area-under-the-curve of .63; p = .027; 95% CI: .52-.74). The current study provided evidence of the LPFS-SR's unidimensionality in both community and clinical samples. Although this study has limitations, its findings contribute to a deeper understanding of the LPFS-SR construct, as well as to its cross-cultural validation.

Psychotic spectrum features in borderline and bipolar disorders within the scope of the DSM-5 section III personality traits: a case control study.

BACKGROUND: Psychotic spectrum features in borderline personality disorder (PD) are a long-standing phenomenon, but remarkably, to date, they have not been the focus of many empirical studies. Moreover, the comparative studies that acknowledge their links to affective psychoses are even more scarce. Likewise, the contributions of empirical research on the DSM-5 dimensional approach to this topic are also uncommon. This study seeks to identify the best set of pathological personality traits and/or symptoms that are predictors of psychotic features (psychoticism and ideation paranoid symptoms) in borderline PD and in bipolar disorder, based on the framework of the DSM-5 section III personality traits. METHODS: A cross-sectional study of two clinical samples: 1) Borderline PD group of 63 participants; 2) Bipolar disorder group of 65 participants. Self-reported assessment: Personality Inventory for DSM-5 (PID-5); Brief Symptom Inventory (BSI). A series of linear and logistic regression analyses were computed. RESULTS: Overall, the data emerging as common predictors are detachment, negative affectivity, psychoticism, depressivity, grandiosity, suspiciousness and interpersonal sensitivity symptoms. Borderline PD has the highest score in BSI paranoid ideation which emerges as its discriminating trait (Nagelkerke R2 = .58): cognitive and perceptual dysregulation (OR: 13.02), restricted affectivity (OR: 12.09), withdrawal (OR: 11.70), anhedonia (OR: 10.98) and emotional lability (OR: 6.69). CONCLUSIONS: Besides the commonality that appears to overlap both disorders with a psychosis superspectrum, the patterns of the pathological personality-symptoms underlying the psychotic features appear to reinforce a position between schizophrenia and bipolar disorders that borderline PD may occupy, highlighting the possibility of its intersection with schizoaffective/psychosis spectra. The pathological personality nature of the psychotic features emerges as a potential comprehensive trait of the phenomenological dimensions.

Bridging the ICD11 and the DSM-5 personality disorders classification systems: The role of the PID5BF + M.

Introduction: In both the ICD-11 Classification of Personality Disorders and the DSM-5 Alternative Model of Personality Disorders (AMPD) personality disorders (PD) are characterized by impairments in self- and interpersonal functioning which distinguish the various levels of dysfunction. Moreover, pathological traits are used by these classification systems to define the stylistic expression of personality dysfunction. Negative affectivity, detachment, antagonism/dissociality, and disinhibition feature as trait domains in each of these models. However, there are also differences between the two models, namely, in the psychoticism domain, which does not feature as a personality trait domain in the ICD-11, and in the anankastia domain, corresponding to compulsivity in the DSM-5, which was removed from the final AMPD model. Furthermore, facets are acknowledged by the DSM-5 within each trait domain, while this does not occur in the ICD-11. In view of the similarity between these classification systems, their harmonization would be beneficial for the clinical profession. With this goal in mind, the PID5BF + M, an algorithm that assesses the DSM-5 and ICD-11 six trait domains and 18 facets, was developed and has proven to adequately characterize the ICD-11 trait domains by means of DSM-5 trait facets. Methods: The current study compares a community sample (N = 280, M age = 48.01, 53.2% females) with a PD sample (N = 131, M age = 42.66, 45.0% females) along with the PID5BF + M, the LPFS-SR and the PID-5. Given that the PID5BF + M total can be seen as a measure of the level of personality dysfunction, strong relations between the PID5BF + M total and the LPFS-SR total are expected. Strong relations between the trait specifiers measured by the PID5BF + M and the PID-5 are also expected. Finally, the community and clinical samples are expected to differentiate by means of the dimensions assessed through the three afore-mentioned measures. The Spearman rank-order correlation coefficient was used to measure the strength and direction of associations between the PID5BF + M total and the LPFS-SR total and between the PID5BF + M and the PID-5 traits. Group differences were explored using the Mann-Whitney U test for independent samples. Results: As expected, there were strong, significant, and positive relations between the measures. Furthermore, higher scores were observed in all the variables for the PD group against the community group. Discussion: Although this study has limitations, its findings sustain that the PID5BF + M has potential to assess the severity of personality disfunction and to characterize the stylistic features of PD as they are conceived by both the ICD-11 and the DSM-5. Although more research is needed regarding the convergent validity of the PID5BF + M, this new test contributes to the harmonization of both systems and to parsimony in the assessment of PD, which is the main objective of clinical practice.

The Self-Administered Version of the Structured Interview for Disorders of Extreme Stress (SIDES-SR) in a Clinical and Non-Clinical Portuguese Sample.

Disorders of Extreme Stress Not Otherwise Specified (DESNOS) refers to a constellation of symptoms deriving from chronic interpersonal trauma, inflicted by caregivers or in the context of intimate relationships. The Structured Interview for Disorders of Extreme Stress-Self-Report (SIDES-SR) was designed for the assessment of DESNOS. This study aimed to validate the Portuguese version of the SIDES-SR in the community (N = 814; Mage = 40.09, SD = 14.25, 39.2% male, 60.8% female) and clinical (N = 310; Mage = 42.49, SD = 12.47, 57.7% male, 42.3% female) samples. It had three objectives: (1) to validate the SIDES-SR rationally derived domains in the community sample; (2) to characterise the reliability of the SIDES-SR scales in both samples; and (3) to explore mean differences in the SIDES-SR results in both samples. The Portuguese SIDES-SR confirmed the six clinical domains of DESNOS and demonstrated acceptable internal consistency levels, similar to those obtained in prior research. Highly significant differences and large and very large effect sizes between the community and clinical samples were found for all the SIDES-SR domains. DESNOS symptomatology was shown to be more frequent in females and the clinical sample reported a higher frequency of traumatic events in life, specifically interpersonal trauma. The results support the relevance of the SIDES-SR for clinical practice in the assessment of the DESNOS diagnosis.

The Utility of ICD-11 and DSM-5 Traits for Differentiating Patients With Personality Disorders From Other Clinical Groups.

The ICD-11 Classification of Personality Disorders delineates five trait domain qualifiers (i.e., negative affectivity, detachment, dissociality, disinhibition, and anankastia), whereas the DSM-5 Alternative Model of Personality Disorders also delineates a separate domain of psychoticism. These six combined traits not only characterize individual stylistic features, but also the severity of their maladaptive expressions. It was, therefore, the aim of this study to investigate the utility of ICD-11 and DSM-5 trait domains to differentiate patients with personality disorders (PD) from patients with other mental disorders (non-PD). The Personality Inventory for DSM-5 Brief Form Plus (PID5BF+M) was administered to a sample of patients diagnosed with a personality disorder (N = 124, M age = 42.21, 42.7% females) along with a sample of patients diagnosed with other mental disorders (N = 335, M age = 44.83, 46.6% females). Group differences were explored using the independent sample t test or the Mann-Whitney U test for independent samples, and discriminant factor analysis was used to maximize group differences for each trait domain and facet score. The PD group showed significantly higher scores for the total PID5BF+M composite score, for the trait domains of negative affectivity, antagonism/dissociality, and disinhibition and for the trait facets of emotional lability, manipulativeness, deceitfulness, and impulsivity. The trait domains of disinhibition, negative affectivity, and antagonism/dissociality as well as the trait facets of impulsivity, deceitfulness, emotional lability, and manipulativeness were the best discriminators between PD and non-PD patients. The global PID5BF+M composite score was also one of the best discriminators supporting its potential as a global severity index for detecting personality dysfunction. Finally, high scores in three or more of the 18 PID5BF+M facets suggested the possible presence of a PD diagnosis. Despite some limitations, our findings suggest that the ICD-11 and DSM-5 traits have the potential to specifically describe the stylistic features that characterize individuals with PD, including the severity of their maladaptive expressions.

In light of the DSM-5 dimensional model of personality: Borderline personality disorder at the crossroads with the bipolar spectrum.

BACKGROUND: State-of-the-art research highlights that borderline personality disorder (PD) and bipolar spectrum disorders have clinical characteristics in common, which imply uncertainty in differential diagnoses. Although there is a growing body of literature on the DSM-5 dimensional model of personality disorder, its discriminative features between these clinical samples are still understudied. In this study, we seek to identify the best set of predictors that differentiate between borderline PD and bipolar spectrum, based on pathological and normative personality traits and symptoms. METHODS: A cross-sectional study of three clinical samples: 1) Borderline PD group of 63 participants; 2) Major depressive disorder group of 89 participants; 3) Bipolar disorder group of 65 participants. Self-reported assessment: Personality Inventory for DSM-5; Brief Symptom Inventory; FFM Inventory. A series of one-way ANOVAs and logistic regression analyses were computed. RESULTS: The major set of data emerging as common discriminants of borderline PD across the bipolar spectrum are unusual beliefs & experiences, paranoid ideation, obsession-compulsion and extraversion. Depressivity (OR: 34.95) and impulsivity (OR: 22.35) pathological traits displayed the greatest predictive values in the differential diagnosis. LIMITATIONS: The small size of the samples; a lack of data from participants' previous clinical history. CONCLUSIONS: Findings support the DSM-5 pathological traits as differentiating borderline PD through bipolar spectrum, and reinforcing the joint use of symptom-related pathological functioning and normal-range personality traits. Alongside the bipolar spectrum, borderline pathology sheds light upon a hypothetical overlap along the depressive and schizoaffective/schizophrenia spectra, representing a borderland space at a crossroads with the psychopathology of a meta-spectrum.

The Portuguese version of the Personality Inventory for the DSM-5 in a community and a clinical sample.

The Personality Inventory for DSM-5 (PID-5) measures the maladaptive traits of the model for personality and its disorders, as proposed in section III of the DSM-5. The current study aimed to examine whether the Portuguese PID-5 distinguished non-clinical participants (N = 1223, Mage  = 36.73, standard deviation = 15.72) from clinical participants (N = 202, Mage  = 43.82, standard deviation = 11.33) with respect to dysfunctional personality traits and to explore the PID-5 factor structure in both samples. The PID-5 scale medians were higher in the clinical sample than in the community sample. All analyses were statistically significant (p ≤ 0.001) with medium size effects. In the community sample, a five-factor structure emerged, and the factors resembled the PID-5 domains. However, in the clinical sample, a four-factor structure was retained, in which the Psychoticism domain did not clearly emerge. The composition of the clinical sample along with its small size may account for these unexpected results. Overall, the results provide evidence of the PID-5's ability to distinguish between psychiatric and community individuals and of the model's structural similarity in community samples, across studies and nationalities. More research is required to understand the Portuguese PID-5 structure in clinical samples. © 2018 John Wiley & Sons, Ltd.

[Level of knowledge of the compositions of analgesic medication containing aspirin]. / Nível de conhecimento sobre a composição de analgésicos com ácido acetilsalicílico.

OBJECTIVE: To evaluate the knowledge of the generic designation, use and composition of analgesic medications containing aspirin. METHODS: A total of 124 interviews were carried out between December 1999 and January 2000, in two neighborhoods of the city of Porto Alegre, southern Brazil. The interview was held with the person who came to answer the door at each of the homes that was drawn. The data collection instruments comprised a set of five different pharmaceutical specialties containing acetylsalicylic acid, and an interview consisting of two open questions concerning the differences and similarities between the products. RESULTS: Three major knowledge-level groups were characterized on the basis of the information that the interviewees were able to provide. The group that was knowledgeable about the matter comprised 14 individuals (11%). The group with limited knowledge contained 61 people (49)%. Those who had no knowledge of the matter at all formed a group of 49 people (40%). CONCLUSIONS: Taking the results as a whole, they indicate that most people (about 90% of the sample investigated) are simply not aware of what the active substance is, even in pharmaceutical specialties that they use frequently.

Nível de conhecimento sobre a composição de analgésicos com ácido acetilsalicílico / Level of knowledge of the compositions of analgesic medication containing aspirin

OBJETIVO: Avaliar o conhecimento sobre a designação genérica, uso e composição de medicamentos analgésicos contendo ácido acetilsalicílico. MÉTODOS: Foram realizadas 124 entrevistas entre dezembro de 1999 e janeiro de 2000, em dois bairros da cidade de Porto Alegre, RS. As entrevistas foram respondidas pela pessoa que atendeu o entrevistador em cada um dos domicílios sorteados. Os instrumentos de coleta de dados foram uma cartela com cinco especialidades farmacêuticas de analgésicos contendo ácido acetilsalicílico e uma entrevista com duas perguntas abertas sobre diferenças e semelhanças entre os produtos. RESULTADOS: A partir do nível de informação demonstrado pelos entrevistados, foram caracterizados três grandes grupos de conhecimento. O grupo das pessoas que demonstraram domínio sobre o assunto foi de 14 indivíduos (11 por cento); os que demonstraram domínio limitado foi de 61 pessoas (49 por cento); e os que não demonstraram domínio sobre o assunto formaram um grupo de 49 pessoas (40 por cento). CONCLUSÕES: Considerando o conjunto de resultados, verificou-se que a maioria das pessoas (cerca de 90 por cento na amostra avaliada) simplesmente desconhece qual a substância ativa presente em uma especialidade farmacêutica de seu uso freqüente.

Contribuição da atenção farmacêutica no tratamento de pacientes hipertensos / Pharmaceutical care in the management of patients with hypertension

Atenção farmacêutica é uma nova prática profissional baseada em ações pró-ativas recomendadas pela Organização Mundial da Saúde (OMS), Associações Médicas Internacionais e pelo Conselho Nacional de Saúde do Brasil. Sua implementação entre as práticas de atenção à saúde pode contribuir para a resolução de problemas de saúde pública. Os primeiros estudos realizados, para avaliar a efetividade dessa intervenção no tratamento de pacientes hipertensos não-controlados, demonstram sua exeqüibilidade e potencial contribuição para o controle da hipertensão