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

Asp, Marie LU ; Lindqvist, Daniel LU ; Fernström, Johan LU ; Ambrus, Livia LU ; Tuninger, Eva LU ; Reis, Margareta LU and Westrin, Åsa LU (2020) In PLoS ONE 15(1).
Abstract

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... (More)

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.

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Contribution to journal
publication status
published
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in
PLoS ONE
volume
15
issue
1
article number
e0227364
publisher
Public Library of Science (PLoS)
external identifiers
  • scopus:85077370173
  • pmid:31895938
ISSN
1932-6203
DOI
10.1371/journal.pone.0227364
language
English
LU publication?
yes
id
fdf6abb2-6638-42cf-826b-8f33db0f1091
date added to LUP
2020-01-21 16:39:43
date last changed
2024-05-15 04:46:22
@article{fdf6abb2-6638-42cf-826b-8f33db0f1091,
  abstract     = {{<p>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&lt;0,0001). Anxiety disorder comorbidity was identified in 58% with SCDP compared to 12% with TDA (p&lt;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.</p>}},
  author       = {{Asp, Marie and Lindqvist, Daniel and Fernström, Johan and Ambrus, Livia and Tuninger, Eva and Reis, Margareta and Westrin, Åsa}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLoS ONE}},
  title        = {{Recognition of personality disorder and anxiety disorder comorbidity in patients treated for depression in secondary psychiatric care}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0227364}},
  doi          = {{10.1371/journal.pone.0227364}},
  volume       = {{15}},
  year         = {{2020}},
}