COMORBID PERSONALITY DISORDERS IN MAJOR DEPRESSIVE DISORDER: A COMPARATIVE STUDY IN A 160 TUNISIAN FEMALE INPATIENTS GROUP.

##plugins.themes.academic_pro.article.main##

Yousri EL Kissi
Selma Ben Nasr
Mouna Ayachi
Nader Jedidi
Habib Ghnaya
Bechir Ben Hadj Ali

Abstract

Background : Major Depressive Disorder (MDD) is often comorbid with personality disorders which are known to change its clinical aspects and worsen its outcome. Objective: This study aimed to compare clinical and outcome aspects of a female depressed inpatients group according to the existence or not of a comorbid personality disorder.
Methods: The study was carried in the psychiatry female inpatient unit of Farhat Hached hospital of Sousse. All entrances to the unit from January 1999 to August 2002 were retrospectively reviewed.
160, corresponding to MDD, were selected. Assessment was based on demographic characteristics, medical history, axis I comorbid disorders, clinical aspects of the index episode and outcome characteristics.
Results: 77 patients (48.1 %) had personality disorder. Compared to those without comorbid personality disorder, these patients were younger (p<10-4), with higher educational level (p=0.005) and better vocational functioning (p=0.018). They also had an earlier age at onset of their depression (p<10-4), more previous suicide attempts (p=0.012) and more axis I comorbid disorders (p<10-4). Comorbid personality disorders were correlated to an impaired outcome, with higher rate of relapses (p=0.021), more recurrences (p=0.026), more persistent symptoms (p<10-4) and more suicide attempts (p=0.031).

Keywords:

Psychiatry, Depressive disorder, Personality disorder, Comparative study

##plugins.themes.academic_pro.article.details##

References

  1. AMERICAN PSYCHIATRIC ASSOCIATION. Diagnostic and Statistical Manual of Mental Disorders 4th ed. Washington DC: American Psychiatric Association Press, 1994.
  2. EZQUIAGA E, GARCIA-LOPEZ A, DE DIOS C, LEIVAA, BRAVO M, MONTEJO J. Clinical and psychosocial factors associated with the outcome of unipolar major depression. J Affect Disord 2004; 79: 63-70.
  3. GUELFI JD, HANIN B, GERARD A. Dépression et troubles de la personnalité. In ; Lemperière T, Dépression et comorbidités psychiatriques, Paris : Masson, 2001: 51-66.
  4. JUDD LL. Epidemiology and public health significance of depressive disorders. Eur Neuropsychopharmacol 1995; 5 : 261-2.
  5. VIINAMAKI H, HINTIKKA J, TANSKANEN A, ET al. Partial remission in major depression: a two-phase, 12-month prospective study. Nord J Psychiatry 2002; 56: 33-7.
  6. SCHOEVERS RA, BEEKMAN ATF, VAN TILBURG W et al. Association of depression and gender with mortality in old age. Br J Psychiatry 2000; 177: 336- 42.
  7. BLACK DW, BELL S, HULBERT J, NASRALLAH A. The importance of Axis II in patients with major depression: a controlled study. J Affec Disord 1988; 14: 115-22.
  8. CORRUBLE E, GINESTET D. Comorbidity in a sample of hospitalized depressed patients. Encéphale1996; 22: 119-26.
  9. KLEIN DN, SCHATZBERG AF, MC CULLOUGH JP et al. Age of onset in chronic major depression: relation to demographic and clinical variables, family history, and treatment response. J Affec Disord 1999; 55: 149-57.
  10. SOLOFF PH, LYNCH KG, KELLY TM, MALONE KM, MANN JJ. Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder: A comparative study. Am J Psychiatry 2000; 157: 601-8.
  11. VIINAMÄKI H, HINTIKKA J, HONKALAMPI K, KOIVUMAAHONKANEN H, KUISMA S, ANTIKAINEN R. Cluster C personality disorder impedes alleviation of symptoms in major depression. J Affec Disord 2002; 71: 35-41.
  12. SERRETTI A, LATTUADA E, CUSIN C, GASPERINI M, SMERALDI E. Clinical and demographic features of psychotic and nonpsychotic depression. Compr Psychiatry 1999; 40: 358-62.
  13. RAMKLINT M, EKSELIUS L. Personality traits and personality disorders in early onset versus late onset major depression. J Affec Disord 2003; 75: 35-42.
  14. JOYCE PR, MULDER R, LUTY S, MC KENZIE JM, SOLLIVAN P, CLONINGER RC. Borderline personality disorder in major depression. Compr Psychiatry 2003; 44: 35-43.
  15. BRIEGER P, EHRT U, BLOEINK R, MARNEROS A. Consequences of comorbid personality disorders in major depression. J Nerv Ment Dis 2002; 190: 304-9.
  16. DE LA FUENTE JM, BOBES J, VIZUETE C, MENDLEWICZ J. Sleep-EEG in borderline patients without concomitant major depression: a comparison with major depressives and normal control subjects. Psychiatry Res 2001; 105: 87-95.
  17. ABELA JR, PAYNE AV, MOUSSALY N. Cognitive vulnerability to depression in individuals with borderline personality disorder. J Personal Disord 2003; 17: 319-29.
  18. GRUNHAUS L, SCHREIBER S, DOLBERG OT, POLAK D, DANNON PN. A randomized controlled comparison of electroconvulsive therapy and repetitive transcranial magnetic stimulation in severe and resistant nonpsychotic major depression. Biol Psychiatry 2003; 53: 324-31.
  19. FAVA M, UEBELACKER LA, ALPERT JE, NIERENBERG AA. Major depressive subtypes and treatment response. Biol Psychiatry 1997; 42: 568-76.
  20. KOOL S, DEKKER J, DUIJSENS IJ, DE JONGHE F, PUITE B. Efficacy of combined therapy and pharmacotherapy for depressed patients. Harv Rev Psychiatry 2003; 11: 133-41.
  21. DE BATTISTA C, MUELLER K. Is electroconvulsive therapy effective for the depressed patient with comorbid borderline personality disorder? J ECT 2001; 17: 91-8.
  22. KRISHNAN KR. Comorbidity and Depression Treatment. Biol Psychiatry 2003; 53: 701-6.
  23. GRILO CM, SANISLOW CA, SHEA MT et al. Two-year prospective naturalistic study of remission from major depressive disorder as a function of personality disorder comorbidity. J Consult Clin Psychol 2005; 73: 78-85.
  24. ROGERS JH, WIDIGER TA, KRUPP A. Aspects of depression associated with borderline personality disorder. Am J Psychiatry 1995; 152: 268-70.
  25. KRONMULLER KT, BACKENSTRASS M, RECK C, KRAUS A, FIEDLER P, MUNDT C. Effect of personality factors and structure on the course of major depression. Nervenarzt 2002; 73: 255-61.