Zimmerman Mark, Rothschild Louis, Chelminski Iwona
Bayside Medical Center, 235 Plain Street, Providence, RI 02905, USA.
Am J Psychiatry. 2005 Oct;162(10):1911-8. doi: 10.1176/appi.ajp.162.10.1911.
The largest clinical epidemiological surveys of personality disorders have been based on unstructured clinical evaluations. However, several recent studies have questioned the accuracy and thoroughness of clinical diagnostic interviews; consequently, clinical epidemiological studies, like community-based studies, should be based on standardized evaluations. The Rhode Island Methods to Improve Diagnostic Assessment and Services project is one of the largest clinical epidemiological studies to use semistructured interviews to assess a wide range of psychiatric disorders conducted in general clinical outpatient practice. In the present report, the authors examined the frequency of DSM-IV personality disorders in a patient group and the comorbidity among them.
Eight hundred fifty-nine psychiatric outpatients were interviewed with the Structured Interview for DSM-IV Personality upon presentation for treatment.
Slightly less than one-third of the patients were diagnosed with one of the 10 official DSM-IV personality disorders (N=270, 31.4%). When the patients with personality disorder not otherwise specified were included, the rate of any personality disorder increased to almost half of the group (N=391, 45.5%). The majority of patients meeting criteria for one of the specific personality disorders were diagnosed with more than one. Avoidant, borderline, and obsessive-compulsive personality disorder were the most frequent specific diagnoses.
Personality disorders, as a group, are among the most frequent disorders treated by psychiatrists. They should be evaluated in all psychiatric patients because their presence can influence the course and treatment of the axis I disorder that patients typically identify as their chief complaint.
人格障碍最大规模的临床流行病学调查一直基于非结构化临床评估。然而，最近的几项研究对临床诊断访谈的准确性和全面性提出了质疑；因此，临床流行病学研究，如同基于社区的研究一样，应基于标准化评估。罗德岛改善诊断评估与服务方法项目是规模最大的临床流行病学研究之一，该研究采用半结构化访谈来评估一般临床门诊实践中广泛的精神障碍。在本报告中，作者研究了一组患者中《精神疾病诊断与统计手册》第四版（DSM-IV）人格障碍的发生率及其共病情况。
859名精神科门诊患者在就诊接受治疗时接受了DSM-IV人格结构化访谈。
略少于三分之一的患者被诊断患有一种10种正式的DSM-IV人格障碍（N = 270，31.4%）。若将未另行规定的人格障碍患者包括在内，任何人格障碍的发生率增至该组患者的近一半（N = 391，45.5%）。大多数符合特定人格障碍标准的患者被诊断患有一种以上障碍。回避型、边缘型和强迫型人格障碍是最常见的特定诊断类型。
人格障碍作为一个群体，是精神科医生治疗的最常见疾病之一。应在所有精神科患者中对其进行评估，因为人格障碍的存在会影响患者通常作为主要诉求的轴I障碍的病程和治疗。
