Williams Erika D, Reimherr Frederick W, Marchant Barrie K, Strong Robert E, Halls Corinne, Soni Poonam, Gale Phillip D, Robison Reid J
Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT 84132, USA.
Ann Clin Psychiatry. 2010 May;22(2):84-93.
Comorbidity of personality disorder (PD) and attention-deficit/hyperactivity disorder (ADHD) has been suggested in several reports. However, assessment of PD is problematic, and studies have over-relied on baseline evaluations.
Forty-seven patients entered a double-blind trial of osmotic release oral system (OROS) methylphenidate (MPH). Patients were assessed at baseline with the Wisconsin Personality Inventory IV (WISPI-IV) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Following the study, all information-including tests, family reports, and extended clinical observations-produced a final PD diagnosis. Three post hoc categories were created: PD-negative (no PD), PD-positive (1 PD), and PD-plus (2 or more PDs).
Twenty-one (45%) patients had a PD on the final assessment vs 62% using SCID-II and 33% using WISPI-IV; final PD diagnosis revealed 9% cluster A, 17% cluster B, and 28% cluster C. Twenty-one percent of patients experienced multiple disorders. Using a weighted kappa, the number of PDs on the final assessment correlated with the WISPI-IV (kappa=.53; P > .001) and the SCID-II (kappa =.70; P < .001). However the SCID-II overidentified and the WISPI-IV underidentified PD.
Almost all PDs were represented in this sample, and past emphasis on cluster B appears unwarranted. Although the SCID-II and WISPI-IV had limited success in identifying specific PDs, they were more successful in identifying the number of PDs present in each patient. The small sample makes these findings preliminary.
几份报告中都指出了人格障碍（PD）与注意力缺陷多动障碍（ADHD）的共病情况。然而，人格障碍的评估存在问题，并且研究过度依赖基线评估。
47名患者进入了渗透泵控释口服系统（OROS）哌甲酯（MPH）的双盲试验。患者在基线时使用威斯康星人格量表第四版（WISPI-IV）和《精神疾病诊断与统计手册》第四版轴II人格障碍结构化临床访谈（SCID-II）进行评估。研究结束后，所有信息——包括测试、家庭报告和扩展临床观察——得出最终的人格障碍诊断。创建了三个事后分类：人格障碍阴性（无人格障碍）、人格障碍阳性（1种人格障碍）和人格障碍加（2种或更多种人格障碍）。
最终评估时有21名（45%）患者患有人格障碍，而使用SCID-II时为62%，使用WISPI-IV时为33%；最终的人格障碍诊断显示9%为A簇，17%为B簇，28%为C簇。21%的患者患有多种障碍。使用加权kappa系数，最终评估时的人格障碍数量与WISPI-IV（kappa = 0.53；P > 0.001）和SCID-II（kappa = 0.70；P < 0.001）相关。然而，SCID-II过度识别了人格障碍，而WISPI-IV则识别不足。
该样本中几乎涵盖了所有类型的人格障碍，过去对B簇的强调似乎没有必要。尽管SCID-II和WISPI-IV在识别特定人格障碍方面成效有限，但它们在识别每位患者存在的人格障碍数量方面更为成功。样本量小使得这些发现具有初步性。
