Division of Psychiatry, UCL, London, United Kingdom.
Camden and Islington NHS Foundation Trust, London, United Kingdom.
PLoS One. 2020 Jun 5;15(6):e0234047. doi: 10.1371/journal.pone.0234047. eCollection 2020.
Personality Disorders (PD) often share clinical and phenomenological overlap with psychotic disorders, especially at onset. However, there is little research on comorbid PD among people experiencing first episode psychosis. We examined the prevalence of PD recording and its sociodemographic and clinical correlates in people accepted to Early Intervention in Psychosis (EIP) services.
Participants were aged 16-35, accepted into 6 EIP services for suspected psychosis, as part of the Social Epidemiology of Psychoses in East Anglia (SEPEA) study. PD was recorded by clinicians according to ICD-10. Multilevel logistic regression was performed.
Of 798 participants, 76 people (9.5%) received a clinical diagnosis of PD, with emotionally unstable PD (75.0%, N = 57) the most common subtype. In multivariable analysis, risk factors for PD included female sex (odds ratio [OR]: 3.4; 95% CI: 2.0-5.7), absence of psychotic disorder after acceptance to EIP (OR: 3.0; 95% CI: 1.6-5.5), more severe hallucinations (OR: 1.6; 95% CI: 1.2-2.1), and lower parental SES (OR: 1.4; 95% CI: 1.1-1.8). Compared with the white British, black and minority ethnic groups were less likely to receive a PD diagnosis (OR: 0.3; 95% CI: 0.1-0.7). There was no association between PD and neighbourhood-level deprivation or population-density.
Recording of a PD diagnosis was three times more common amongst participants later found not to meet threshold criteria for psychotic disorder, implying phenomenological overlap at referral which highlights difficulties encountered in accurate diagnostic assessment, treatment and onward referral. People with PD experienced more individual-level, but not neighbourhood-level social disadvantage in an already disadvantaged sample.
人格障碍（PD）常与精神病性障碍具有临床和现象学上的重叠，尤其是在发病初期。然而，在首次出现精神病性症状的人群中，关于共患 PD 的研究甚少。我们研究了在接受早期精神病干预（EIP）服务的人群中 PD 的患病率及其与社会人口学和临床特征的相关性。
参与者年龄在 16-35 岁之间，被纳入 6 家 EIP 服务机构，以接受疑似精神病的治疗，该研究是东英吉利地区精神病社会流行病学（SEPEA）研究的一部分。PD 由临床医生根据 ICD-10 进行诊断。采用多水平逻辑回归进行分析。
在 798 名参与者中，76 人（9.5%）被临床诊断为 PD，其中情绪不稳定型 PD（75.0%，N=57）是最常见的亚型。多变量分析显示，PD 的危险因素包括女性（优势比[OR]：3.4；95%置信区间[CI]：2.0-5.7）、EIP 服务机构接受后未出现精神病性障碍（OR：3.0；95% CI：1.6-5.5）、更严重的幻觉（OR：1.6；95% CI：1.2-2.1）和较低的父母社会经济地位（OR：1.4；95% CI：1.1-1.8）。与白种英国人相比，黑人及少数族裔人群更不可能被诊断为 PD（OR：0.3；95% CI：0.1-0.7）。PD 与社区层面的贫困程度或人口密度无关。
在后来被发现不符合精神病性障碍诊断标准的参与者中，PD 的诊断记录要高出三倍，这表明在转介时存在现象学重叠，突出了在准确诊断评估、治疗和后续转介方面所面临的困难。在本已处于劣势的样本中，PD 患者经历了更多个体层面的社会劣势，但在社区层面没有劣势。
