Cocchi Maddalena, Girone Nicolaja, Leonardi Matteo, Achilli Francesco, Benatti Beatrice, dell'Osso Bernardo
Luigi Sacco University Hospital, University of Milan, Via GB Grassi 74, 20154 Milan, Italy.
University of Milan, Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, Milan, Italy and "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy.
Clin Neuropsychiatry. 2025 Aug;22(4):279-286. doi: 10.36131/cnfioritieditore20250402.
Personality disorders (PDs) are chronic and pervasive mental health conditions associated with significant functional impairment and high psychiatric comorbidity. Although psychotherapeutic interventions are the primary treatment approach, pharmacotherapy is frequently prescribed to manage specific symptoms. However, adherence to pharmacological treatment in PDs remains a critical challenge, influenced by both personality traits and clinical factors. The present study aims to assess adherence rates in a large cohort of patients with PDs and explore potential sociodemographic and clinical factors associated with compliance.
This observational study included 200 patients diagnosed with PDs according to DSM-5 criteria, recruited from different psychiatric services in Milan, Italy. Adherence was assessed using the Clinician Rating Scale (CRS), with positive adherence defined as CRS ≥ 5 and poor adherence as CRS < 5. Sociodemographic and clinical data were collected and analyzed across adherence groups and PD clusters.
Positive adherence was observed in 64.5% of the sample. Cluster C PDs exhibited significantly higher adherence rates (83.3%) compared to Cluster B (61.3%), mixed-feature (60%), and Cluster A (73.3%; p<.05). A positive family history of psychiatric disorders was associated with greater adherence (60.3% vs. 45.5%, p<.05). A trend toward lower adherence was observed in patients with lifetime and current substance use.
Higher adherence in Cluster C PDs may be linked to anxiety-driven behavioral patterns, while lower adherence in Cluster B and mixed-feature PDs suggests impulsivity and mistrust contribute to non-compliance. Additionally, a positive family history of psychiatric disorders emerged as a potential protective factor, possibly enhancing treatment engagement through greater awareness and support networks. Future research should focus on developing tailored interventions to the specific needs of different PD clusters to improve long-term treatment outcomes.
人格障碍（PDs）是慢性且普遍存在的心理健康状况，与显著的功能损害和高精神共病率相关。尽管心理治疗干预是主要的治疗方法，但药物治疗也经常被用于管理特定症状。然而，人格障碍患者对药物治疗的依从性仍然是一个关键挑战，受到人格特质和临床因素的影响。本研究旨在评估一大群人格障碍患者的依从率，并探索与依从性相关的潜在社会人口学和临床因素。
这项观察性研究纳入了200名根据DSM-5标准诊断为PDs的患者，这些患者从意大利米兰的不同精神科服务机构招募。使用临床医生评定量表（CRS）评估依从性，CRS≥5定义为依从性良好，CRS<5定义为依从性差。收集并分析了依从性组和PD簇之间的社会人口学和临床数据。
样本中64.5%的患者依从性良好。与B簇（61.3%）、混合特征（60%）和A簇（73.3%；p<0.05）相比，C簇人格障碍患者的依从率显著更高（83.3%）。精神疾病的阳性家族史与更高的依从性相关（60.3%对45.5%，p<0.05）。在有终生和当前物质使用史的患者中观察到依从性较低的趋势。
C簇人格障碍患者较高的依从性可能与焦虑驱动的行为模式有关，而B簇和混合特征人格障碍患者较低的依从性表明冲动性和不信任导致不依从。此外，精神疾病的阳性家族史是一个潜在的保护因素，可能通过更强的意识和支持网络增强治疗参与度。未来的研究应专注于针对不同PD簇的特定需求开发量身定制的干预措施，以改善长期治疗效果。
