Barbato N, Hafner R J
WA Dibden Neuropsychiatry Research Unit, Glenside Hospital, Eastwood, Australia.
Aust N Z J Psychiatry. 1998 Apr;32(2):276-80. doi: 10.3109/00048679809062739.
The aims of this study were to determine the prevalence of personality disorder in a sample of patients with well-documented bipolar disorder, and to assess the effects of comorbidity.
The sample (n = 42) was drawn from patients currently case-managed within a community treatment program who fully met DSM-IV criteria for bipolar I disorder. The International Personality Disorder Examination, a structured interview, was used to diagnose personality disorder. The Brief Symptom Inventory assessed overall levels of psychological symptoms.
Seven of the 13 men (55%) in the sample had 10 personality disorder diagnoses and 12 of the 29 women (41%) had 28 diagnoses, an overall prevalence of 45%. Hospital admission rates and all measures of psychological symptoms and impairment were significantly elevated in the comorbid group, who found medication significantly less helpful.
Comorbid personality disorder was common in the sample studied, which was representative of Australian patients treated in public community psychiatry programs. However, only three (7%) had a personality disorder diagnosis recorded in their case notes, reflecting clinicians' reluctance to apply what is widely viewed as a pejorative and therapeutically nihilistic label. New treatments for personality disorder have proven effective within both public and private psychiatric settings, so that underdiagnosis represents undertreatment. The findings suggest that clinicians should be more vigilant for comorbid personality and bipolar disorder, and less reluctant to diagnose it.
本研究旨在确定有充分记录的双相情感障碍患者样本中人格障碍的患病率，并评估共病的影响。
样本（n = 42）取自目前在社区治疗项目中接受个案管理且完全符合DSM-IV标准的双相I型障碍患者。采用结构化访谈《国际人格障碍检查表》来诊断人格障碍。使用《简明症状量表》评估心理症状的总体水平。
样本中的13名男性中有7名（55%）被诊断出患有人格障碍，29名女性中有12名（41%）被诊断出患有人格障碍，总体患病率为45%。共病组的住院率以及心理症状和功能损害的所有指标均显著升高，且他们发现药物治疗的帮助明显较小。
在所研究的样本中，共病性人格障碍很常见，该样本代表了在公共社区精神病学项目中接受治疗的澳大利亚患者。然而，只有三名（7%）患者的病例记录中有关于人格障碍的诊断，这反映出临床医生不愿使用这个被广泛视为带有贬义且在治疗上毫无意义的标签。新的人格障碍治疗方法已在公共和私人精神病学环境中均被证明有效，因此漏诊意味着治疗不足。研究结果表明，临床医生应对共病的人格障碍和双相情感障碍更加警惕，而不应那么不愿意进行诊断。
