Hostname: page-component-76fb5796d-22dnz Total loading time: 0 Render date: 2024-04-28T10:27:57.620Z Has data issue: false hasContentIssue false
  • English
  • Français

Social function, clinical symptoms and personality disturbance

Published online by Cambridge University Press:  13 June 2014

Ula Nur ,
Peter Tyrer ,
Stephen Merson  and
Tony Johnson
Ula Nur
Affiliation:
Department of Psychological Medicine, Imperial College, Claybrook Centre, 37 Claybrook Road, W6 8LN, England
Peter Tyrer
Affiliation:
Department of Psychological Medicine, Imperial College, Claybrook Centre, 37 Claybrook Road, W6 8LN, England
Stephen Merson
Affiliation:
Assertive Outreach, 1 Benton View, Forest Hall, Newcastle upon Tyne, NE12 OJJ, England
Tony Johnson
Affiliation:
MRC Biostatistics Unit, University of Cambridge Institute of Public Health, England
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: To investigate the relationship between psychiatric symptoms, personality disturbance, and social function.

Method: Longitudinal study of 100 psychiatric patients presenting as emergencies originally entered to a randomised trial of community and hospital-based treatment strategies. Ratings of social function using the Social Functioning Questionnaire, personality status using the Personality Assessment Schedule, and clinical symptomatology using the Comprehensive Psycho-pathological Rating Scale were recorded at baseline with assessment of social function repeated at two, four and 12 weeks. Correlation, regression, and path analysis were performed to test the hypothesis that personality status had more influence than clinical symptoms on social function.

Results: Path and regression analysis showed, that at baseline both psychopathology and personality pathology contributed to social dysfunction equally, but from two weeks onwards personality abnormality contributed to a greater degree than clinical psychopathology. Of the 100, 35 patients had a personality disorder and in these there was a strong correlation between social function scores at baseline and 12 weeks (48% of variation explained) whereas in those with no personality disorder the correlation was much weaker (14%); regression analyses confirmed this conclusion.

Conclusions: Psychopathology and personality status contribute to social dysfunction in patients presenting as emergencies but persistent social dysfunction is more likely to reflect personality pathology than other forms of mental disorder.

Keywords

Social functionPersonality disorderPsychopathologyChronicity
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 21 , Issue 1 , March 2004 , pp. 18 - 21
Copyright
Copyright © Cambridge University Press 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Tyrer, P, Casey, P. Social Function in Psychiatry: the Hidden Axis of Classification Exposed. Petersfield: Wrightson Biomedical Publishing Ltd; 1993.Google Scholar
2.Reich, JH, Vasile, RG. Effect of personality disorders on the treatment outcome of axis I conditions: an update. J Nerv Ment Dis 1993; 181: 475–84.CrossRefGoogle ScholarPubMed
3.Tyrer, P, Gunderson, J, Lyons, M, Tohen, M. Extent of co-morbidity between mental state and personality disorders. J Pers Disorders 1997; 11: 242–59.CrossRefGoogle ScholarPubMed
4.Rendu, A, Moran, P, Patel, A, Knapp, M, Mann, A. Economic impact of personality disorders in UK primary care attenders. Br J Psychiatry 2002; 181: 62–66.CrossRefGoogle ScholarPubMed
5.Casey, PR, Tyrer, P, Piatt, S. The relationship between social functioning and psychiatric symptomatology in primary care. Soc Psychiatry 1985; 20: 5–9.CrossRefGoogle ScholarPubMed
6.Leader, JB, Klein, DN. Social adjustment in dysthymia, double depression and episodic major depression. J Affect Disord 1996; 37: 91–101.CrossRefGoogle ScholarPubMed
7.Casey, PR, Tyrer, PJ. Personality, functioning and symptomatology. J Psychiat Res 1986; 20: 363–374.CrossRefGoogle ScholarPubMed
8.Merson, S, Tyrer, P, Onyett, S, Lack, S, Birkett, P, Lynch, S, Johnson, T. Early intervention in psychiatric emergencies: a controlled clinical trial. Lancet 1992; 339: 1311–1314.CrossRefGoogle ScholarPubMed
9.Tyrer, P, Merson, S, Onyett, S, Johnson, T. The effect of personality disorder on clinical outcome, social networks and adjustment: a controlled clinical trial of psychiatric emergencies. Psychol Med 1994; 24: 731–740.CrossRefGoogle ScholarPubMed
10.Tyrer, P, Alexander, J. Classification of personality disorder. Br J Psychiatry 1979; 135: 163–167.CrossRefGoogle ScholarPubMed
11.Åsberg, M, Montgomery, SA, Perris, C, Schalling, D, Sedvall, G. A comprehensive psychopathological rating scale. Acta Psychiat Scand 1978; suppl 271: 5–29.Google Scholar
12.Tyrer, P. Personality disorder and social functioning. In: Peck, DF, Shapiro, CM. Measuring human problems: a practical guide. Chichester, John Wiley & Sons; 1990: 119–142.Google Scholar
13.Tyrer, P, Johnson, T. Establishing the severity of personality disorder. Am J Psychiatry 1996; 153: 1593–1597.Google ScholarPubMed
14.Remington, M, Tyrer, P. The Social Functioning Schedule – a brief semi-structured interview. Soc Psychiat 1979; 14: 151–157.CrossRefGoogle Scholar
15.Tyrer, P, Merson, S, Harrison-Read, P, Lynch, S, Birkett, P, Onyett, S. A pilot study of the effects of early intervention on clinical symptoms and social functioning in psychiatric emergencies. Ir J Psychol Med 1990; 7: 132–134CrossRefGoogle Scholar
16.Tyrer, P, Karlsen, S, Crawford, M. Social function, chronic strains and personality difficulties. In: Sproston, K, Nazroo, J, editor. Ethnic minority psychiatric illness rates in the community (EMPIRIC). London: The Stationery Office; 2002: 63–80.Google Scholar
17.Tyrer, P, Seivewright, H, Simmonds, S, Johnson, T. Prospective studies of cothymia (mixed anxiety-depression): how do they inform clinical practice? Eur Arch Psychiatry Clin Nerurosci 2001; 251: 54–56.Google ScholarPubMed
18.Wright, S. Theory of path coefficients: A reply to Niles criticism. Genetics 1923; 8: 239–255.CrossRefGoogle ScholarPubMed
19.Wright, S. Path coefficients and path regressions: Alternative or complementary concepts? Biometrics 1960; 16: 189–202.CrossRefGoogle Scholar
20.Loehlin, JC. Latent Variable Models: an introduction to factor, path, and structural analysis. 3rd ed. London: Lawrence Erlbaum Associates; 1998.Google Scholar
21.Everitt, B, Dunn, G. Applied multivariate data analysis. London: Arnold; 2001.CrossRefGoogle Scholar
22.Snedecor, GW, Cochran, WG. Statistical Methods. Ames: The Iowa State University Press; 1980.Google Scholar
23.Marks, IM, Connolly, J, Muijen, M, Audini, B, Mcnamee, G, Lawrence, RE. Home-based versus hospital-based care for people with serious mental illness. Br J Psychiatry 1994; 165: 179–194.CrossRefGoogle ScholarPubMed
24.Lang, A, Steiner, E, Berghofer, G, Henkel, H, Schmitz, M, Schmidl, F, Rudas, S. Quality of life and other characteristics of Viennese mental health care users. Int J Soc Psychiatry 2002; 48: 59–69.CrossRefGoogle ScholarPubMed
25.Pomeroy, JC, Ricketts, B. Long-term attendance in the psychiatric outpatient department for non-psychotic illness. Br J Psychiat 1985; 147: 508–516.CrossRefGoogle ScholarPubMed
26.Paykel, ES. Achieving gains beyond response. Acta Psychiat Scand 2002; 106: suppl 415, 12–17.CrossRefGoogle Scholar
27.Seivewright, H, Tyrer, P, Johnson, T. Persistent social dysfunction in anxious and depressed patients with personality disorder. Acta Psychiat Scand 2004; 109: 104–109.CrossRefGoogle ScholarPubMed
28.Grilo, CM, McGlashan, TH, Skodol, AE. Stability and course of personality disorders: The need to consider comorbidities and continuities between axis I psychiatric disorders and axis II personality disorders. Psychiatric Quart 2000; 71: 291–307.CrossRefGoogle ScholarPubMed
29.Shea, MT, Yen, S. Stability as a distinction between axis I and axis II disorders. J Pers Disorders 2003; 17: 373–386.CrossRefGoogle ScholarPubMed