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A quantitative analysis of the relationship between affective state and personality ratings in inpatient depression (RAPID)

Published online by Cambridge University Press:  03 March 2022

Kaushadh Jayakody Open the ORCID record for Kaushadh Jayakody [Opens in a new window] ,
Peter Gallagher Open the ORCID record for Peter Gallagher [Opens in a new window] ,
Adrian J. Lloyd  and
David Andrew Cousins Open the ORCID record for David Andrew Cousins [Opens in a new window]
Kaushadh Jayakody
Affiliation:
Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
Peter Gallagher
Affiliation:
Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK Northern Centre for Mood Disorders, Newcastle University, Newcastle upon Tyne, UK
Adrian J. Lloyd
Affiliation:
Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK Northern Centre for Mood Disorders, Newcastle University, Newcastle upon Tyne, UK
David Andrew Cousins*
Affiliation:
Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK Northern Centre for Mood Disorders, Newcastle University, Newcastle upon Tyne, UK
*
Author for correspondence: David Andrew Cousins, E-mail: david.cousins@newcastle.ac.uk
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Abstract

Background

The relationship between major depressive disorder (MDD) and personality disorders is complex, with implications for diagnosis and treatment. We sought to explore the relationship between these disorders quantitatively in an inpatient setting.

Methods

We conducted a structured observational study exploring symptoms of depression and selected neurocognitive functions over the span of an inpatient admission in those with depression and personality disorders. Sixty inpatients presenting with symptoms of depression completed ratings of mood and neurocognitive function. Diagnosis was confirmed by structured clinical interview (SCID-5-RV) at discharge and used to allocate patients to one of the two groups for analysis: those with MDD-only and those with a personality disorder (with or without MDD).

Results

On admission, observer-based ratings of depression were significantly higher in the MDD-only group while subjective ratings were higher in the personality disorder group. Depression rating scores lessened in both groups during the admission, but at discharge, the personality disorder group continued to report higher subjective ratings. The personality disorder group also rated themselves as more cognitively impaired than the MDD-only group and unlike the MDD-only group, they did not report subjective improvements in cognitive function over the course of admission. Objective assessment of cognitive function demonstrated improvements in both groups.

Conclusions

In this study, the presence of a personality disorder was associated with greater subjective severity of depressive symptomatology and selected neurocognitive functioning, despite similar or lower objective severity in comparison with those with MDD. This finding has implications for understanding the patient journey through health care settings.

Keywords

Major depressive disorderneurocognitionpersonality disorder
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 8 , June 2023 , pp. 3416 - 3425
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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References

Ahern, E., & Semkovska, M. (2017). Cognitive functioning in the first-episode of major depressive disorder: A systematic review and meta-analysis. Neuropsychology, 31, 52–72.CrossRefGoogle ScholarPubMed
Bagby, R. M., Ryder, A. G., Schuller, D. R., & Marshall, M. B. (2004). The Hamilton Depression Rating Scale: Has the gold standard become a lead weight? The American Journal of Psychiatry, 161(12), 2163–2177.CrossRefGoogle ScholarPubMed
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory (2nd ed., Manual). San Antonio, TX: The Psychological Corporation.Google Scholar
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.CrossRefGoogle ScholarPubMed
Biachi, G. N., & Fergusson, D. M. (1977). The effect of mental state on MPI scores. British Journal of Psychiatry, 131, 306–309.CrossRefGoogle Scholar
Black, D. W., Forbush, K. T., Langer, A., Shaw, M., Graeber, M. A., Moser, D. J., … Blum, N. (2009). The neuropsychology of borderline personality disorder: A preliminary study on the predictive variance of neuropsychological tests vs. personality trait dimensions. Personality and Mental Health, 3(2), 128–141.CrossRefGoogle Scholar
Bridger, R. S., Johnsen, S. A., & Brasher, K. (2013). Psychometric properties of the Cognitive Failures Questionnaire. Ergonomics, 56(10), 1515–1524.CrossRefGoogle ScholarPubMed
Broadbent, D. E., Cooper, P. F., FitzGerald, P., & Parkes, K. R. (1982). The Cognitive Failures Questionnaire (CFQ) and its correlates. British Journal of Clinical Psychology, 21, 1–16.CrossRefGoogle ScholarPubMed
Burgess, J. W. (1990). Cognitive information processing in borderline personality disorder: A neuropsychiatric hypothesis. Jefferson Journal of Psychiatry, 8, 34–49.CrossRefGoogle Scholar
Burgess, J. W. (1991a). Relationship of depression and cognitive impairment to self-injury in borderline personality disorder, major depression, and schizophrenia. Psychiatry Research, 38, 77–87.CrossRefGoogle ScholarPubMed
Burgess, J. W. (1991b). Neurocognition in acute and chronic depression: Personality disorders, major depression and schizophrenia. Biological Psychiatry, 30, 305–309.CrossRefGoogle ScholarPubMed
Burgess, J. W. (1991c). The personality inventory scales: A self-rating clinical instrument for diagnosis of personality disorders. Psychological Reports, 69, 1235–1246.CrossRefGoogle Scholar
Burgess, J. W. (1992). Neurocognitive impairment in dramatic personalities: Histrionic, narcissistic, borderline, and antisocial disorders. Psychiatry Research, 42, 283–290.CrossRefGoogle ScholarPubMed
Carter, J. D., Frampton, C. M., Mulder, R. T., Luty, S. E., & Joyce, P. R. (2010). The relationship of demographic, clinical, cognitive and personality variables to the discrepancy between self and clinician rated depression. Journal of Affective Disorders, 124(1–2), 202–206.CrossRefGoogle Scholar
Coppen, A., & Metcalfe, M. (1965). Effect of a depressive illness on MPI scores. British Journal of Psychiatry, 111, 236–239.CrossRefGoogle Scholar
Corruble, E., Ginestet, D., & Guelfi, J. D. (1996). Comorbidity of personality disorders and unipolar major depression: A review. Journal of Affective Disorders, 37(2–3), 157–170.CrossRefGoogle ScholarPubMed
Davies, B., Burrows, G., & Poynton, C. (1975). A comparative study of four depression rating scales. The Australian and New Zealand Journal of Psychiatry, 9(1), 21–24.CrossRefGoogle ScholarPubMed
Domken, M., Scott, J., & Kelly, P. (1994). What factors predict discrepancies between self and observer ratings of depression? Journal of Affective Disorders, 31(4), 253–259.CrossRefGoogle ScholarPubMed
Duberstein, P. R., & Heisel, J. H. (2007). Personality traits and the reporting of affective disorder symptoms in depressed patients. Journal of Affective Disorders, 103, 165–171.CrossRefGoogle ScholarPubMed
Enns, M. W., Larsen, D. K., & Cox, B. J. (2000). Discrepancies between self and observer ratings of depression. The relationship to demographic, clinical and personality variables. Journal of Affective Disorders, 60(1), 33–41.CrossRefGoogle ScholarPubMed
First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer, R. L. (2015a). Structured clinical interview for DSM-5 – research version (SCID-5 for DSM-5, research version; SCID-5-RV). Arlington, VA: American Psychiatric Association.Google Scholar
First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer, R. L. (2015b). Structured clinical interview for DSM-5 – personality disorder (SCID-5-PD). Arlington, VA: American Psychiatric Association.Google Scholar
First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer, R. L. (2015c). Structured clinical interview for DSM-5 – screening personality questionnaire (SCID-5-SPQ). Arlington, VA: American Psychiatric Association.Google Scholar
Fossati, A., Donati, D., Donini, M., Novella, L., Bagnato, M., & Maffei, C. (2001). Temperament, character, and attachment patterns in borderline personality disorder. Journal of Personality Disorders, 15(5), 390–402.CrossRefGoogle ScholarPubMed
Foster, T., Gillespie, K., & McClelland, R. (1997). Mental disorders and suicide in Northern Ireland. British Journal of Psychiatry, 170(5), 447–452.CrossRefGoogle ScholarPubMed
Friborg, O., Martinsen, E. W., Martinussen, M., Kaiser, S., Overgard, K. T., & Rosenvinge, J. H. (2014). Comorbidity of personality disorders in mood disorders: A meta-analytic review of 122 studies from 1988 to 2010. Journal of Affective Disorders, 152–154, 1–11.CrossRefGoogle ScholarPubMed
Goodman, M., Roiff, T., Oakes, A. H., & Paris, J. (2012). Suicidal risk and management in borderline personality disorder. Current Psychiatry Reports, 14(1), 79–85.CrossRefGoogle ScholarPubMed
Guy, W. (1976). Early clinical drug evaluation assessment manual for psychopharmacology – revise (pp. 218–222). Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, The National Institute of Mental Health Psychopharmacology Research Branch, Division of Extramural Research Programs.Google Scholar
Guy, W. (2000). Clinical global impressions (CGI) scale, modified. In Rush, J. A. (Ed.), Task force for the handbook of psychiatric measures. Handbook of psychiatric measures (1st ed., pp. 100–102). Washington, DC: American Psychiatric Association.Google Scholar
Hakulinen, C., Elovainio, M., Pulkki-Raback, L., Virtanen, M., Kivimaki, M., & Jokela, M. (2015). Personality and depressive symptoms: Individual participant meta-analysis of 10 cohort studies. Depression and Anxiety, 32, 461–470.CrossRefGoogle ScholarPubMed
Hamilton, M. A. (1960). Rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62.CrossRefGoogle ScholarPubMed
Hirschfeld, R. M. A., & Klerman, G. L. (1979). Personality attributes in affective disorders. American Journal of Psychiatry, 136, 67–70.Google ScholarPubMed
Hirschfeld, R. M. A., Klerman, G. L., Clayton, P. J., & Keller, M. B. (1983a). Personality and depression: Empirical findings. Archives of General Psychiatry, 40, 993–998.CrossRefGoogle ScholarPubMed
Hirschfeld, R. M. A., Klerman, G. L., Clayton, P. J., Keller, M. B., McDonald, S. P., & Larkin, B. H. (1983b). Assessing personality: Effects of the depressive state on trait measurement. American Journal of Psychiatry, 140, 695–699.Google ScholarPubMed
Ingram, J. G. (1966). Changes in MPI scores in neurotic patients: A three year follow up. British Journal of Psychiatry, 112, 931–939.CrossRefGoogle Scholar
Jaeger, J. (2018). Digit symbol substitution test, the case for sensitivity over specificity in neuropsychological testing. Journal of Clinical Psychopharmacology, 38(5), 513–519.CrossRefGoogle ScholarPubMed
Joiner, T. E., Schmidt, K. L., & Metalsky, G. I. (1994). Low-end specificity of the Beck Depression Inventory. Cognitive Therapy and Research, 18(1), 55–68.CrossRefGoogle Scholar
Kerr, T. A., Schapira, K., & Roth, M. (1970). The relationship between the Maudsley Personality Inventory in the course of affective disorders. British Journal of Psychiatry, 116, 11–19.CrossRefGoogle ScholarPubMed
Kool, S., Dekker, J., Duijsens, I. J., de Jonghe, F., & Puite, B. (2003). Changes in personality pathology after pharmacotherapy and combined therapy for depressed patients. Journal of Personality Disorders, 17(1), 60–72.CrossRefGoogle ScholarPubMed
Lambert, M. J., Hatch, D. R., Kingston, M. D., & Edwards, B. C. (1986). Zung, Beck, and Hamilton rating scales as measures of treatment outcome: A meta-analytic comparison. Journal of Consulting and Clinical Psychology, 54(1), 54–59.CrossRefGoogle ScholarPubMed
Leonard, F. (2004). Management of personality disorders in acute in-patient settings. Part I: Borderline personality disorders. Advances in Psychiatric Treatment, 10, 93–99.Google Scholar
Lezak, M. D., Howieson, D. B., & Loring, D. W. (2004). Neuropsychological assessment (pp. 368–370). New York: Oxford University Press.Google Scholar
McDermott, L. M., & Ebmeier, K. P. (2009). A meta-analysis of depression severity and cognitive function. Journal of Affective Disorders, 119(1–3), 1–8.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence. (2009a). Depression in adults: recognition and management (NICE Guideline No. 90). https://www.nice.org.uk/guidance/cg90.Google Scholar
National Institute for Health and Care Excellence. (2009b). Borderline personality disorder: recognition and management (NICE Guideline No. 78). https://www.nice.org.uk/guidance/cg78.Google Scholar
O'Leary, K. M., Brouwers, P., Gardner, D. L., & Cowdry, R. W. (1991). Neuropsycholgical testing of patients with borderline personality disorder. American Journal of Psychiatry, 148(1), 106–111.Google Scholar
Paykel, E. S., Prusoff, B. A., Klerman, G. L., & DiMascio, A. (1973). Self-report and clinical interview ratings in depression. The Journal of Nervous and Mental Disease, 156(3), 166–182.CrossRefGoogle ScholarPubMed
Peirson, A. R., & Heuchert, J. W. (2001). The relationship between personality and mood: Comparison of the BDI and the TCI. Personality and Individual Differences, 30, 391–399.CrossRefGoogle Scholar
Peselow, E. D., Sanfilipo, M. P., Fieve, R. R., & Gulbenkian, G. (1994). Personality traits during depression and after clinical recovery. British Journal of Psychiatry, 164, 349–354.CrossRefGoogle ScholarPubMed
Pfol, B., Stangl, D., & Zimmerman, M. (1984). The implications of DSM III personality disorders for patients with major depression. Journal of Affective Disorders, 4, 309–318.CrossRefGoogle Scholar
Prusoff, B. A., Klerman, G. L., & Paykel, E. S. (1972). Concordance between clinical assessments and patients' self-report in depression. Archives of General Psychiatry, 26(6), 546–552.CrossRefGoogle ScholarPubMed
Rane, L. J., Fekadu, A., Wooderson, S., Poon, L., Markopoulou, K., & Cleare, A. J. (2010). Discrepancy between subjective and objective severity in treatment-resistant depression: Prediction of treatment outcome. Journal of Psychiatric Research, 44, 1082–1087.CrossRefGoogle ScholarPubMed
Richter, J., Polak, T., & Eisemann, M. (2003). Depressive mood and personality in terms of temperament and character among the normal population and depressive inpatients. Personality and Individual Differences, 35, 917–927.CrossRefGoogle Scholar
Richter, P., Werner, J., Heerlein, A., Kraus, A., & Sauer, H. (1998). On the validity of the Beck Depression Inventory. A review. Psychopathology, 31(3), 160–168.CrossRefGoogle ScholarPubMed
Rudd, D., & Rajab, H. (1995). Specificity of the Beck Depression Inventory and the confounding role of comorbid disorders in a clinical sample. Cognitive Therapy and Research, 19(1), 51–68.CrossRefGoogle Scholar
Ruocco, A. C. (2005). The neuropsychology of borderline personality disorder: A meta-analysis and review. Psychiatry Research, 137(3), 191–202.CrossRefGoogle ScholarPubMed
Ruocco, A. C., Lam, J., & McMain, S. F. (2014). Subjective cognitive complaints and functional disability in patients with borderline personality disorder and their nonaffected first-degree relatives. Canadian Journal of Psychiatry, 59(6), 335–344.CrossRefGoogle ScholarPubMed
Rush, A. J., Hiser, W., & Giles, D. E. (1987). A comparison of self-reported versus clinician related symptoms in depression. The Journal of Clinical Psychiatry, 48(6), 246–248.Google ScholarPubMed
Russell, T. J., & Joseph, J. R. (1988). Personality and depression. Journal of Psychiatry Research, 22(4), 279–286.Google Scholar
Schnurr, R., Hoaken, P. C., & Jarrett, F. J. (1976). Comparison of depression inventories in a clinical population. Canadian Psychiatric Association Journal, 21(7), 473–476.CrossRefGoogle Scholar
Semkovska, M., Quinlivan, L., O'Grady, T., Johnson, R., Collins, A., O'Connor, J., … Gload, T. (2019). Cognitive function following a major depressive episode: A systematic review and meta-analysis. The Lancet Psychiatry, 6(10), 851–861.CrossRefGoogle Scholar
Silk, K. R. (2010). The quality of depression in borderline personality disorder and the diagnostic process. Journal of Personality Disorders, 24(1), 35–37.CrossRefGoogle ScholarPubMed
Stanley, B., & Wilson, S. T. (2006). Heightened subjective experience of depression in borderline personality disorder. Journal of Personality Disorders, 20(4), 307–318.CrossRefGoogle ScholarPubMed
Tang, T. X., DeRubeis, R. J., Hollon, S. D., Amsterdam, J., Shelton, R., & Schalet, B. (2009). Personality change during depression treatment: A placebo-controlled trial. Archives of General Psychiatry, 66(12), 1322–1330.CrossRefGoogle ScholarPubMed
Van der Linden, D., Keijers, G. P. J., Eling, P., & Van Schaijk, R. (2005). Work stress and attentional difficulties: An initial study on burnout and cognitive failures. Work and Stress, 19, 23–36.CrossRefGoogle Scholar
Van Veen, M., Wierdsma, A. I., van Boeijen, C., Dekker, J., Zoeteman, J., Koekkoek, B., & Mulder, C. L. (2019). Suicide risk, personality disorder and hospital admission after assessment by psychiatric emergency services. BMC Psychiatry, 19(1), 157.CrossRefGoogle ScholarPubMed
Velikonja, T., Velthorst, E., McClure, M. M., Rutter, S., Calabrese, W. R., Rosell, D., … Perez-Rodriguez, M. M. (2019). Severe childhood trauma and clinical and neurocognitive features in schizotypal personality disorder. Acta Psychiatrica Scandinavica, 140, 50–64.CrossRefGoogle ScholarPubMed
Wagle, A. C., Berrios, G. E., & Ho, L. (1999). The cognitive failures questionnaire in psychiatry. Comprehensive Psychiatry, 40(6), 478–484.CrossRefGoogle ScholarPubMed
Zanarini, M. C., Frankenburg, F. R., Dubo, E. D., Sickel, A. E., Trikha, A., Levin, A., & Reynolds, V. (1998). Axis I comorbidity of borderline personality disorder. The American Journal of Psychiatry, 155(12), 1733–1739.CrossRefGoogle ScholarPubMed
Zimmerman, M., Martinez, J. H., Morgan, T. A., Young, D., Chelminski, I., & Dalrymple, K. (2013). Distinguishing bipolar II depression from major depressive disorder with comorbid borderline personality disorder: Demographic, clinical and family history differences. Journal of Clinical Psychiatry, 74(9), 880–886.CrossRefGoogle ScholarPubMed
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