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The prevalence of personality disorder in schizophrenia and psychotic disorders: systematic review of rates and explanatory modelling

Published online by Cambridge University Press:  10 December 2007

G. Newton-Howes ,
P. Tyrer ,
B. North  and
M. Yang
G. Newton-Howes*
Affiliation:
Department of Psychological Medicine, Imperial College, London, UK
P. Tyrer
Affiliation:
Department of Psychological Medicine, Imperial College, London, UK
B. North
Affiliation:
Imperial College, South Kensington Campus, Sir Alexander Fleming Building, London, UK
M. Yang
Affiliation:
Queen Mary, University of London, William Harvey House, London, UK
*
*Address for correspondence: Dr G. Newton-Howes, MRCPsych, Department of Psychological Medicine, Imperial College, St Dunstan's Road, London W6 8RP, UK. (Email: gilesandnicola@hotmail.com)
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Abstract

Background

Personality disorder (PD) in psychosis is poorly studied. As PD can affect outcome in mental disorders, it is important to understand its prevalence in order to plan services, understand prognosis more fully and maximize management options.

Method

Literature searching revealed 3972 potential papers. Twenty papers including 6345 patients were included in the final analysis. There was great variation in prevalence and multilevel modelling was used to identify possible reasons for this heterogeneity.

Results

The prevalence of PD varied from 4.5% to 100%. Multilevel analysis suggested country of study, study type, the instruments used to diagnose PD and patient care correlated with the prevalence data explaining the study level heterogeneity, with 34.2, 33.4, 17.0 and 4.5% by each variable respectively. Personality studies in Canada and Sweden reported lower PD prevalence, whereas in Spain it was higher than the multinational study. Compared with randomized controlled trials, case-control studies reported lower prevalence [odds ratio (OR)=0.35, 95% confidence interval (CI) 0.15–0.79] and observational studies higher prevalence (OR 70.5, 95% CI 8.5–583). Primary-care patients were less likely to be diagnosed (OR 0.02, 95% CI 0–0.19) than hospital patients, and out-patients had higher prevalence (OR 12.5, 95% CI 1.77–88.6).

Conclusions

The reported prevalence of PD in schizophrenia varies significantly. Statistical modelling suggests care, country, study type and diagnostic tools for PD all bias prevalence rates. The number of papers reaching the inclusion criteria, the relative paucity of information and the difficulties in developing an accurate statistical model limited interpretation from the study.

Keywords

Personality disorderprevalenceschizophrenia
Type
Review Article
Information
Psychological Medicine , Volume 38 , Issue 8 , August 2008 , pp. 1075 - 1082
Copyright
Copyright © 2007 Cambridge University Press

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