IPDE - Extranet Systems - World Health Organization

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27 Epidemiology of DSM-Ill PDs school. Less than half of the diagnosed subjects had a significant record of arrest. Occupational problems were found in 94% of the sample, violence in 85%. and severe marital difficulties in 67%. Some form of substance abuse occurred in 84% of individuals with antisocial PD.w Associations with schizophrenia and mania were also found. In the Christchurcb Psychiatric Epidemiologic Study, carried out in New Zealand with a methodology similar to the ECA, six month and lifetime antisocial PD prevalence rates of 0.9% and 3.1% were found among a sample of 1498 adults, aged 18 to 64 years.2s Males showed antisocial PD more frequently than females for both the six month (1.3% vs 0.5%) and lifetime (4.2% vs 0.5%) prevalence, but the differences did not achieve statistical significance. The authors also studied the one-year recovery rate, defined as the percentage of persons who had ever met criteria for a DIS DSM-111 disorder but who had not experienced an episode or key symptoms of the disorder in the 12-months prior to the interview. The recovery rate for antisocial PD was 51.6%. However, it is possible that many recovered subjects were substance abusers, who no longer appeared personality disordered when abstinent. In the Edmonton (Canada) study 3258 randomly selected adult household residents were interviewed with the DIS,Z2' and 33.8% of the pop ulation met criteria for one or more disorders at some time in their life. A prevalence rate of 3.7% (6.5% for males and 0.8% for females) was found for antisocial PD. The disorder showed the highest me in the age group 18-34, and among widowed, separated, and divorced subjects. The mean age of onset was 8 years for males and 9 years for females. All cases of antisocial personality had their onset before 20 years of age. In Taiwan the rates of antisocial personality were considerably lower, ranging from 0.03% in rural villages to 1.4% in metropolitan Tai~ei.2~ This was consistent with the lower rates of most DSM-III disorders at the Taiwan site. In a survey of 131 subjects living in an Indian village in the western US, who were administered the SADS-L, only one male and no female cases were f0und.2~ Lee et al.M performed a replication of the ECA study in the city of Seoul. Korea. They found a prevalence rate of antisocial personality disorder of 2.08% in a community sample of 3134. As in other studies there was a higher prevalence in males than females (3.54% vs 0.78%). Another replication of the ECA studya1 in Hong Kong, gave a prevalence of antisocial personality disorder of 2.78% in males and 0.53% in females in a sample of 7229 subjects. Antisocial personality disorder was one of the four most prevalent mental disorders found in males.
28 J. H. Reich and G. de Girolarno Both Reich er al.Is and Zimmerman and Coryell,12 using the PDQ, found considerably lower rates, 0.4% and 0.9% respectively. However, the rates increased to 3.0% when interviews were used, suggesting that selfreports may underestimate antisocial personality. Maier et a1.,I0 however, using a structured interview, also found a low rate of 0.2% in Germany. Interesting results were obtained by Koegel et al.'2 in a survey canied out among 328 homeless individuals living in the inner city of Los Angeles, who were administered the DIS, modified for use with a homeless population. An overall lifetime rate of 20.8% of antisocial PD was found compared to a rate of 4.7% in the Los Angeles sample in the ECA study (N = 3055). The risk ratio of having antisocial PD in the homeless as compared to the ECA sample was 4.4. The difference in rates was even more striking when the six month prevalence rate was considered. The rate among the homeless was 17.4% compared to 0.8% in the ECA sample, for ariskratio of 21.8. To summarize, antisocial PD seems to have a prevalence of around 3% in the general population, and to be more frequent among males than females, with sex ratios ranging from 2:l to 7:l. It is also more common among younger adults, those Living in urban areas, and the lower socioeconomic classes. People with a diagnosis of antisocial PD are also high users of medical services. Reich et al.lS and Baron er al.,14 in their sample of relatives of normal probands, found no cases of avoidant personality (Table 1). Zimmerman and Coryell12 reported rates ranging from 0.4% (PDQ) to 1.3% (SIF'D). The rate reported by Maier er al.lo (1.1%) was comparable to that obtained by Zimmerman and Coryell12 and by Baron er ol.l4 (1.6%) among relatives of schizophrenic probands. Dependent Reich et al.15 and Zimmerman and C~ryell,~~ using the PDQ, reported rates of 5.1% and 6.7% respectively (Table 1). However, the rates were lower when a structured interview was used (SIPD: 1.7%; SCID: 1 .6%).12,L0 Compulsive The rates of compulsive disorder were comparable in two studie~l~.~~ in which the PDQ was used (6.4%15 and 4.0%LZ). However, lower rates
Page 2 and 3: Until recently, the standardization
Page 4 and 5: Assessment and diagnosis of persona
Page 6 and 7: Contents Contributors Preface Annan
Page 8 and 9: Contributors Dr Antonio Andreoli Ho
Page 10 and 11: Preface One of the major goals of t
Page 12 and 13: ... Xlll Acknowledgements The IPDE
Page 14 and 15: Problems in the field of personalit
Page 16 and 17: 5 Problems in the field of PD perso
Page 18 and 19: 7 Problems in the field of PD In DS
Page 20 and 21: 9 Problems in the field of PD cultu
Page 22 and 23: 11 Review of diagnostic instruments
Page 30 and 31: 19 Epidemiology of DSM-Ill PDs in c
Page 32 and 33: Table l. Prevalence rates of specif
Page 35 and 36: 24 1. H. Reich and G. de Girolamo (
Page 37: 26 .- 5 2 0 W C .- 0 P g F ? g e Q
Page 41 and 42: Table 3. Prevalence rates ofpersona
Page 44 and 45: Pfohl etal.. l986 (67) Pilgrim & Ma
Page 46 and 47: 35 Epidemiology of DSM-Ill PDs were
Page 48 and 49: 37 Epidemiology of DSM-Ill PDs migh
Page 50 and 51: 39 Epidemiology of DSM-Ill PDs 23 R
Page 52 and 53: 4 1 Epidemiology of DSM-Ill PDs 55
Page 54 and 55: 43 International personality disord
Page 56 and 57: I 45 IPDE iner what he is actually
Page 58 and 59: 47 IPDE Sample of IPDE item The que
Page 60 and 61: 49 IPDE dimensional scores are not
Page 62 and 63: 1 9 IPDE considerable training and
Page 64 and 65: 53 Experiences with IPDE The invest
Page 66 and 67: 55 Experiences with IPDE passive ag
Page 68 and 69: 57 Field Trial
Page 70 and 71: 59 Sampling, inte~iewers, interview
Page 72 and 73: Description of centres participatin
Page 74 and 75: 63 Centres participating in IPDE fi
Page 82 and 83: P- P Table 1. Sample sizes and IPDE
Page 84 and 85: 73 Results Table 3. ICD-I0 Disorder
Page 86 and 87: 75 Results Table 5. Frequency of CO
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77 Results Table 8. Interrater reli
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Discussion and conclusions Armand W
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8 1 Discussion and Conclusions stab
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83 Discussion and Conclusions Repet
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Discussion and Conclusions of princ
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87 Discussion and Conclusions Frequ
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89 Discussion and Conclusions emoti
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9 1 Discussion and Conclusions inte
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93 Appendix Table A2 Persomlity dis
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95 Appendix Table A4 Personality di
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97 Appendix Table A6 Personaliry di
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99 Appendix Table SA Personaliry di
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Table A10 Personality disorder diag
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103 Appendix Table A12 Personality
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Table A13 (con?) Criterion B7 B8 1
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107 Appendix Table A13 (cont) Frequ
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109 Appendix Table A14 (cont.) Freq
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Acknowledgements 113 Manual History
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Manual History of the IPDE One of t
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116 Manual Struchlre of the IPDE Th
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118 Manual that is likely to enhanc
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120 Manual data. If examiners have
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122 Manual Scoring conventions Much
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124 Manual Recording the scores Req
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126 Manual Q. What do you do when s
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128 Manual section, if there are qu
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ICD-10 criteria and corresponding I
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132 ICD-10 criteria and correspondi
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134 IPDE ICD-10 module screening qu
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136 Screening questionnaire 47 1 lo
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I 138 IPDE ICD-10 module* interview
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140 Interview schedule 2. 0 1 2 7 0
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142 Inte~iew schedule 4. O 1 2 I N
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144 Interview schedule 6. O l Z ? 0
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146 Interview schedule 8. 0 1 2 1 0
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148 Interview schedule .10. 0 1 2 ?
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150 Interview schedule 12. 0 1 2 7
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152 lnte~iew schedule 14. 0 1 2 ? 0
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154 Interview schedule 16. 0 1 2 ?
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156 interview schedule 18. 0 1 2 ?
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158 Interview schedule 20. O 1 2 N
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164 Interview schedule *26. 0 1 2 ?
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166 lntewiew schedule 28. 0 1 2 ? 0
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170 lnte~iew schedule 32. O 1 2 7 N
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174 lntewiew schedule 36. 0 1 2 ? 0
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176 lnterv~ew schedule 38. 0 1 2 ?
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184 lnte~iew schedule 46. 0 1 2 7 0
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~ 186 Interview schedule 48. 0 1 2
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194 Interview schedule 56. 0 1 2 1
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196 Interview schedule VI. IMPULSE
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200 Interview schedule Have you eve
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202 Interview schedule 1 63. 0 1 2
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204 Intewiew schedule Rate the foll
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206 IPDE ICD-10 module handscoring
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+ 39+44=4, 208 Handscoring algorith
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210 Handscoring algorithms and summ
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IPDE ICD-10 module summary scoreshe
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224 Index paranoid 108 schizoid 108
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226 Index Personalily Assessment Sc
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