Personality disorders (PDs) are prevalent in about one in every 10 adults. Prior to the introduction of the ICD-10 in Denmark, the incidence rate for PD (including schizotypal) among psychiatric patients was approximately 12% and the prevalence rate 14%.
The aim of the present clinical epidemiology study is to investigate the use of ICD-10 PD as primary and secondary diagnoses in years 1995, 2000 and 2006, comorbid disorders and their relation to age and gender.
The study includes all adult patients admitted to any psychiatric hospital (inpatients and outpatients) in Denmark.
Both incidence and prevalence rates of PD diagnoses decrease over the study period. It is evident that all specific diagnoses significantly decrease or remain stable whereas the unspecified and mixed type significantly increases constituting up to 50% of diagnoses. Emotionally unstable PD stands out as the single most prevalent covering around one third of PD diagnoses. A decrease is found in the prevalence of patients receiving a PD diagnosis as a primary diagnosis, but an increase as a secondary diagnosis (most often as comorbid to depression or anxiety disorder). Differences are found in relation to gender and age.
PDs are among the most prevalent disorders; however, rates are decreasing in psychiatric settings. There seem to be a rather huge gap between clinical evaluation and research data on prevalence of PDs. Clinicians need more education and sufficient time for in-depth personality assessment of PDs in all patient groups.
First episode psychosis (FEP) patients have an increased risk for violence and criminal activity prior to initial treatment. However, little is known about the prevalence of criminality and acts of violence many years after implementation of treatment for a first episode psychosis.
To assess the prevalence of criminal and violent behaviors during a 10-year follow-up period after the debut of a first psychosis episode, and to identify early predictors and concomitant risk factors of violent behavior.
A prospective design was used with comprehensive assessments of criminal behavior, drug abuse, clinical, social and treatment variables at baseline, five, and 10-year follow-up. Additionally, threatening and violent behavior was assessed at 10-year follow-up. A clinical epidemiological sample of first-episode psychosis patients (n=178) was studied.
During the 10-year follow-up period, 20% of subjects had been apprehended or incarcerated. At 10-year follow-up, 15% of subjects had exposed others to threats or violence during the year before assessment. Illegal drug use at baseline and five-year follow-up, and a longer duration of psychotic symptoms were found to be predictive of violent behavior during the year preceding the 10-year follow-up.
After treatment initiation, the overall prevalence of violence in psychotic patients drops gradually to rates close to those of the general population. However, persistent illicit drug abuse is a serious risk factor for violent behavior, even long after the start of treatment. Achieving remission early and reducing substance abuse may contribute to a lower long-term risk for violent behavior in FEP patients.