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Personality disorder in ADHDPart 1: Assessment of personality disorder in adult ADHD using data from a clinical trial of OROS methylphenidate

Erika D. Williams, MSW

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

Frederick W. Reimherr, MD

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

Barrie K. Marchant, MS

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

Robert E. Strong, DO

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

Corinne Halls, MS

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

Poonam Soni, MD

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

Phillip D. Gale, MD

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

Reid J. Robison, MD

Mood Disorders Clinic, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA

BACKGROUND: Comorbidity of personality disorder (PD) and attention-deficit/hyperactivity disorder (ADHD) has been suggested in several reports. However, assessment of PD is problematic, and studies have over-relied on baseline evaluations.

METHODS: Forty-seven patients entered a double-blind trial of osmotic release oral system (OROS) methylphenidate (MPH). Patients were assessed at baseline with the Wisconsin Personality Inventory IV (WISPI-IV) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Following the study, all information—including tests, family reports, and extended clinical observations—produced a final PD diagnosis. Three post hoc categories were created: PD-negative (no PD), PD-positive (1 PD), and PD-plus (2 or more PDs).

RESULTS: Twenty-one (45%) patients had a PD on the final assessment vs 62% using SCID-II and 33% using WISPI-IV; final PD diagnosis revealed 9% cluster A, 17% cluster B, and 28% cluster C. Twenty-one percent of patients experienced multiple disorders. Using a weighted kappa, the number of PDs on the final assessment correlated with the WISPI-IV (κ =.53; P > .001) and the SCID-II (κ =.70; P < .001). However the SCID-II overidentified and the WISPI-IV underidentified PD.

CONCLUSION: Almost all PDs were represented in this sample, and past emphasis on cluster B appears unwarranted. Although the SCID-II and WISPI-IV had limited success in identifying specific PDs, they were more successful in identifying the number of PDs present in each patient. The small sample makes these findings preliminary.

KEYWORDS: ADHD, adult, personality disorder, Wisconsin Personality Inventory-IV (WISPI-IV), SCID-II

ANNALS OF CLINICAL PSYCHIATRY 2010;22(2):84-93

CORRESPONDENCE: Fred W. Reimherr, MD Mood Disorders Clinic, Department of Psychiatry, University of Utah Health Sciences Center, 30 N 1900 E Rm 5R218 Salt Lake City, UT 84132, USA E-MAIL: fred.reimherr@hsc.utah.edu

 
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