title: Personality disorders and accentuations in at-risk persons with and without conversion to first-episode psychosis.
abstract: OBJECTIVE
  The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Cluster A personality disorders (PDs), particularly schizotypal PD, are considered a part of the schizophrenia spectrum and a risk factor of psychosis. The role of PDs and personality accentuations (PAs) in predicting conversion to psychosis was studied in patients symptomatically considered at risk, assuming a major role of the schizotypal subtype.
  
  
  METHODS
  PDs and PAs, assessed at baseline with a self-report questionnaire, were compared between risk-, gender- and age-matched at-risk patients with (n = 50) and without conversion to psychosis (n = 50).
  
  
  RESULTS
  Overall, Cluster A-PDs were the least frequent cluster (14%), and schizotypal PD was rare (7%). Yet, PDs in general were frequent (46%), especially Cluster B- (31%) and C-PDs (23%). Groups did not differ in frequencies of PDs, yet converters tended to have a higher expression of schizoid (P = 0.057) and Cluster A-PAs (P = 0.027). In regression analyses, schizoid PA was selected as sole but weak predictor of conversion (OR = 1.685; 95% CIs: 1.134/2.504).
  
  
  CONCLUSIONS
  Unexpectedly, schizotypal PD was infrequent and did not predict conversion. Conversion was best predicted by schizoid PA, indicating more severe, persistent social deficits already at baseline in later converters. This corresponds to premorbid social deficits reported for genetic high-risk children and low social functioning in at-risk patients later converting to psychosis. Further, PDs occurred frequently in at-risk patients irrespective of conversion. As psychopathology and personality relate closely to one another, this result highlights that, beyond the current narrow focus on schizotypal PD, personality-related factors should be considered more widely in the prevention of psychosis.
authors.affiliation: University Hospital of Child and Adolescent Psychiatry, Research Department, Bern, Switzerland. frauke.schultze-lutter@kjp.unibe.ch
authors.forename: Frauke
authors.initials: F
authors.lastname: Schultze-Lutter
authors.forename: Joachim
authors.initials: J
authors.lastname: Klosterkötter
authors.forename: Chantal
authors.initials: C
authors.lastname: Michel
authors.forename: Karen
authors.initials: K
authors.lastname: Winkler
authors.forename: Stephan
authors.initials: S
authors.lastname: Ruhrmann
mesh_terms: D000293:Adolescent; D000328:Adult; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D010554:Personality Disorders / Q000150:complications / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000150:complications / Q000523:psychology*; D012307:Risk Factors; D057566:Self Report