title: Personality disorders in heart failure patients requiring psychiatric management: comorbidity detections from a routine depression and anxiety screening protocol.
abstract: Several international guidelines recommend routine depression screening in cardiac disease populations. No previous study has determined the prevalence and comorbidities of personality disorders in patients presenting for psychiatric treatment after these screening initiatives. In the first stage 404 heart failure (HF) patients were routinely screened and 73 underwent structured interview when either of the following criteria were met: (a) Patient Health Questionnaire ≥10; (b) Generalized Anxiety Disorder Questionnaire ≥7); (c) Response to one item panic-screener. Or (d) Suicidality. Patients with personality disorders were compared to the positive-screen patients on psychiatric comorbidities. The most common personality disorders were avoidant (8.2%), borderline (6.8%) and obsessive compulsive (4.1%), other personality disorders were prevalent in less than <3% of patients. Personality disorder patients had significantly greater risk of major depression (risk ratio (RR) 1.2; 95% confidence interval (CI) 1.2-13.3), generalized anxiety disorder (RR 3.2; 95% CI 1.0-10.0), social phobia (RR 3.8; 95% CI 1.3-11.5) and alcohol abuse/dependence (RR 3.2; 95% 1.0-9.5). The findings that HF patients with personality disorders presented with complex psychiatric comorbidity suggest that pathways facilitating the integration of psychiatric services into cardiology settings are warranted when routine depression screening is in place.
authors.affiliation: Freemasons Foundation Centre for Men׳s Health, Discipline of Medicine, School of Medicine, The University of Adelaide, SA 5005, Australia; Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany; Heart Failure Support Service, The Queen Elizabeth Hospital, Woodville, SA, Australia. Electronic address: phillip.tully@adelaide.edu.au.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Tully
authors.affiliation: Heart Failure Support Service, The Queen Elizabeth Hospital, Woodville, SA, Australia.
authors.forename: Terina
authors.initials: T
authors.lastname: Selkow
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000523:psychology; D008875:Middle Aged; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D015995:Prevalence
keywords: Borderline personality disorder; Cardiovascular disease; Coronary heart disease; Heart failure; Major depression; Obsessive compulsive personality disorder