title: Unrecognised psychopathology in patients with difficult asthma: major mental and personality disorders.
abstract: BACKGROUND
  Difficult asthma is a severe subgroup of asthma in which the main feature is uncontrollability of symptoms. Psychopathology is suggested to be prominent in patients with difficult asthma and considered important in its treatment; however, the evidence is scarce.
  
  
  OBJECTIVE
  To describe psychopathology in difficult asthma, both major mental and personality disorders, based on diagnostic interviews.
  
  
  METHODS
  This study was conducted in a specialised asthma care centre. A total of 51 patients with difficult asthma were diagnosed at the start of the treatment programme using two structured clinical interviews for both major mental (SCID-I) and personality disorders (SCID-II) according to DSM-IV-TR.
  
  
  RESULTS
  About 55% of the patients with difficult asthma had a psychiatric disorder of which 89% was undiagnosed and untreated before being interviewed. About 49% had a minimum of one major mental disorder of which the cluster of anxiety disorders was the most common cluster of major mental disorders, followed by somatoform disorders. About 20% were diagnosed with a personality disorder. Of the 10 patients with a personality disorder, 9 had an obsessive-compulsive personality disorder.
  
  
  CONCLUSIONS
  This study demonstrates that more than half of patients with difficult asthma had a psychiatric disorder of which 89% was unrecognised. This study highlights the importance of offering patients with difficult asthma a psychiatric diagnostic interview and/or a psychiatric consultation as part of their routine medical examination and provision of appropriate psychiatric treatment. Moreover, it highlights the urgency of further research into the role of psychopathology in the development of difficult asthma.
  
  
  BACKGROUND
  None.
  © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
authors.affiliation: , MSc, Department of Medical Health Psychology, University of Tilburg, The Netherlands.
authors.forename: Lonneke C J
authors.initials: LC
authors.lastname: Prins
authors.affiliation: , PhD, Department of Clinical Psychology, Utrecht University, The Netherlands.
authors.forename: Maarten J M
authors.initials: MJ
authors.lastname: van Son
authors.affiliation: , MD, PhD, Asthma Center Heideheuvel, Hilversum, The Netherlands.
authors.forename: Anton R J
authors.initials: AR
authors.lastname: van Keimpema
authors.affiliation: , MD, PhD, Revant, Pulmonary Rehabilitation Center 'Schoondonck', Breda, The Netherlands.
authors.forename: Jan-Willem G
authors.initials: JG
authors.lastname: Meijer
authors.affiliation: , MD, PhD, Altrecht Psychosomatic Medicine, Zeist, The Netherlands.
authors.forename: Martina E F
authors.initials: ME
authors.lastname: Bühring
authors.affiliation: , MD, PhD, Department of Medical Health Psychology, University of Tilburg, The Netherlands.
authors.forename: Victor J M
authors.initials: VJ
authors.lastname: Pop