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Personality Disorder Assessments in Acute Depressive Episodes: Stability at Follow-Up

Lopez-Castroman, Jorge MD*†; Galfalvy, Hanga PhD; Currier, Dianne PhD; Stanley, Barbara PhD; Blasco-Fontecilla, Hilario MD*; Baca-Garcia, Enrique PhD*†; Harkavy-Friedman, Jill Martine JM, PhD†‡; Mann, Joseph John MD; Oquendo, Maria Antonia MD

Journal of Nervous & Mental Disease:
doi: 10.1097/NMD.0b013e318257c6ab
Original Article

Abstract: Assessment of personality disorders during the acute phase of major depression may be invalidated by the potential distortion of personality traits in depressed mood states. However, few studies have tested this assumption. We examined the stability of personality disorder diagnoses during and then after a major depressive episode (MDE). Subjects with major depression (N = 82) completed the 17-item Hamilton Depression Scale (HAM-17) and the Structured Clinical Interview for Axis II both at baseline during an MDE and at 3-month follow-up. We compared subjects who continued to meet DSM-IV criteria for the same Axis II diagnoses with patients whose diagnosis changed and patients with no DSM-IV personality disorder to determine the relationship to major depression and its severity. Sixty-six percent of subjects met DSM-IV criteria for at least one Axis II diagnosis at baseline and 80% had the same personality disorder diagnoses at follow-up. Thirty-four percent had a full remission of MDE at 3-month follow-up. Instability of Axis II diagnosis was associated with number of Axis II diagnoses at baseline (p = .036) and Hispanic ethnicity (p = .013). HAM-17 score change was unrelated to differences in the number of symptoms of personality disorders from baseline to follow-up, nor was remission from MDE on follow-up. Axis II diagnoses in acutely depressed patients reassessed after 3 months are often stable and not associated with remission of or improvement in major depression.

Author Information

*Department of Psychiatry, Fundacion Jimenez Diaz, Madrid, Spain; †Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute/Department of Psychiatry, Columbia University, New York, NY; and ‡Department of Clinical Phenomenology, New York State Psychiatric Institute, New York, NY.

Send reprint requests to Jorge Lopez-Castroman, MD, IIS-Fundacion Jimenez Diaz, Avenida Reyes Catolicos 2, 28040 Madrid. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.