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Table of Content - Volume 21 Issue 2 - February 2022
A study on personality disorders among cases of deliberate self-harm
M D Shahanawaz Zafar1*, Upendra Paswan2
1Senior Resident, 2Professor & HOD, Department of Psychiatry, Darbhanga Medical College and Hospital, Darbhanga, Bihar, INDIA. Email: zafarshahanawaz8@gmail.com
Abstract Background: Previous Indian studies have found that persons who attempt suicide had lower incidence of psychiatric and personality disorders than those who die by suicide. To understand more about the types of psychiatric and personality issues that people with deliberate self-harm have and how common they are. Method Total 50 DSH patients who presented Darbhanga Medical College and Hospital, were assessed using a structured clinical interview and a standardised instrument. During the period of January, 2019 to November 2020. Results: Affective disorder was present in 38 patients (76%). A Depressive episode was present in male cases 68.4% & Female cases were71.0%. Substance use disorders (alcohol) present in 16(32.0%) cases. Substance use disorders(Drug) users was present 30(60%) cases. Neurotic, stress, somotoform disorders was found 19(38%) cases. Eating disorder was observed 14(28%) cases. & Schizophrenia cases was found 7(14%) respectively. Conclusion: In DSH patients, psychiatric and personality disorders, as well as their comorbidity, are common. This has significant assessment and management consequences. Keywords: personality disorders.
INTRODUCTION
METHODS All DSH patients who presented to the hospital and were medically fit to be questioned on recruiting days, which covered both weekdays and weekends to ensure the patient sample was dispersed throughout the week, were considered for inclusion in the possible sample. The general hospital psychiatric service evaluates the majority of DSH patients that present to Darbhanga Medical College & Hospital's general hospital. However, attempts were made to attract people who had not previously been visited by the service, usually after a mental evaluation. If the patient was discharged before they could be contacted, a phone call was made to follow up. Using data from the Monitoring System for Attempted Suicide, which collects information on all DSH patients presenting at Darbhanga Medical College & hospital. Measurement of tools Interview Schedule The WHO/Euro Multicentre Study on Parasuicide[6] was utilised to administer the programme. The following topics of inquiry are included in the schedule: demographics, present and previous DSH episodes, life events, social support, interaction with health experts, and physical and mental health. Personality Assessment Schedule: Tyrer and colleagues used the self-report version of the Personality Assessment Schedule (PAS),9 which was modified according to ICD-10 criteria. Tyrer et al method's was used to categorise the ratings within each personality area, with a rating of seven or more indicating personality disorder and a rating of 4-6 trait accentuation. At the follow-up interview, the PAS was completed (see below). This enabled us to examine personality at a time when psychiatric disorders were less likely to be present. [10] ICD-10 Diagnostic Schedule: The duration and nature of current and prior psychiatric symptoms were recorded using a systematic interview schedule established by our group and based only on ICD-10 research diagnostic criteria [7,8] The diagnosis was based on the patient's self-report of symptoms in the weeks leading up to the DSH index episode, as well as the patient's behaviour during the interview. Patients were asked screening questions for each condition group. When one or more of the screening questions were answered affirmatively, the entire set of research criteria for the specific diagnosis as indicated in ICD-10 was presented. The research interviewers were taught by a physician psychiatric researcher with extensive experience in diagnostic interviewing, as well as another researcher with similar experience.
RESULTS Table 1: Demographic characteristics among study population
Total 50 patients including in the study, Maximum no of the patients were belongs to 20-30 years of age group, i.e. 29(58.0%). Next commonest age group was 31-40 years, patients consisted 11(22.0%). Female cases were predominately higher than male cases,
Table 2: Psychiatric disorder according to ICD10
Affective disorder was present in 38 patients (76%). A Depressive episode was present in male cases 68.4% & Female cases were71.0%. Substance use disorders (alcohol) present in 16(32.0%) cases. Substance use disorders(Drug) users was present 30(60%) cases. Neurotic, stress, somotoform disorders was found 19(38%) cases. Eating disorder was observed 14(28%) cases. & Schizophrenia cases was found 7(14%) respectively.
DISCUSSION We discovered a high prevalence of both psychiatric (84.0 percent) and personality (41.2 percent) disorders in a representative sample of DSH patients presenting to a general hospital in Darbhanga Medical College, with the most common psychiatric disorders being depression, substance use, and anxiety disorders. The rates of psychiatric disorder discovered in this study are significantly greater than those reported in prior UK studies that employed systematic screening tools.[11] The rates and profile of psychiatric disorders in this study are more similar to those reported in UK studies of completed suicides.12 One possible explanation for the disparity between the findings of this study and those from the 1970s is a change in the DSH population's characteristics over time. It is also likely that the implementation of a standardised diagnostic routine led to the over-diagnosis of mental diseases among susceptible people. However, given the level of reported historical psychiatric disease, such an effect, if present, would be minor. Suominen et al13. also reported discrepancies between the frequency of psychiatric diagnoses in DSH patients based on research interviews and those made in routine clinical consultations. In comparison to usual consultations, they discovered considerably greater incidence of depression, alcohol dependence/abuse, and comorbidity of psychiatric diseases following research interviews. They came to the conclusion that this discovery had significant consequences for clinical practise. Furthermore, recent studies from other countries have found comparable rates of psychiatric disorders in DSH patients to those found in this study, Barnes, and KennedyEnnis et al, 1989, 85 percent ; Suominen, Henriksson, and SuokasSuominen et al, 1996, 98 percent Nearly half of our sample had several psychiatric diseases, which is consistent with the findings of Suominen et al.,13 The number of DSH patients having a personality disorder in this study (45.9 percent) is comparable to that discovered in previous investigations by Ferreira de Castro, Cunha, and Pimenta (Ferreira de Castro et al, 1998, 50.6 percent).14 In various investigations of DSH patients, borderline personality disorder was found to be the most common personality disorder.15 Recurrent threats or acts of self-harm are one of its diagnostic features. This study found no significant gender differences in the prevalence and severity of depressive disorders, the prevalence of anxiety disorders, or the frequency of psychiatric and/or personality disorder comorbidity. There were, however, significant gender disparities in prevalence of alcohol dependence or hazardous use, as well as eating disorders.16
CONCLUSION Psychiatric and personality disorders, as well as their comorbidity, are common among DSH patients. This has substantial implications for assessment and management. The high rates of psychiatric morbidity discovered in this study imply that DSH patients' assessments should include comprehensive screening for psychiatric symptoms. This has ramifications for employee training. The high incidence of depressed symptoms and the huge number of patients with severe depressive episodes begs the question of whether affective disorders are under-recognized and under-treated in DSH patients. While psychosocial therapies are regarded to be appropriate for the majority of patients.
REFERENCES
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