Prevalence of personality disorders among civil inpatients at Mathari Hospital

Abstract

Introduction: Personality disorders are enduring patterns of inner experience and behavior that deviates markedly from expectations of the individual's culture. This pattern is chronic, inflexible and pervasive across a broad range of personal and social situations. The prevalence of personality disorders in psychiatric inpatients is higher than that found in the general population. Objective: To determine the prevalence and pattern of personality disorders among civil psychiatric inpatients at Mathari Hospital and the relationship between Axis-I disorders and Axis-Il personality disorders in the same population. Design: A descriptive cross-sectional study. Setting: Mathari Hospital, the national referral and teaching psychiatric hospital in Kenya. Method: One hundred and forty-eight patients aged 18 and above were randomly selected. Informed consent was sought and given for participation in the study. A socio-demographic questionnaire, Structured Clinical Interviews for DSM IV Axis-I Disorders (SCID-I) and for Axis II Personality Disorders (SCID-II) were administered. Results: Out of the 148 patients interviewed for the study 30 (20.3%) had a personality disorder. The majority of these patients had a Cluster B personality disorder (86.6%) in the following order: Antisocial Personality Disorder (53.3%), Borderline Personality Disorder (26.7%), Histrionic Personality Disorder (3.3%) and Narcissistic Personality Disorder (3.3%). Dependant Personality Disorder (6.7%) and Personality Disorder Not Otherwise Specified (6.7%) were also prevalent. The study found no statistically significant differences in age, sex, marital status, level of education, occupation, average monthly income, age at onset of illness and past medical admissions between those with personality disorders and those without. Among those with personality disorders, 18 (66.7%) had a diagnosis of substance abuse or dependence, compared to 25 (21.2%) among those without a personality disorder. This difference was statistically significant (p<O.OOI). There was a statistically significant correlation between personality disorders and mood disorders (p=O.002).The patients with a mood disorder and a personality disorder were 14 (46.7%) whereas 23 (19.5%) had a mood disorder without a personality disorder. Conclusions and recommendations: The prevalence of personality disorders among civil inpatients at Mathari Hospital was found to be lower than that in other similar studies. This may be due to the fact that the diagnostic concepts contained in most personality disorder instruments may not be sufficiently relevant to non-Western societies. It is recommended that all patients admitted at Mathari Hospital with an Axis I diagnosis should be screened for personality disorders.