Publications
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Mansell C, Yang M, Tyrer P, 2024, Effect of drama training on self-esteem and personality strengths: A feasibility case control study of nidotherapy., Int J Soc Psychiatry
BACKGROUND: Although there are many case reports and qualitative studies on the likely positive effects of drama on mental health there have been few quantitative studies with mentally ill patients. AIMS: To assess the effect of drama training in patients receiving nidotherapy with a range of mental and personality disorders on changes in self-esteem and personality strengths over a 1-month period compared with two control groups, one with similar mental disorders and another without, who had similar assessments but no acting involvement. METHOD: A total of 19 patients were recruited from a mental health charity with current significant mental illness (active group: n = 6) (b) a control group of patients with current mental illness who were not involved in acting (n = 5), and an additional control group with no current mental illness (n = 8) The patients involved in drama were taking part in nidotherapy, an environmental intervention. Two self-rating scales, the Rosenberg Self-Esteem Scale (RSES) and Abbreviated Personality Strengths Scale (APSS) recorded changes in self-esteem and personality strengths at base-line and after 1 month in the participants. Random effects modelling was used to analyse the data. RESULTS: The intervention group showed positive improvement in personality strengths (p = .009) compared to the control group that had no mental illness, and also improved more than the control group with mental illness but not to a significant degree (p = .16). Self-esteem recorded with the Rosenberg scale was lower in those in the acting group at baseline compared with the other two groups (p = .088) but after acting training improved by 29% to be equivalent to the control groups. CONCLUSIONS: Despite the limited numbers in this study, and the consequent inability to make firm conclusions about the efficacy of drama therapy as part of nidotherapy, the findings suggest that larger trials of this approach are feasible and worth exploring. .
Tyrer P, Duggan C, Yang M, et al., 2023, The effect of environmental change, planned and unplanned life events on the long-term outcome of common mental disorders, Social Psychiatry and Psychiatric Epidemiology: the international journal for research in social and genetic epidemiology and mental health services, Pages: 1-12, ISSN: 0933-7954
PURPOSE: To examine the nature of positive and negative environmental change on clinical outcome in 210 patients presenting with anxiety and depression and followed up over 30 years. METHODS: In addition to clinical assessments, major environmental changes, particularly after 12 and 30 years, were recorded in all patients by a combination of self-report and taped interviews. Environmental changes were separated into two major groups, positive or negative, determined by patient opinion. RESULTS: In all analyses positive changes were found to be associated with better outcome at 12 years with respect to accommodation (P = 0.009), relationships (P = 007), and substance misuse (P = 0.003), with fewer psychiatric admissions (P = 0.011) and fewer social work contacts at 30 years (P = 0.043). Using a consolidated outcome measure positive changes were more likely than negative ones to be associated with a good outcome at 12 and 30 years (39% v 3.6% and 30.2% v 9.1%, respectively). Those with personality disorder at baseline had fewer positive changes (P = 0.018) than others at 12 years and fewer positive occupational changes at 30 years (P = 0.041). Service use was greatly reduced in those with positive events with 50-80% more time free of all psychotropic drug treatment (P < 0.001). Instrumental positive change had greater effects than imposed changes. CONCLUSIONS: Positive environmental change has a favourable impact on clinical outcome in common mental disorders. Although studied naturalistically in this study the findings suggest that if harnessed as a therapeutic intervention, as in nidotherapy and social prescribing, it would yield therapeutic dividends.
Ikkos G, Bouras N, Tyrer P, 2023, Madness and society in Britain., BJPsych Bull, Vol: 47, Pages: 152-156, ISSN: 2056-4694
The fiftieth anniversary of the Royal College of Psychiatrists, and the publication of a detailed multidisciplinary social history of British psychiatry and mental health in recent decades have offered an opportunity to take a helicopter view and reflect on the relation between psychiatry and changing British society. We argue that the time has come to move on from the rhetoric of deinstitutionalisation and community mental healthcare to lead public debate and advocacy for the needs of the mentally ill in the new era of 'meta-community psychiatry and mental healthcare'. We need to respond effectively to the increasing awareness of mental health problems across society, aiming for a pluralist, integrated and well-funded reform led by joint professional and patient interests which could be unstoppable if we all work together.
Mulder R, Tyrer P, 2023, Borderline personality disorder: a spurious condition unsupported by science that should be abandoned, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 116, Pages: 148-150, ISSN: 0141-0768
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Tyrer P, Tyrer H, Johnson T, et al., 2022, Thirty year outcome of anxiety and depressive disorders and personality status: comprehensive evaluation of mixed symptoms and the general neurotic syndrome in the follow-up of a randomised controlled trial, Psychological Medicine, Vol: 52, Pages: 3999-4008, ISSN: 0033-2917
BackgroundCohort studies of the long-term outcome of anxiety, depression and personality status rarely join together.MethodsTwo hundred and ten patients recruited with anxiety and depression to a randomised controlled trial between 1983 and 1987 (Nottingham Study of Neurotic Disorder) were followed up over 30 years. At trial entry personality status was assessed, together with the general neurotic syndrome, a combined diagnosis of mixed anxiety–depression (cothymia) linked to neurotic personality traits. Personality assessment used a procedure allowing conversion of data to the ICD-11 severity classification of personality disorder. After the original trial, seven further assessments were made. Observer and self-ratings of psychopathology and global outcome were also made. The primary outcome at 30 years was the proportion of those with no Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis.Data were analysed using multilevel repeated measures models that adjusted for age and gender. Missing data were assumed to be missing at random, and the models allowed all subjects to be included in the analysis with missing data automatically handled in the model estimation.ResultsAt 30 years, 69% of those with a baseline diagnosis of panic disorder had no DSM diagnosis compared to 37–47% of those with generalised anxiety disorder, dysthymia or mixed symptoms (cothymia) (p = 0.027). Apart from those with no personality dysfunction at entry all patients had worse outcomes after 30 years with regard to total psychopathology, anxiety and depression, social function and global outcome.ConclusionsThe long-term outcome of disorders formerly called ‘neurotic’ is poor with the exception of panic disorder. Personality dysfunction accentuates poor recovery.
Crawford M, Leeson V, McQuaid A, et al., 2022, Severe COVID anxiety among adults in the United Kingdom: protocol for a cohort study and nested feasibility trial of modified Cognitive Behaviour Therapy for Health Anxiety., BMJ Open, Vol: 12, Pages: 1-9, ISSN: 2044-6055
IntroductionSome people are so anxious about COVID that it impairs their functioning. However, little is known about the course of severe COVID anxiety or what can be done to help people who experience it. Methods and analysisCohort study with a nested feasibility trial with follow-up at three and six months. We recruited 306 people who were aged 18 and over, lived in the United Kingdom and had severe COVID anxiety (indicated by a score of nine or more on the Coronavirus Anxiety Scale). To take part in the nested feasibility trial, participants also had to have a score of 20 or more on the Short Health Anxiety Inventory. We excluded people from the trial if they had had COVID-19 within the previous four weeks, if they were currently self-isolating or if they were already receiving psychological treatment. We publicised the study nationally through adverts, social media and posts on chat boards. We also recruited participants via clinicians working in primary and secondary care NHS services in London. All those in the active arm will be offered five to ten sessions of remotely delivered modified Cognitive Behaviour Therapy for Health Anxiety (CBT-HA). We will examine the proportion of participants who remain above threshold on the Coronavirus Anxiety Scale at three and six months and factors that influence levels of COVID anxiety over six months using mixed-effects logistic regression. The key feasibility metrics for the nested trial are the level of uptake of CBT-HA and the rate of follow-up.Ethics and disseminationApproved by Leicester Central Research Ethics Committee (reference: 20/EM/0238). The results of the study will be published in peer-reviewed scientific journals. Trial registration: International Standard Randomised Control Trial Number Register - ISRCTN14973494
Tyrer P, 2022, Response: Personality disorder is here to stay across the lifespan – a response to Commentaries on the May 2022 Debate, Child and Adolescent Mental Health, Vol: 27, Pages: 253-255, ISSN: 1475-357X
BackgroundThe classification of personality disorder is in a state of flux. Revision is necessary, overdue, and is provided by the new ICD-11 classification.AimsTo explain the advantages of the new classification system and why ‘borderlne’ is a redundant term. To summarise positive and negative views about its implications, especially in young people.Materials and MethodsReview of recent literature and developments.ResultsPersonality disturbance is ubiquitous and changes across the life span. The data are unequivocal.DiscussionAs personality disturbance is so common in childhood and adolescence it should be recognised and acknowledged at this time even though it is very likely to change.ConclusionsThe stigma surrounding personality disorder can be countered by science and courage.
Mittal T, Evans E, Pottle A, et al., 2022, MINDFULNESS-BASED INTERVENTION IN PATIENTS WITH PERSISTENT PAIN IN CHEST (MIPIC) OF NON-CARDIAC CAUSE: A FEASIBILITY RANDOMISED-CONTROL STUDY, Annual Conference of the British-Cardiovascular-Society - 100 Years of Cardiology, Publisher: BMJ PUBLISHING GROUP, Pages: A139-A140, ISSN: 1355-6037
Tyrer P, Tyrer H, Yang M, 2022, Relationships between treatments received in the Nottingham Study of Neurotic Disorder over 30 years and personality status, Personality and Mental Health: multidisciplinary studies from personality dysfunction to criminal behaviour, Vol: 16, Pages: 99-110, ISSN: 1932-8621
We compared the drug treatments and health service contacts of anxious and depressed patients with and without personality disturbance in a cohort of 200 patients over 30 years. Details of all contacts made with health professionals at 5, 12 and 30 years were recorded. Multilevel models based on follow-up data at all time points were used. Over 30 years, patients with dependent and anankastic personality disturbance and cothymia ( the general neurotic syndrome) were 2.27 times more likely to receive SSRI and new antidepressants (95%CI: 1.22-4.24), and were 1.6 weeks (95% CI: 1.2-2.3) longer on the drug than those without the syndrome. Similar results with SSRI’s and new antidepressants in patients with personality disorder fell short of significance after adjusting for age, gender and DSM status. Most patients had a DSM diagnosis at follow-up points, and these had increased psychological treatment, psychiatric admissions, multiple drugs, SSRI’s and new antidepressants. At later follow-up most drug treatments decreased apart from psychological treatment, SSRI’s and new antidepressants. Over 30 years, those with personality disorder had longer drug treatments than others. It is concluded that anxiety and depressive disorders, whether or not associated with personality disturbance, receive many treatments without resolution of symptoms.
Tyrer P, 2022, Debate: Young people with personality disorder should be recognised and appropriately managed, Child and Adolescent Mental Health, Vol: 27, Pages: 199-200, ISSN: 1475-357X
<jats:p>The characteristic features of personality disorder that are found in older people are also present in young people. These features are currently not diagnosed as personality problems by most UK practitioners, through a mixture of fear and prejudice, which is used to justify this avoidant diagnostic behaviour. A simple solution is offered. State that personality function is ‘disordered’ in those who cross the threshold for diagnosis but emphasise that it is often ephemeral and can be managed.</jats:p>
Mittal TK, Evans E, Pottle A, et al., 2022, Mindfulness-based intervention in patients with persistent pain in chest (MIPIC) of non-cardiac cause: a feasibility randomised control study, OPEN HEART, Vol: 9, ISSN: 2053-3624
Yang M, Tyrer P, Tyrer H, 2022, The recording of personality strengths: An analysis of the impact of positive personality features on the long-term outcome of common mental disorders, PERSONALITY AND MENTAL HEALTH, Vol: 16, Pages: 120-129, ISSN: 1932-8621
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Tyrer P, Tyrer H, Yang M, 2022, The influence of personality disorder in predicting suicidal behaviour in common mental disorders: A 30-year study, PERSONALITY AND MENTAL HEALTH, Vol: 16, Pages: 111-119, ISSN: 1932-8621
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Jha M, Barrett B, Brewin C, et al., 2022, Matching ICD-11 personality status to clinical management in a community team-The Boston (UK) Personality Project: Study protocol, Personality and Mental Health: multidisciplinary studies from personality dysfunction to criminal behaviour, Vol: 16, ISSN: 1932-8621
Epidemiological studies show 30% to 50% of all patients in community mental health teams have personality disorders. These are normally comorbid with other psychiatric disorders, often as Galenic syndromes, and are seldom identified. In the Boston (UK) Personality Project all patients under a community health service in Boston in Lincolnshire will be asked to agree to have their personality status assessed using scales recording the new ICD-11 classification, together with clinical ratings, social function and satisfaction. A control group of 100 patients from an adjacent service of similar demographics (Spalding) will also have similar ratings but no personality assessments. Changes in clinical status, social function and service satisfaction will be made after 6 and 12 months in both groups. The patients in the Boston group will be offered matched interventions using a stepped care approach for both the severity of disorder and its domain structure. These interventions will include shorter versions of existing psychological treatments, environmental therapies including nidotherapy, adaptive and acceptance models, drug reduction and social prescribing. Full costs of psychiatric care will be measured in both groups. The main hypothesis is that greater awareness of personality function will lead to better clinical outcomes and satisfaction.
Duggan C, Tyrer P, 2022, Specialist teams as constituted are unsatisfactory for treating people with personality disorders., BJPsych Bull, Vol: 46, Pages: 100-102, ISSN: 2056-4694
It is now becoming standard practice in most advanced economies to provide specialist services for those with personality disorder. Such services, almost exclusively, provide complex well-structured psychological interventions lasting many months for a small number of those with borderline personality disorder pathology. The evidence suggests that these treatments are effective but they can only be provided for a small number of people. However, in every area the numbers of patients with significant personality disorder far exceeds those that are treated, and most of these have other personality disorders. It is argued that the current service system is not working efficiently and should be replaced by one that provides resources and expertise within community teams with some external advice from specialists but no transfer of responsibility to a designated team.
Yang M, Tyrer H, Johnson T, et al., 2022, Personality change in the Nottingham Study of Neurotic Disorder: 30-Year cohort study, Australian & New Zealand Journal of Psychiatry, Vol: 56, Pages: 260-269, ISSN: 0004-8674
Background:Persistence is said to be a feature of personality disorder, but there are few long-term prospective studies of the condition. A total of 200 patients with anxiety and depressive disorders involved in a randomised controlled trial initiated in 1983 had full personality status assessed at baseline. We repeated assessment of personality status on three subsequent occasions over 30 years.Methods:Personality status was recorded using methods derived from the Personality Assessment Schedule, which has algorithms for allocating Diagnostic and Statistical Manual of Mental Disorders (DSM) and the 11th International Classification of Diseases (ICD-11) categories. The category and severity of personality diagnosis were recorded at baseline in the randomised patients with DSM-III anxiety and depressive diagnoses. The same methods of assessing personality status was repeated at 2, 12 and 30 years after baseline.Results:Using the ICD-11 system, 47% of patients, mainly those with no personality disturbance at baseline, retained their personality status; of the others 16.8% improved and 20.4% worsened to more severe disorder. In DSM-III diagnosed patients, those diagnosed as Cluster A and Cluster C increased in frequency (from 14% to 40%, p < 0.001, and 21.5% to 36%, p < 0.001, respectively) over follow-up, while those with Cluster B showed little change in frequency (22% to 18%, p = 0.197).Conclusion:In this population of patients with common mental disorders, personality status showed many changes over time, inconsistent with the view that personality disorder is a persistent or stable condition. The increase in diagnoses within the Cluster A and C groups suggests personality disorder generally increases in frequency as people age.
Tyrer P, Mulder R, Newton-Howes G, et al., 2022, Galenic syndromes: combinations of mental state and personality disorders too closely entwined to be separated, The British Journal of Psychiatry, Vol: 220, Pages: 1-2, ISSN: 0007-1250
Many mental disorders are linked to personality, but this is rarely recognised in clinical practice. It is suggested here that when the links are very close, the two can be joined. Galenic syndromes are so named because Galen was the first physician to recognise the links between personality and disease.
Tyrer PJ, Mulder R, 2022, Personality Disorder From Evidence to Understanding, ISBN: 9781108948371
We are frequently asked to remember George Santayana's comment, made by many others, that "those who cannot remember the past are condemned to repeat it" (Santayana, 1905). But this is hardly relevant for a textbook on The Wheel.
Tyrer P, Tyrer H, Yang M, et al., 2021, Is social function a good proxy measure of personality disorder?, Personality and Mental Health: multidisciplinary studies from personality dysfunction to criminal behaviour, Vol: 15, Pages: 261-272, ISSN: 1932-8621
Background:Personality assessment is often difficult and proxy measures may be useful. Aims: To examine the assessment of social functioning in relationship to personality disorder. Method:Secondary analysis of data from three clinical studies; following deliberate self-harm (n=460), cognitive behaviour therapy for health anxiety (n=444), and a 30-year follow up of 200 anxious/depressed patients. Social function and personality were assessed using the Social Functioning Questionnaire (SFQ) and the Personality Assessment Schedule. A five item short version of the SFQ, the Short Social Functioning Questionnaire (SSFQ) was also developedResults:The SFQ score in the first two studies (area under curve (AUC) 0.64 and 0.65) partly predicted personality status; in the third study this achieved close agreement (AUC SFQ 0.85 (95% CI 0.8-0.9; AUC SSFQ 0.84 (95% CI 0.78-0.89). In all studies social function deteriorated linearly with increasing personality pathology. Cut-off points of 4 on the SSFQ and 7 on the SFQ had high sensitivity (SSFQ 82-90%; SFQ 82-83%) and acceptable specificity (SSFQ 66-75%; SFQ 69-75%) in identifying personality disorder in the third study. Conclusions: Social functioning recorded in either a 5-item or 8-item self-rating is a useful proxy measure of personality disturbance, and may be the core of disorder.
Tyrer P, 2021, Remembered jewels: The role of diagnosis in psychiatry by Robert Kendell, BJPsych Advances, Pages: 1-2, ISSN: 2056-4678
This is the first of a series of articles on key works in psychiatry that should not be forgotten. Many were published before our current generation of psychiatrists had easy access to them, but they need recall. It is my strong belief that originality of thought only occurs in youth. Robert Kendell's book The Role of Diagnosis in Psychiatry (1975) illustrates this perfectly.
Tyrer P, 2021, A Partly Anglicised Kiwi: A Psychiatrist Remembers By Brian Barraclough (edited by Jennifer Barraclough) Independently Published. 2020. £8.00 (pb). 236 pp. ISBN 9798623114792, BJPsych Bulletin, Vol: 45, Pages: 254-255, ISSN: 2056-4694
Tyrer P, Wang D, Crawford M, et al., 2021, Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over 8 years: a randomised-controlled trial., Psychological Medicine, Vol: 51, Pages: 1714-1722, ISSN: 0033-2917
BACKGROUND: Health anxiety is an under-recognised but a frequent cause of distress. It is particularly common in general hospitals. METHODS: We carried out an 8-year follow-up of medical out-patients with health anxiety (hypochondriasis) enrolled in a randomised-controlled trial in five general hospitals in London, Middlesex and Nottinghamshire. Randomisation was to a mean of six sessions of cognitive behaviour therapy adapted for health anxiety (CBT-HA) or to standard care in the clinics. The primary outcome was a change in score on the Short Health Anxiety Inventory, with generalised anxiety and depression as secondary outcomes. Of 444 patients aged 16-75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics, 306 (68.9%) were followed-up 8 years after randomisation, including 36 who had died. The study is registered with controlled-trials.com, ISRCTN14565822. RESULTS: There was a significant difference in the HAI score in favour of CBT-HA over standard care after 8 years [1.83, 95% confidence interval (CI) 0.25-3.40, p = 0.023], between group differences in generalised anxiety were less (0.54, 95% CI -0.29 to 1.36), p = 0.20, ns), but those for depression were greater at 8 years (1.22, 95% CI 0.42-2.01, p < 0.003) in CBT-HA than in standard care, most in standard care satisfying the criteria for clinical depression. Those seen by nurse therapists and in cardiology and gastrointestinal clinics achieved the greatest gains with CBT-HA, with greater improvement in both symptoms and social function. CONCLUSIONS: CBT-HA is a highly long-term effective treatment for pathological health anxiety with long-term benefits. Standard care for health anxiety in medical clinics promotes depression. Nurse therapists are effective practitioners.
Tyrer P, Wang D, Crawford M, et al., 2021, Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over eight years: randomised controlled trial (vol 51, pg 1714, 2021), PSYCHOLOGICAL MEDICINE, Vol: 51, Pages: 1723-1723, ISSN: 0033-2917
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Halder N, Tyrer P, Casey P, 2021, Peer reviewing made easier: your questions answered, BJPsych Advances, Vol: 27, Pages: 255-262, ISSN: 2056-4678
<jats:title>SUMMARY</jats:title><jats:p>Peer reviewing is a hugely important part of the scientific process that ensures published articles are of sufficient quality to deserve dissemination to the wider scientific community. Building on a previous article published in this journal, this article addresses topics that potential or practising peer reviewers may find useful. These include what peer reviewing is, why do peer reviews, how to become a reviewer, what to write in a review and where to find more information. It includes a template for writing a review, and lists various websites and guidelines that can help ease the entire process depending on what type of article is being reviewed. Peer reviewing can be enormously rewarding and help clinicians diversify their scope of work while also benefiting the scientific community by contributing to the quality control of published work.</jats:p>
Tyrer P, Tyrer H, Yang M, 2021, Premature mortality of people with personality disorder in the Nottingham Study of Neurotic Disorder, PERSONALITY AND MENTAL HEALTH, Vol: 15, Pages: 32-39, ISSN: 1932-8621
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Tyrer P, Wang D, Tyrer H, et al., 2021, Influence of apparently negative personality characteristics on the long-term outcome of health anxiety: Secondary analysis of a randomized controlled trial., Personality and Mental Health: multidisciplinary studies from personality dysfunction to criminal behaviour, Vol: 15, Pages: 72-86, ISSN: 1932-8621
BACKGROUND: It is known that personality has an influence on the outcome of mental state disorders, but detailed studies on its long-term impact are few. We examined the influence of personality status on the 8-year outcome of health anxiety and its relationship to the effects of cognitive behaviour therapy in a randomized controlled trial. AIMS: This study aims to examine both the usefulness of the diagnosis of personality disorder and an additional measure of pathological dependence, in predicting the outcome of medical patients with health anxiety treated with cognitive behaviour therapy. Because the influence of personality is often shown in the long term, these assessments covered the period of 8 years after randomization. An additional aim is to examine the costs of different levels of personality dysfunction in each treatment group. METHOD: Personality dysfunction, using both ICD-10 and ICD-11 classifications of severity, was assessed at baseline by interview in a randomized controlled trial. Patients were also assessed for pathological dependence using the Dependent Personality Questionnaire, also scored along a severity dimension. Four hundred forty-four patients from medical clinics with pathological health anxiety were treated with a modified form of cognitive behaviour therapy for health anxiety (CBT-HA) or standard care. Total costs over follow-up were calculated from hospital data and compared by personality group. RESULTS: At baseline, 381 (86%) had some personality dysfunction, mainly at the lower level of personality difficulty (not formally a disorder). One hundred eighty four (41%) had a personality disorder. A similar proportion was found with regard to dependent personality. Using the ICD-10 classification, 153 patients (34.6%) had a personality disorder, with 83 (54.2%) having anxious or dependent personality disorder, 20 (13.1%) having an anankastic disorder, but also with 66 (43.1%) having mixed disorder. During initial treatment, those
Tyrer P, Fox C, Gardiner C, et al., 2021, Initial assessment of patients with putative functional disorders in medical settings, Clinical Medicine, Vol: 21, Pages: 8-12, ISSN: 1470-2118
Patients presenting with symptoms suggestive of functionaldisorder are very frequent in practice. While it is alwaysnecessary to exclude treatable organic pathology, there areimportant clues in the presentation that can help the clinician.In particular, it is important to identify pathological healthanxiety early in assessment, as failure to do so may leadto unnecessary investigations and the dangerous path ofreinforcing reassurance. Because full assessment of functionalsymptoms takes time, it is suggested that a clinical supportnurse with some training in psychological management shouldbe available to guide the management of the patients withthese disorders. Such support nurses, based in the clinic, offera seamless way of providing care that is not achieved byexternal referral to psychologists or equivalent staff.
Tyrer P, 2020, Conquer the Clutter: Strategies to Identify, Manage, and Overcome Hoarding By Elaine Birchall and Suzanne Cronkwright Johns Hopkins University Press. 2019. £14.77 (pb). 273 pp. ISBN 9781421431512, The British Journal of Psychiatry, Vol: 217, Pages: 655-655, ISSN: 0007-1250
Tyrer P, 2020, COVID‐19 health anxiety, World Psychiatry, Vol: 19, Pages: 307-308, ISSN: 1723-8617
Tyrer P, Howard R, 2020, Late-onset personality disorder: a condition still steeped in ignorance, BJPsych Advances, Vol: 26, Pages: 219-220, ISSN: 2056-4678
Personality disorder is likely to be common in late life, but our ignorance is such that, at present, we can only speculate about its frequency and importance. The only firm evidence we have is that antisocial personality features tend to be attenuated in older age and obsessional and detached features accentuated. Differentiating personality change following organic disease from personality disorder requires more attention as it is important for good clinical management.
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