Investigations
1st investigations to order
clinical interview
Test
People with personality disorders do not present to a primary care physician seeking relief from their personality difficulties, and may have little or no insight into their personality issues.
Diagnosis will be focused on broad symptom categories that are observable in physician-patient encounters or present in the patient's history, whether obtained from the patient him/herself or from others who know the patient (collateral sources).
Further screening tests for the assessment of comorbid symptoms may be helpful.
Specialist referral is required for a detailed assessment of personality disorder traits.
Result
symptoms dating from adolescence/early adulthood; not occurring solely in the presence of another disorder such as depression or anxiety; significant difficulties in interpersonal interactions may lead to suspected diagnosis of personality disorder
Investigations to consider
suicide risk screening questions
Test
There is inconclusive evidence for routine assessment of suicide risk in primary care. Strongest suicide risk factors are: presence of mood disorder, comorbid substance abuse, history of deliberate self-harm, prior suicide attempt. Screening tools specific for suicide risk have not been validated in primary care settings.[67]
Result
positive or negative for factors that indicate increased suicide risk in this patient population
Standardized Assessment of Personality-Abbreviated Scale (SAPAS)
Test
A brief screening interview test for personality disorder, which has been validated in psychiatric settings.[57][58]
Within the primary care setting, it may be appropriate for use with patients who have comorbid psychiatric conditions, such as anxiety or depression. However, it is not recommended for routine screening in primary care settings, where prevalence of personality disorder is lower than in psychiatric settings.[57]
Result
may demonstrate positive ratings for personality disorder
Millon Clinical Multiaxial Inventory-III (MCMI-III)
Test
Commonly used instrument that may be used by a consulting psychologist or psychiatrist following referral from primary care.
Result
may demonstrate positive ratings for personality disorder
Structured Clinical Interview for DSM-5-TR Alternative Model for Personality Disorders Version (SCID-5-AMPD)
Test
Semi-structured interview for use by trained clinicians with a basic knowledge of the concepts of personality disorders. Formatted as three independent modules: self and interpersonal functioning, assessment of five pathological personality trait domains and their corresponding 25 trait facets, assessment of six specific personality disorders and Personality Disorder-Trait-Specified.
Result
may demonstrate positive ratings for components of personality pathology and/or personality disorder
Structured Clinical Interview for DSM-5-TR Personality Disorders
Test
Commonly used instrument that may be used by a consulting psychologist or psychiatrist following referral from primary care. Assesses the 10 DSM-5-TR Personality Disorders across Clusters A, B, and C as well as Other Specified Personality Disorder. There is also an optional self-report patient questionnaire.
Result
may demonstrate positive ratings for personality disorder
MRI/CT scan of brain
Test
Ordered in cases of sudden appearance of one or more of the following: cognitive-perceptual symptoms, affective dysregulation, atypical features, or impulsive behavioural dyscontrol. An abnormal result would indicate a need for further medical or neurological testing.
Result
normal in personality disorder
urine drug screen
Test
Ordered in cases of one or more of the following: cognitive-perceptual symptoms, affective dysregulation, or impulsive behavioural dyscontrol. Personality disorder is not diagnosed if suggestive symptoms occur only during times of active substance use.
Result
positive result suggests comorbid substance use disorder diagnosis or substance use disorder in absence of personality disorder
The Primary Care Evaluation of Mental Disorders (PRIME-MD)
Test
Administered in primary care settings for patients with the possibility of comorbid axis I disorder(s).
The test is comprised of a patient questionnaire followed by clinician evaluation. It assesses for the presence of mood, anxiety, somatoform, and eating disorders, as well as alcohol abuse/dependence.[62]
Result
normal or a result suggesting the presence of comorbid axis I disorder(s)
Patient Health Questionnaire-9 (PHQ-9)
Test
Administered in primary care setting in patients with symptoms of depression. Includes a question about suicide and self-harm.
Test score interpretation: 5-9, minimal symptoms; 10-14, mild symptoms; 15-19, moderate symptoms; 20 or greater, severe symptoms.[63] Patient Health Questionnaire PHQ-9 Opens in new window
Personality disorder should be considered in patients for whom depression scores do not improve with treatment.
Result
score indicative of depression severity
Mood Disorder Questionnaire
Test
Administered in primary care setting for patients with symptoms of affective dysregulation or impulsive behavioural dyscontrol.
Mood disorder screening score of 7 or more yields sensitivity of 0.73 and specificity of 0.90.[66]
Result
normal or a result suggestive of manic or hypomanic symptoms
Generalised Anxiety Disorder-7 (GAD-7) and GAD-2
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