Symptoms of patients with personality disorders worsened during COVID-19 lockdown

Patients with personality disorders experienced worsened symptoms, some of which have not improved, during the COVID-19 pandemic, according to an observational retrospective study published in Psychiatry Research.

“Subjects affected by personality disorders (PDs) resulted to be more compromised in terms of general psychopathology than depressed and anxiety/[obsessive-compulsive] ones and showed more severe anxiety symptoms than [schizophrenia] patients,” Alice Caldiroli, MD, of the University of Milan, and colleagues wrote.

Caldiroli and colleagues designed the study to compare the change in severity of psychiatric symptoms in different diagnostic groups during the first wave of the COVID-19 pandemic. Between Nov. 12, 2020, and Jan. 31, 2021, 166 patients aged 18 to 65 years (mean age, 49.22 years) from the Monza district in Northern Italy were routinely evaluated during psychiatric visits to assess changes in their psychopathological status throughout the pandemic. A total of 39.8% of the patients had schizophrenia, 17.5% bipolar disorder, 21.7% major depressive disorder, 10.2% anxiety or obsessive-compulsive disorder and 10.8% personality disorders.

The researchers divided the study into three time points: T0, representing the outbreak of the pandemic (January or February 2020), T1 as the lockdown period (March or April 2020) and T2 as reopening (May or June 2020), with the changes and developments among the individuals being assessed in all three. The researchers divided the patients into five groups (schizophrenia, bipolar disorder, MDD, anxiety disorders or OCD and personality disorders) and used linear regression models to determine whether change over time in psychometric scores differed between diagnostic groups. They performed descriptive analysis on the entire sample and used the Brief Psychiatry Rating Scale (BPRS), Clinical Global Impression scale (CGI-S) and the Hamilton Anxiety Rating scale (HAM-A) to assess the individuals at T0, T1 and T2.

Caldiroli and colleagues noted significant worsening of psychometric scores during the lockdown restrictions, followed by mild improvement in symptoms at the reopening for general psychopathology, global severity and functioning, anxiety, disability and depressive symptoms in patients with affective disorders. Those with personality disorders reported overall more severe anxiety than patients with schizophrenia during the first 6 months of the pandemic.

“Overall, psychometric scores showed a significant worsening at T1 with a mild improvement at T2,” Caldiroli and colleagues wrote. “Only psychopathology in schizophrenia patients and obsessive-compulsive symptoms did not significantly improve at T2.”

The authors noted that despite psychiatric hospital visits dropping in T1 across Northern Italy, BPRS and CGI-S scores showed that psychiatric symptoms, particularly for patients with MDD and anxiety/OCD, worsened globally. The study’s findings that OCD symptoms showed “poor improvement” at T3 are supported by other studies, according to the authors.

“In conclusion, subjects affected by [personality disorders] require specific clinical attention during COVID-19 pandemic,” Caldiroli and colleagues wrote. “Moreover, the worsening of [schizophrenia] and OCD symptoms should be strictly monitored by clinicians, as these aspects did not improve with the end of lockdown measures.”