Personality Disorders In Individuals With An At-Risk Mental State For Psychosis: a Systematic Review and Meta-Analysis

Introduction: Increasing evidence shows that personality pathology is common among patients at clinical high risk (CHR) for psychosis. Despite the impact that this comorbidity might have on presenting high-risk psychopathology and transition to full psychotic disorders, the relationship between personality syndromes and CHR states has received little empirical attention. This meta-analytic review aimed at: (1) estimating the prevalence rates of personality disorders (PDs) in CHR individuals and (2) examining the potential role of PDs in predicting transition to psychosis. Methods: The systematic search of the empirical literature identified 17 relevant studies, examining a total of 2,144 CHR individuals. Three distinct meta-analyses were performed to provide prevalence estimates of PDs in the CHR population. The first and more comprehensive meta-analysis focused on any comorbid PD (at least one diagnosis), the second one focused on schizotypal personality disorder (SPD), and the last one focused on borderline personality disorder (BPD). Moreover, a narrative review was presented to define the predictive role of the personality of CHR patients in promoting more severe outcomes. Results: The findings showed that the prevalence rate of comorbid personality diagnoses in CHR patients was 39.4% (95% CI [26.5%–52.3%]). More specifically, 13.4% (95% CI [8.2%–18.5%]) and 11.9% (95% CI [0.73%–16.6%]) of this clinical population presented with SPD and BPD, respectively. Finally, the studies examining the effects of baseline personality diagnoses on transition to psychotic disorders showed contradictory and insufficient results concerning the potential impact of SPD. Conversely, no effect of BPD was found. Conclusions: The present meta-analytic review indicated that the CHR population includes a large subgroup with serious personality pathology. These findings could have relevant clinical implications in promoting preventive interventions and enhancing treatment effectiveness.