Neuropsychological outcome after traumatic temporal lobe damage

The most frequent sequelae after severe brain injury include changes in personality traits, disturbances of emotional behaviour and impairment of cognitive functions. In particular, emotional changes and/or verbal and non verbal dysfunctions were found in patients with bilateral or unilateral temporal lobe lesions. The aim of our study is to correlate the localization of the brain damage after severe brain injury, in particular of the temporal lobe, with the cognitive impairment and the emotional and behavioural changes resulting from these lesions. The patients with right temporal lobe lesions showed significantly better scores in verbal intelligence and verbal memory in comparison with patients with left temporal lobe lesions and those with other focal brain lesions or diffuse brain damage. In contradistinction, study of the personality and the emotional changes (MMPI and FAF) failed to demonstrate pathological scores in the 3 groups with different CT lesions, without any significant difference being found between the groups with temporal lesions and those with other focal brain lesions or diffuse brain damage. The severity of the brain injury and the prolongation of the disturbance of consciousness could, in our patients, account for prevalence of congnitive impairment on personality and emotional changes.

The relationship between MCMI personality scales and clinician-generated DSM-III-R personality disorder diagnoses

This study examined the relationship between elevations on the personality scales of the Millon Clinical Multiaxial Inventory (MCMI) and clinician-generated Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) diagnoses for 101 psychiatric patients at a VA medical center/psychiatric hospital in the Southeastern United States. Personality disorder diagnoses were made by employing a personality symptom checklist that consisted of all the verbatim criteria for personality disorders contained in the DSM-III-R. Clinicians who completed the checklists were required to have had at least 5 hr of direct contact with the patients who completed the MCMI. The results indicated that only the Schiozotypal scale of the MCMI was related to its respective DSM-III-R personality disorder in the simple correlation. An examination of the diagnostic efficiency statistics for each of the MCMI personality disorder scales revealed overall low sensitivity, poor specificity, poor positive predictive power, and low diagnostic power, which suggests that the MCMI may have only limited utility in identifying personality disorders.

Creatine phosphokinase levels in children with severe developmental disturbances

Serum creatine phosphokinase (CPK) levels were studied in individuals: 40 psychotic children suffering from childhood autism, atypical personality development, and childhood schizophrenia; five children with childhood aphasia; 22 children with severe personality disorders; 29 normal children and normal siblings of psychotic children; and 14 normal parents of psychotic children. Creatine phosphokinase levels from the entire population of adults and children were normally disturbed, and the mean CPK levels for the eight diagnostic groups were within normal limits. Those 22 children with personality disorders had significantly higher CPK levels than the other diagnostic groups. This relatively higher level of CPK may be related to vulnerability to later development of schizophrenic spectrum disorders. There was no apparent relationship between CPK levels and motor activity, nor was there any change in the level of CPK during a trial of psychoactive medication. Creatine phosphokinase levels remained relatively stable on test-retest determination.

Axis I and II comorbidities in subjects with and without nocturnal panic

Our purpose in this study was to compare the prevalence and pattern of Axis I and II comorbidities between patients with and without nocturnal panic (NP) attacks. One hundred and sixteen subjects with panic disorder (PD; according to DSM-IV criteria) were included: We assessed Axis I and II comorbidities using the Structured Clinical Interview for DSM-IV Axis I and II disorders, respectively. Of the sample, 27.6% of subjects had recurrent nocturnal panic attacks (NP group). Subjects with NP did not differ from those without in any sociodemographic or clinical characteristics. In the sample (94 subjects), 81% had at least one lifetime comorbid Axis I disorder, without significant differences between subjects with and without nocturnal panic even when considering comorbidity rates for single disorders; a trend toward significance was found for anorexia nervosa and somatization disorder, which both were more frequent among subjects with NP. Concerning Axis II disorders, 49.1% of the sample (57 subjects) met the criteria for at least one personality disorder, without significant differences between patients with and without NP. No significant differences were detected in comorbidity rates for any single Axis II personality disorder. Personality might play a relevant role in influencing treatment approaches to PD, but it does not appear to be a differential focus of concern in patients with compared to those without NP.

Obsessional scores and subjective general psychiatric complaints of patients with duodenal ulcer or ulcerative colitis

The Leyton Obsessional Inventory (LOI), together with 46 questions taken from Sections M-R or the Cornell Medical Index, were administered to 30 inpatients suffering from duodenal ulcer and to 30 patients admitted for ulcerative colitis to test the hypothesis that the latter have more obsessional traits than the former. The results indicated that although the two groups did not differ much in their obsessive personality traits, the ulcerative colitis patients were significantly more worried and concerned about them. None of the socio-cultural factors measured, which are known from other studies to influence these obsessive scores, was associated with the differences found. An analysis of the individual LOI items between the two groups showed that the ulcerative colitis patients were more indecisive, and also more morose, more rigid and more punctual than the duodenal ulcer patients, i.e. traits traditionally associated with obsessional personality types. The two groups did not differ on the Cornell score.

Toward a firmer foundation for DSM-5.1: domains of impairment in DSM-IV/DSM-5 personality disorders

In recent editions of the Diagnostic and Statistical Manual of Mental Disorders, personality disorders (PDs) have been conceptualized as reflecting impairments in four areas: cognition, affectivity, interpersonal functioning, and impulse control. However, there have been no systematic surveys of PD symptoms to assess the degree to which these four domains of impairment are actually represented in the DSM-IV/DSM-5 PD symptom criteria. Results of such a survey indicated that the most common domain of impairment for DSM-IV/DSM-5 PDs is interpersonal functioning (41% of all PD symptoms), followed by cognition (30%), and affectivity (18%), with relatively few PD symptoms reflecting difficulties in impulse control (6%). Comparison of the proportions of symptoms in different impairment domains in DSM-III, DSM-III-R, and DSM-IV/DSM-5 confirmed that these symptom distributions have been stable across revisions of the diagnostic manual. Implications of these results for the conceptualization of PDs in DSM-5.1 and beyond are discussed.

Identifying personality pathology associated with major depressive episodes: incremental validity of informant reports

Major limitations are associated with the use of a single source of information to assess personality pathology. The construct validity of standardized interviews and informant reports on personality pathology has been established relative to other measures of personality pathology, but it is also important to consider these measures in relation to other constructs that should be related to personality pathology. One example is major depression. In this study, we evaluated whether less common clinical methods of assessment for measuring the same personality pathology constructs, including semistructured interviews and informant reports, demonstrate unique validity, using major depressive episode (MDE) as the external criterion. This analysis focuses on a representative, community-based sample of 1,437 participants and informants. We conducted a hierarchical logistic regression analysis and determined the order of entering the predictor variables based on likelihood of being used in a clinical setting as well as empirical recommendations. Each step of our regression model significantly increased our ability to predict lifetime MDE, including self, interviewer, and informant reports of personality pathology. Overall, these findings indicate that multiple sources of personality assessment provide unique information about the relationship between maladaptive personality traits and a history of MDE. Thus, semistructured diagnostic interviews and informant reports can be used as a resource to improve the validity of personality assessments.

I. Formulation

The authors describe a systematic approach to the process of formulation. Four interlocking phases are considered. The longitudinal data collection evaluate the patient's developmental journey. The cross-sectional evaluation includes careful consideration of phenomenological and dynamic factors. The integrative evaluation of these factors permits the construction of both a dynamic and a phenomenological diagnosis. Finally, in hypothesizing a tentative prognosis, we attemt to predict the capacity and quality of a person's potential change and readjustment.

Personality characteristics of men who physically abuse women

OBJECTIVE

Studies have suggested that personality disorders may be common among men who habitually commit domestic violence. The study reported here attempted to characterize personality traits and psychological and cognitive characteristics of men who batter women in order to distinguish them from nonbattering men.

METHODS

A group of 21 batterers were compared with a group of nonbatterers using the Minnesota Multiphasic Personality Inventory and its personality disorder scales (MMPIPDS) and the Hostility and Direction of Hostility Questionnaire. Comparability of the two groups was assessed on several demographic variables and on scores on the Revised Michigan Alcoholism Screening Test, three cognitive measures, and three measures of affective disturbance.

RESULTS

Batterers scored higher on only the borderline and antisocial MMPIPDS and on the acting-out hostility and self-criticism scales of the hostility questionnaire. Problem-solving skills for both of the groups were considerably poorer than published norms. No significant differences were found between the groups in age, race, education, socioeconomic status, alcohol abuse, performance on cognitive measures, depression scale scores, or overall scores on the MMPI. As children, batterers were more likely to have experienced physical or emotional abuse.

CONCLUSIONS

Men who commit domestic violence may be found among a larger pool of men with poor problem-solving skills, but in addition they appear to have borderline-antisocial personality traits, certain types of hostility, and histories of abuse as children that may predispose them to become violent with their female companions.

A family history method for DSM-III anxiety and personality disorders

A family history method for DSM-III anxiety and personality disorders (FHPD) was validated by direct interview of 182 relatives. The categories of "any anxiety disorder," "panic disorder," and "any personality disorder" achieved sensitivities and specificities equivalent to currently accepted psychiatric family history methods. The family history results for the DSM-III dramatic and anxious personality disorder clusters showed good specificities, but only fair sensitivities. It is possible these cluster sensitivities could be improved in the future by using less stringent criteria. The FHPD is designed so that it can easily be integrated into the Family History-Research Diagnostic Criteria format and scoring.

Melancholia and axis II comorbidity

This study assessed whether the rates of comorbid personality disorders differed between DSM-IV melancholic and nonmelancholic major depressive disorder. We evaluated 260 consecutive depressed outpatients (140 women [53.8%]; mean age, 39.01 +/- 10.4 years) with DSM-III-R major depressive disorder (MDD). MDD was diagnosed with the use of the Structured Clinical Interview for DSM-III-R-Patient Edition (SCID-P); enrolled patients were required to have a score >/= 16 on the 17-item Hamilton Rating Scale for Depression (HAM-D-17). The presence of the melancholic subtype of major depression was determined with the use of a DSM-IV checklist, while the presence of personality disorders was assessed using the Structured Clinical Interview for DSM-III-R-Personality Disorders (SCID-II). Of the 102 (39.2%) patients who met criteria for melancholic depression and the 158 (60.7%) who did not, there were no significant differences in age, gender, or rates of personality disorder diagnoses. We observed no significant difference in rates of individual personality disorder clusters between melancholic and nonmelancholic depressed patients. Our findings of comparable rates of comorbid personality disorders between melancholic and nonmelancholic depression are consistent with the decision made by the DSM-IV task force to drop the DSM-III-R melancholic feature criterion of "no significant personality disturbance before first major depressive episode" as they challenge the usefulness of trying to establish such absence of premorbid personality features in acutely depressed patients.

Characterizing DSM-5 and ICD-11 personality disorder features in psychiatric inpatients at scale using electronic health records

BACKGROUND

Investigation of personality traits and pathology in large, generalizable clinical cohorts has been hindered by inconsistent assessment and failure to consider a range of personality disorders (PDs) simultaneously.

METHODS

We applied natural language processing (NLP) of electronic health record notes to characterize a psychiatric inpatient cohort. A set of terms reflecting personality trait domains were derived, expanded, and then refined based on expert consensus. Latent Dirichlet allocation was used to score notes to estimate the extent to which any given note reflected PD topics. Regression models were used to examine the relationship of these estimates with sociodemographic features and length of stay.

RESULTS

Among 3623 patients with 4702 admissions, being male, non-white, having a low burden of medical comorbidity, being admitted through the emergency department, and having public insurance were independently associated with greater levels of disinhibition, detachment, and psychoticism. Being female, white, and having private insurance were independently associated with greater levels of negative affectivity. The presence of disinhibition, psychoticism, and negative affectivity were each significantly associated with a longer stay, while detachment was associated with a shorter stay.

CONCLUSIONS

Personality features can be systematically and scalably measured using NLP in the inpatient setting, and some of these features associate with length of stay. Developing treatment strategies for patients scoring high in certain personality dimensions may facilitate more efficient, targeted interventions, and may help reduce the impact of personality features on mental health service utilization.

Reliability of the WAIS-R with psychiatric inpatients

WAIS-R subtest and composite scale reliabilities, standard errors of measurement, and standard errors of estimate were determined for a sample of psychiatric inpatients (N = 100). For Digit Span and Digit Symbol, test-retest stability coefficients were obtained; split-half reliability coefficients were calculated for all other subtests. With the exception of Object Assembly (rxx = .38), all subtest and composite scale reliability coefficients were large and acceptable. Based on the standard error of measure, the most reliable WAIS-R subtests were Digit Symbol (.77), Information (1.04), and Picture Completion (1.07). Reliability coefficients for the psychiatric inpatient sample were, in general, comparable to those values reported for the standardization group (Wechsler, 1981). Significant differences were obtained only on the Object Assembly and Vocabulary subtests.

MMPI subtypes for cocaine abusers

The MMPIs of 104 cocaine abusers in treatment were subjected to a hierarchical cluster analysis and two basic profile types emerged. Type I consisted of a spike on Pd and a subspike on Hyp, reflecting a rebellious, acting out character-disordered style with narcissistic traits. Type II consisted of a high-ranging, floating profile consisting of marked elevations on F, Sc, Dep, Pt, Pd, and Pa, reflecting a psychiatric patient who concurrently abused cocaine. These findings were contrasted to other MMPI typological studies, and the similarities and differences were discussed.

Reliability and validity of the Danish version of the Schema Mode Inventory (SMI)

Schema modes are conceptualized as different parts of oneself, related to specific emotions, cognitions, and behaviors. They are a central concept in schema therapy for personality pathology and other chronic psychiatric disorders. Prior research confirms the factorial validity of the Schema Mode Inventory (SMI), an instrument to assess schema modes. This study presents an evaluation of the Danish version of the SMI, including reliability and validity analyses. Psychometric properties, such as factor structure, internal reliability, as well as intercorrelations between subscales were assessed. This was done on the basis of a mixed Danish sample (N = 657; M age = 29.32 years; range = 18-66 years; 78.5% females) composed of 266 clinical and 391 nonclinical adult participants. Results indicated model fit for the 14-factor structure of the SMI and adequate to excellent internal reliabilities of the 14 subscales (Cronbach's α =.74-.96). Furthermore, the SMI scales differentiated between clinical and nonclinical participants as theoretically predicted. These findings imply that the SMI is a sound instrument to measure the schema mode model in a Danish setting, both for clinical and research purposes, and in particular for assessment prior to schema therapy.

Predictors of work disabilities in patients with panic disorder with agoraphobia

Objective

The aim of this study was to ascertain predictors of work insufficiency in patients with panic disorder (PD) with agoraphobia (AG).

Method

Linear regression was used to identify predictors of work insufficiency in a sample of 72 consecutive outpatients with PD with AG. Intensity of work insufficiency was ascertained from modified National Institute of Mental Health Panic Questionnaire (NIMH PQ). That represented dependent variable. Independent variables were demographic data, duration of illness, presence of comorbid current major depression episode, presence of any personality disorder and scores on the Panic and Agoraphobia Scale (PAS) subscales: panic attacks, AG (avoidance behavior), anticipatory anxiety and worries about health.

Results

Patients reported severe work insufficiency. The best predict variable for the work insufficiency in patients with PD with AG was high score on the PAS dimension of AG.

Conclusion

Patients generally reported severe effects of PD with AG on work efficacy and the results suggested that the impaired work efficacy was the most associated with avoidance behavior. These results recommend that the treatment of PD with AG patients should be related to decreasing avoidance behavior in order to establish adequate work performance in patients.

Ten-year stability of depressive personality disorder in depressed outpatients

OBJECTIVE

The purpose of this study was to examine the long-term stability of depressive personality disorder.

METHOD

The subjects included 142 outpatients with axis I depressive disorders at study entry; 73 had depressive personality disorder. The patients were assessed by using semistructured diagnostic interviews at baseline and in four follow-up evaluations at 2.5-year intervals over 10.0 years. Follow-up data were available for 127 (89.4%) of the patients.

RESULTS

The 10.0-year stability of the diagnoses of depressive personality disorder was fair, and the rate of depressive personality disorder declined over time. The dimensional score was moderately stable over 10.0 years. Growth curve analyses revealed a sharp decline in the level of depressive personality disorder traits between the baseline and 2.5-year assessments, followed by a gradual linear decrease. Reductions in depressive personality disorder traits were associated with remission of the axis I depressive disorders. Finally, depressive personality disorder at baseline predicted the trajectory of depressive symptoms over time in patients with dysthymic disorder.

CONCLUSIONS

Depressive personality disorder is moderately stable, particularly when assessed with a dimensional approach. However, the diagnosis rate and traits of depressive personality disorder tend to decline over time. The degree of stability for depressive personality disorder is comparable to that for the axis II disorders in the main text of DSM-IV. Finally, depressive personality disorder has prognostic implications for the course of axis I mood disorders, such as dysthymic disorder.

The relationship of behavioural undercontrol to alcoholism in higher-functioning adults

Externalising behaviours, including the personality characteristics of behavioural undercontrol (BU), represent one of several genetically influenced domains that impact on the alcoholism risk. Because genes explain only about 60% of the vulnerability toward alcohol use disorders (AUDs), an optimal understanding of how such behaviours affect the risk requires evaluation of their impact in the context of additional influences. Few studies have addressed this question regarding BU among relatively well-functioning adults. This paper presents results from testing a BU-based mediational model of risk in men from the San Diego Prospective Study. Structured research instruments were used with 430 adult Caucasian males to evaluate the performance of BU in predicting AUDs at the 15-year follow-up using Pearson product - moment correlations among domains and an AMOS-based structural equation model (SEM). While both the family history of AUDs (FHalc) and BU predicted alcohol-related outcome, BU by itself did not mediate the relationship of the FH to alcohol disorders. The impact of BU on alcohol problems was mediated by alcohol expectancies, peer drinking and by coping. The SEM explained 42% of the variance for AUDs. The current results indicate that BU contributed to the risk for alcohol-related problems, even among more highly functional subjects and after excluding the impact of the antisocial personality disorder, but by itself did not mediate the relationship of FH to outcome in these subjects.

Personality and repeated suicide attempts in dependent adolescents and young adults

This study compared personality characteristics of subjects with dependence disorders who had previously made a suicide attempt. The population, recruited in France, Belgium, and Switzerland, was composed of 570 subjects (225 females, 345 males, mean age = 27.3, SD = 8.5). The subjects' psychological dimensions were investigated by means of several self-report questionnaires including: BDI-13 (Beck), Sensation-Seeking Scale (Zuckerman), Toronto Alexithymia Scale (Taylor), Interpersonal Dependency Inventory (Hirschfeld), MMPI-2, and some additional scales. For most dimensions, repeat attempters, both past and recent, but more specifically the recent repeaters, had a more severe psychological profile compared to the other suicide attempters.

Family history assessment of personality disorders: II. Association with measures of psychosocial functioning in direct evaluations with relatives

To test the convergent validity of the Family History Interview for Personality Disorders (FHIPD), as well as the general utility of informants' reports of personality disorders, we explored the relationship between proband informant reports of Axis II diagnoses on the FHIPD and relative reports of various indices of psychosocial adjustment. Subjects were the first degree relatives (n = 454) of 224 probands participating in a family study of mood and personality disorders. Relatives provided information on the Structured Clinical Interview for DSM-III-R (SCID), the Personality Disorder Examination (PDE), and other variables reflecting aspects of psychosocial dysfunction that are common in personality disorders. Proband informants were interviewed about their relatives using the FHIPD Proband informant reports of personality disorders on the FHIPD were associated with a variety of forms of psychosocial dysfunction as determined in direct assessments with the relatives, even for those with no diagnosable Axis II psychopathology dysfunction as determined in direct assessments with the relatives, even for those with no diagnosable Axis II psychopathology on direct interview. These results support the convergent validity of the FHIPD, and suggest that informants may provide important information on Axis II psychopathology that is not obtained from direct interviews with the subjects themselves.

Multimethod Validity Assessment of the SWAP-200 Dysphoric Q-Factor

The aim of this study was to investigate the convergent validity of the Shedler-Westen Assessment Procedure Q-Sort Dysphoric Q-Factor with scales from the therapist, the patient, and independent observers. Therapists used the Shedler-Westen Assessment Procedure Q-Sort to describe their patients after the therapeutic assessment and the first two therapy sessions (when available). Independent observers completed a number of symptom distress, global functioning, and Axis II psychopathology measures after watching videotapes of the therapeutic assessment. They also completed a measure of social cognition and object relations after watching videotape of the therapeutic assessment and the first two therapy sessions (when available). Patients completed measures of symptomatology and personality assessment. Results indicated several significant correlations between the Dysphoric Q-Factor and a number of the clinician ratings of depressive symptomatology. In addition, three clinician ratings (Personality Disorder Index, Global Assessment of Functioning scale, and the experience and management of aggressive impulses variable of the Social Cognition and Object Relations Scale) demonstrated unique and nonredundant predictive ability in accounting for the variance of the Dysphoric Q-Factor. The patient self-report measures, however, did not correlate significantly with the Dysphoric Q-Factor, although several correlations demonstrated trends toward statistical significance.