Patient-informant concordance on the Structured Clinical Interview for DSM-III-R personality disorders (SCID-II)

Resting-State Functional Network Scale Effects and Statistical Significance-Based Feature Selection in Machine Learning Classification

In recent years, functional brain network topological features have been widely used as classification features. Previous studies have found that network node scale differences caused by different network parcellation definitions significantly affect the structure of the constructed network and its topological properties. However, we still do not know how network scale differences affect the classification accuracy, performance of classification features, and effectiveness of the feature selection strategy using P values in terms of the machine learning method. This study used five scale parcellations, involving 90, 256, 497, 1003, and 1501 nodes. Three local properties of resting-state functional brain networks were selected (degree, betweenness centrality, and nodal efficiency), and the support vector machine method was used to construct classifiers to identify patients with major depressive disorder. We analyzed the impact of the five scales on classification accuracy. In addition, the effectiveness and redundancy of features obtained by the different scale parcellations were compared. Finally, traditional statistical significance (P value) was verified as a feature selection criterion. The results showed that the feature effectiveness of different scales was similar; in other words, parcellation with more regions did not provide more effective discriminative features. Nevertheless, parcellation with more regions did provide a greater quantity of discriminative features, which led to an improvement in the accuracy of the classification. However, due to the close distance between brain regions, the redundancy of parcellation with more regions was also greater. The traditional P value feature selection strategy is feasible with different scales, but our analysis showed that the traditional P < 0.05 threshold was too strict for feature selection. This study provides an important reference for the selection of network scales when applying topological properties of brain networks to machine learning methods.

The Goldwater Rule: Perspectives From, and Implications for, Psychological Science

When, if ever, should psychological scientists be permitted to offer professional opinions concerning the mental health of public figures they have never directly examined? This contentious question, which attracted widespread public attention during the 1964 U.S. presidential election involving Barry Goldwater, received renewed scrutiny during and after the 2016 U.S. presidential campaign, when many mental health professionals raised pointed questions concerning the psychiatric status of Donald Trump. Although the Goldwater Rule prohibits psychiatrists from offering diagnostic opinions on individuals they have never examined, no comparable rule exists for psychologists. We contend that, owing largely to the Goldwater Rule's origins in psychiatry, a substantial body of psychological research on assessment and clinical judgment, including work on the questionable validity of unstructured interviews, the psychology of cognitive biases, and the validity of informant reports and of L (lifetime) data, has been overlooked in discussions of its merits. We conclude that although the Goldwater Rule may have been defensible several decades ago, it is outdated and premised on dubious scientific assumptions. We further contend that there are select cases in which psychological scientists with suitable expertise may harbor a "duty to inform," allowing them to offer informed opinions concerning public figures' mental health with appropriate caveats.

Long Non-Coding RNA: Potential Diagnostic and Therapeutic Biomarker for Major Depressive Disorder

Background

The criteria for diagnosing depression are based on behavioral observation and self-reporting of symptoms by the patients or guardians without any biological validation of the disease. This study aimed to identify long non-coding RNAs (lncRNAs) in peripheral blood mononuclear cells (PBMCs) as robust and predictive biomarkers for diagnosis and therapy response in major depressive disorder (MDD).

Material/Methods

We used human lncRNA 3.0 microarray profiling (which covers 30,586 human lncRNAs), using PBMCs from five MDD patients and five controls. Differentially expressed lncRNAs in the PBMCs of MDD patients were identified, of which 10 candidate lncRNAs were selected for real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis in a larger cohort of 138 MDD patients and 63 healthy controls. Then among the 138 MDD patients who received standard antidepressant treatment, 30 were randomly selected for lncRNAs expression retesting and symptomatology assessments after three-weeks and six-weeks of antidepressant treatment.

Results

Six lncRNAs (TCONS_00019174, ENST00000566208, NONHSAG045500, ENST00000517573, NONHSAT034045, and NONHSAT142707) were significantly downregulated in MDD patients compared to control patients, and the area under the receiver operator curve (ROC) of these six lncRNAs cases, combined, was 0.719 (95% confidence interval (CI): 0.617–0.821). There was no difference in the expression of these six lncRNAs based on gender (p>0.05) or age (p>0.05).

Conclusions

These results suggest that the combined expression of six lncRNAs in PBMCs may serve as a potential biomarker for diagnosis and therapy response of MDD in the clinical setting.

Collecting Information for Rating Global Assessment of Functioning (GAF): Sources of Information and Methods for Information Collection

INTRODUCTION

Global Assessment of Functioning (GAF) is an assessment instrument that is known worldwide. It is widely used for rating the severity of illness. Results from evaluations in psychiatry should characterize the patients. Rating of GAF is based on collected information. The aim of the study is to identify the factors involved in collecting information that is relevant for rating GAF, and gaps in knowledge where it is likely that further development would play a role for improved scoring.

METHODS

A literature search was conducted with a combination of thorough hand search and search in the bibliographic databases PubMed, PsycINFO, Google Scholar, and Campbell Collaboration Library of Systematic Reviews.

RESULTS

Collection of information for rating GAF depends on two fundamental factors: the sources of information and the methods for information collection. Sources of information are patients, informants, health personnel, medical records, letters of referral and police records about violence and substance abuse. Methods for information collection include the many different types of interview - unstructured, semi-structured, structured, interviews for Axis I and II disorders, semistructured interviews for rating GAF, and interviews of informants - as well as instruments for rating symptoms and functioning, and observation. The different sources of information, and methods for collection, frequently result in inconsistencies in the information collected. The variation in collected information, and lack of a generally accepted algorithm for combining collected information, is likely to be important for rated GAF values, but there is a fundamental lack of knowledge about the degree of importance.

CONCLUSIONS

Research to improve GAF has not reached a high level. Rated GAF values are likely to be influenced by both the sources of information used and the methods employed for information collection, but the lack of research-based information about these influences is fundamental. Further development of GAF is feasible and proposals for this are presented.

Neuroticism associated with cocaine-induced psychosis in cocaine-dependent patients: a cross-sectional observational study

BACKGROUND

Cocaine consumption can induce transient psychotic symptoms, which has been correlated with more severe addiction and aggressive behavior. However, little is known about the nature of the relationship between personality traits and psychotic symptoms in cocaine-dependent patients. This study examined the relationship between neuroticism and cocaine-induced psychosis.

METHODS

A total of 231 cocaine-dependent patients seeking treatment were recruited to the study. Personality was evaluated by the Zuckerman-Kuhlman Personality Questionnaire. Cocaine-induced psychosis questionnaire, SCID-I, and SCID-II were used to evaluate comorbidity and clinical characteristics. Data analysis was performed in three steps: descriptive, bivariate, and multivariate analyses.

RESULTS

Cocaine-induced psychosis was reported in 65.4% of the patients and some personality disorder in 46.8%. Two personality dimensions (Neuroticism-Anxiety and Aggression-Hostility) presented a significant effect on the risk of experiencing psychotic symptoms (t(229) = 2.69, p = 0.008; t(229) = 2.06, p = 0.004), and patients with psychotic symptoms showed higher scores in both variables. On the multivariate analysis, only Neuroticism remained as a significant personality factor independently associated with psychotic symptoms (Wald = 7.44, p<0.05, OR = 1.08, CI 95% 1.02-1.16) after controlling for age, gender and number of consumption substances.

CONCLUSIONS

An association between high neuroticism scores and presence of psychotic symptoms induced by cocaine has been found, independently of other consumption variables. Personality dimensions should be evaluated in cocaine-dependent patients in order to detect high scores of neuroticism and warn patients about the risk of developing cocaine-induced psychotic symptoms.

Suicide in the absence of mental disorder? A review of psychological autopsy studies across countries

BACKGROUND

While numerous past reviews of psychological autopsy (PA) studies have examined the relationship between mental disorder and suicide, there has been little systematic investigation of suicide occurring in the absence of any identifiable psychiatric condition.

AIM

This article reviews available literature on the topic by considering Axis I, sub-threshold, mild disorders and personality disorders.

METHOD

We conducted a systematic review of PA studies from 2000 onwards. Studies included in the review had to clearly describe the proportion of suicide cases without a classifiable mental disorder or sub-threshold condition.

RESULTS

Up to 66.7% of suicide cases remained without diagnosis in those studies that only examined Axis I disorders (n = 14). Approximately 37.1% of suicide cases had no psychiatric condition in research papers that assessed personality and Axis I disorders (n = 9), and 37% of suicides had no Axis I, sub-threshold/mild conditions (n = 6). In general, areas in China and India had a higher proportion of suicides without a diagnosis than studies based in Europe, North America or Canada.

CONCLUSION

Variation in the proportion of suicide cases without a psychiatric condition may reflect cultural specificities in the conceptualization and diagnosis of mental disorder, as well as methodological and design-related differences between studies.

Psychometric properties of the Spanish version of the diagnostic interview for depressive personality

The aim of this study was to evaluate the reliability and validity of the Spanish-language version of the diagnostic interview for depressive personality (DIDP). The DIDP was administered to 328 consecutive outpatients and the test-retest and inter-rater reliability were assessed. Factor analysis was used in search of factors capable of explaining the scale and a cutoff point was established. The DIDP scales showed adequate Cronbach's α values and acceptable test-retest and inter-rater reliability coefficients. Convergent and discriminant validity were explored, the latter with respect to avoidant and borderline personality disorders. The results of the factor analysis were consistent with the four-factor structure of the DIDP scales. The receiver operating characteristic (ROC) analysis revealed the area under the curve to be 0.848. We found 30 to be a good cutoff point, with a sensitivity of 74.5% and a specificity of 78.5%. The DIDP proved to be a reliable and valid instrument for assessing depressive personality disorder, at least among our outpatients. The psychometric properties of the DIDP support its clinical usefulness in assessing depressive personality.

Self- and informant-reported perspectives on symptoms of narcissistic personality disorder

Because narcissistic individuals tend to have an inflated view of themselves and their abilities, the reliance on self-reported information in the assessment and diagnosis of narcissistic personality disorder (NPD) is problematic. Hence, the use of informants in the assessment of NPD may be necessary. In the current study we examined self- and informant-reported features of NPD using agreement, frequency, and discrepancy analyses. The results indicated that informants tended to report more NPD features than selves, and that there were either low or nonsignificant levels of self-informant agreement among the 9 NPD diagnostic criteria and its categorical diagnosis. Informants were increasingly more likely to report higher raw scores relative to selves, indicating that the discrepancy between self- and informant reports increases with the NPD scale. Informants also reported NPD features that selves often did not, suggesting that current prevalence estimates of NPD, which use only self-reported information, are most likely underestimates. These results highlight the importance of gathering informant-reported data in addition to self-reported data when assessing NPD. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

The next generation of psychological autopsy studies. Part I. Interview content

The psychological autopsy (PA) is a systematic method to understand the psychological and contextual circumstances preceding suicide. The method requires interviews with one or more proxy respondents (i.e., informants) of decedents. The methodological challenges that need to be addressed when determining the content of these research interviews for PA studies are described and recommendations are made for meeting these challenges in future PA investigations. Ways to improve the data collected about mental disorders and life events--domains that are assessed in almost all PA studies--are discussed at length. Other understudied content areas considered include the role of personality traits, medical illness and functional limitations, availability of lethal agents, medications, and select distal variables including child maltreatment and family history of mental disorders and suicide. The benefits and challenges to using common protocols across studies are also discussed.

Self-other disagreement in personality assessment: significance and prognostic value

The feasibility of the use of multiple informant reports in clinical practice was examined in a sample of 105 psychiatric outpatients who provided self-ratings and (2-3) informants' reports on the Five Factor Personality Inventory. The response rate was 97%. The patients assessed themselves as less extraverted and more emotionally stable than their proxies did. In addition, the significance of self-other disagreement was investigated. Our first hypothesis, stating that self-other disagreement would correlate with (personality) pathology, was confirmed: self-other disagreement predominantly occurred in introverted, shy, hostile and depressed persons who tended to have more personality problems and co-morbidity. We found no support for our second hypothesis, stating that self-other disagreement would predict a diminished therapy effect. An important finding, however, was that self-other disagreement proved to be a strong predictor of dropout. Furthermore, a decrease in depression, hostility and shyness was positively correlated with a decrease in self-other disagreement.

[Prevalence, diagnosis and treatment of personality disorders in older adults]

AIM

This article addresses manifestation, course, diagnosis and treatment of personality disorders in older adults (>60 yrs).

METHOD

A literature search, using "Cochrane Central Register of Controlled Trials (CENTRAL)", Cochrane Database of Systematic Reviews (CDSR)", "PsychINFO 2000-present" and "PUBMED", concerning relevant literature from 1980-2009. Keywords were "personality disorder", "elderly", "older adults", "prevalence", "diagnosis" and "treatment". The combinations of these keywords resulted in 32 relevant hits.

RESULTS

Prevalence studies addressing specific personality disorders show that within different subpopulations personality pathology of clusters A and C (odd respectively anxious behaviour) are quite common in older adults whereas cluster B personality disorders (impulsive behaviour) is more prevalent in younger adults. Besides, it appears that the personality questionnaires and interviews used in adult care are not yet validated for older adults in mental health care and nursing homes. Furthermore, there is no convincing reason why psychotherapy variants proven to be effective for adults (<50 yrs) wouldn't be feasible for older adults. Particularly with respect to cognitive (behavioural) therapy and schema therapy, there is some evidence from case studies suggesting that these therapies are well applicable to the elderly.

CONCLUSION

Prevalence rates appear questionable since the assessment methods applied in the epidemiological studies correspond inadequately to the specific behavioural manifestations of elderly persons with personality pathology. In addition, the number of specific (test)diagnostic tools for older adults are scarce. Currently, there is a lack of empirical data concerning treatment of personality disorders in older adults. However, at this moment several studies are focussed to improve diagnostics and therapy of personality disorders in geriatric psychiatry in the Netherlands and Belgium.

Assessment of depression and suicidal actions: agreement between suicide attempters and informant reports

Knowledgeable informants may be able to provide useful information about depressive symptoms and suicidal actions when a suicidal patient is uncooperative with a clinical interview or not available for a psychiatric evaluation. The present study was designed to examine information gathered from psychiatric inpatients who had attempted suicide as compared to similar information obtained from a close friend or family member. From a larger sample of adult psychiatric inpatients diagnosed with major depression, 25 suicide attempters were assessed and their reports were compared to similar information solicited from a close friend or family member. The assessment focused on depressive symptoms from the SCID and the presence of various suicidal actions. Moderate to high agreement was found on all measures. Psychiatric patients and their informants tended to agree on the presence of depressive symptoms, the presence of recent stressful life events, and specific actions taken during the suicidal crisis, suggesting that informants may be capable of providing useful information about the patient.

Assessing normal and abnormal personality functioning: strengths and weaknesses of self-report, observer, and performance-based methods

Assessing personality characteristics; distinguishing the boundaries between normal and abnormal functioning; identifying impairment in the domains of work, interpersonal relationships, and emotional state due to maladaptive personality traits; and translating these findings into effective, appropriate treatment interventions is a complicated endeavor. Valid, reliable conclusions about an individual's personality functioning and adjustment cannot be reached unless one has accurate information about that person's patterns of behavior, cognitions, emotions, and interpersonal relationships. I discuss strengths and weaknesses of assessment approaches utilizing explicit assessment methods, such as self-report measures and clinical interviews; information obtained from knowledgeable observers; and performance-based, implicit assessment methods such as the Rorschach Comprehensive System (Exner, 2003). In contrast to explicit methods of assessment, implicit methods can provide salient information about a personality construct whether or not individuals have accurately conceptualized that construct, have weighed how the construct describes them, are self-aware, and are willing to openly provide information relevant to that construct. I propose that the accuracy of conclusions about an individual's personality style, problems in adjustment, and treatment needs may be improved if conclusion are based on a multimethod assessment approach that incorporates information gathered using explicit assessment methods, information provided by significant others, and data from performance-based or implicit measures of personality.

Reliability of personality disorder diagnosis during depression: the contribution of collateral informant reports

OBJECTIVE

Research has found low concordance of personality disorder diagnoses made during depression versus after remission and made using patient versus collateral informants, but little is known about the reliability of personality disorder (PD) diagnoses made during depression using patient and collateral reports.

METHOD

A total of 168 patients were evaluated for PDs during depression and following response using patient and close informant reports. kappa coefficients of inter-informant and test-retest reliability were calculated.

RESULTS

After depression response, the proportion diagnosed with cluster A and C PDs fell by both patient and close informant report, and overall inter-informant reliability declined. Overall test-retest reliability did not differ between patients and informants.

CONCLUSION

Collateral informants do not improve the reliability of PD diagnoses made during depressive episodes.

Critical issues in psychological autopsy studies

This paper reviews research based on the psychological autopsy (PA) method applied to the study of suicide. It evidences the presence of a number of methodological problems. Shortcomings concern sampling biases in the selection of control subjects, confounding influences of extraneous variables, and reliability of the assessment instruments. The absence of homogeneity among studies in the procedure employed, as well as the lack of defined guidelines for performing this type of inquiry are emphasized. Questions needing empirical investigation in the future are pointed out. It is concluded that the validity and reliability of findings emerging from the use of this method of investigation would benefit from a standardization of its application.

Development of scales to screen for eight common psychiatric disorders

The present study was designed to create a group of scales from the items on the Symptom Checklist 90 (SCL-90) to identify common psychiatric diagnoses. Subjects were 1457 adult psychiatric outpatients who completed the Symptom Checklist-90 and a structured diagnostic interview at the time of their initial evaluation. A combination of rational and empirical test construction methods was used to create the SCL-90 Diagnostic Scales, item sets that identify eight common psychiatric conditions: major depression, bipolar disorder, schizophrenia, antisocial personality disorder, somatization disorder, obsessive-compulsive disorder, panic disorder, and agoraphobia. These specially constructed scales were found to possess good internal reliability. These scales were also shown to differentiate patients positive for each of the eight psychiatric disorders from other psychiatric patients who did not have that disorder. Sensitivities and specificities are reported for each item set. In addition to their utility at the time of initial assessment as an aid in identifying diagnosis, the SCL-90 Diagnostic Scales may have other potential uses, such as in monitoring the symptom course of the patient's disorder or disorders over time.

Evidence-based assessment of personality disorders

The purpose of this article is to provide a foundation for the development of evidence-based guidelines for the assessment of personality disorders, focusing in particular on integrated assessment strategies. The general strategy recommended herein is to first administer a self-report inventory to alert oneself to the potential presence of particular maladaptive personality traits followed by a semistructured interview to verify their presence. This strategy is guided by the existing research that suggests particular strengths of self-report inventories and semistructured interviews relative to unstructured clinical interviews. However, the authors also consider research that suggests that further improvements to the existing instruments can be made. The authors emphasize, in particular, a consideration of age of onset, distortions in self-perception and presentation, gender bias, culture and ethnicity, and personality change.

Concordance of DSM-IV Axis I and II diagnoses by personal and informant's interview

The validity and reliability of using psychological autopsies to diagnose a psychiatric disorder is a critical issue. Therefore, interrater and test-retest reliability of the Structured Clinical Interview for DSM-IV Axis I and Personality Disorders and the usefulness of these instruments for the psychological autopsy method were investigated. Diagnoses by informant's interview were compared with diagnoses generated by a personal interview of 35 persons. Interrater reliability and test-retest reliability were assessed in 33 and 29 persons, respectively. Chi-square analysis, kappa and intraclass correlation coefficients, and Kendall's tau were used to determine agreement of diagnoses. Kappa coefficients were above 0.84 for substance-related disorders, mood disorders, and anxiety and adjustment disorders, and above 0.65 for Axis II disorders for interrater and test-retest reliability. Agreement by personal and relative's interview generated kappa coefficients above 0.79 for most Axis I and above 0.65 for most personality disorder diagnoses; Kendall's tau for dimensional individual personality disorder scores ranged from 0.22 to 0.72. Despite of a small number of psychiatric disorders in the selected population, the present results provide support for the validity of most diagnoses obtained through the best-estimate method using the Structured Clinical Interview for DSM-IV Axis I and Personality Disorders. This instrument can be recommended as a tool for the psychological autopsy procedure in post-mortem research.

Convergent and Discriminant Validity of Three Measures of Depressive Personality Disorder

Sixty-eight outpatients from a veterans' administration psychiatry clinic and community mental health center were assessed with 3 measures of depressive personality disorder (DPD)-the Diagnostic Interview for Depressive Personality Disorder (Gunderson, Phillips, Triebwasser, & Hirschfeld, 1994), the Depressive Personality Disorder Inventory (Huprich, Margrett, Barthelemy, & Fine, 1996), and the Structured Clinical Interview for DSM-IV Axis II Disorders (First, Gibbon, Spitzer, Williams, & Benjamin, 1997a)-to evaluate their convergent and discriminant validity. Evidence supporting the measures' validity was mixed. The rate of convergence of depressive personality diagnoses across 3 measures was less than optimal, but the degree of intercorrelation among the measures was strong. Although depressive personality scores had moderate levels of intercorrelations with other personality disorders, the degree of intercorrelation decreased substantially after controlling for depressive symptoms. I conclude that further work is needed to strengthen the validity of measures of DPD.

Screening for personality disorder: a comparison of personality disorder assessment by patient and informants

The Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II Version 2.0) is becoming the most favoured instrument to measure personality disorder but takes up to an hour to complete. The Standardized Assessment of Personality (SAP), an informant-based measure, takes 10 to 15 minutes to complete. Both instruments have been validated independently. This study aimed to determine whether the SAP is a suitable screening instrument for personality disorder as measured by the SCID-II. Fifty-seven psychiatric patients were assessed for personality disorder using both the SAP and the SCID-II. The SAP assessments were conducted blind to the results of the SCID-II assessments. Agreement between the two instruments in this population was low (kappa = 0.3). The level of agreement differed between personality disorder categories, ranging from kappa = 0.4 (antisocial) to 0.1 (narcissistic). In this population of patients, the SAP proved to be a poor screen for the SCID-II. The study highlights the discrepancy between informant and self-report assessments for personality disorder.

Evaluating facet-level predictions and construct validity of depressive personality disorder

The purpose of this study was to evaluate Widiger, Trull, Clarkin, Sanderson, and Costa's (1994) facet-level predictions about depressive personality disorder, thereby evaluating the validity of the depressive personality disorder construct. A sample of 67 patients was collected from two treatment facilities. Participants completed three different measures of depressive personality disorder and the NEO-PI-R (Costa & McCrae, 1992). All measures of depressive personality disorder were significantly correlated with three of the four predicted facets: Anxiety, Depression, and Self-Consciousness. All three measures were significantly correlated with the Vulnerability, Warmth, Gregariousness, Assertiveness, Positive Emotions, Actions, Trusts, and Achievement Striving facets. A series of regression analyses was performed. Two of the predicted facets--Self-Consciousness and Tendermindedness--were able to uniquely account for variance in all three measures of depressive personality across most analyses. However, there was a lack of specificity across other facets in predicting the depressive personality disorder. A facet-level understanding of depressive personality disorder appears to be empirically justified, and the validity of the depressive personality disorder further supported. Additional work is needed on improving the measurement of depressive personality disorder.

Patients' versus informants' reports of personality disorders in predicting 7 1/2-year outcome in outpatients with depressive disorders

Concordance between patients' and informants' reports of personality disorders (PDs) is low, raising the questions of which source provides more valid data and whether both contribute unique information. This study compared patients' and informants' reports of PDs in predicting outcome in a 7 1/2-year follow-up of 85 depressed outpatients. Patients and informants were independently evaluated using structured interviews; outcome was assessed using structured interviews with patients. Both patients' and informants' reports of PD diagnoses and dimensional scores independently predicted depression symptoms and global functioning at follow-up. However, only informants' reports made a unique contribution to predicting social adjustment. This finding indicates that both patients and informants provide unique information on Axis II psychopathology and argues for the use of both sources in the assessment of PDs.

Current issues in the assessment of personality disorders

Most patients will have clinically significant maladaptive personality traits. These personality traits can substantially complicate the effective treatment of other mental disorders, and they can also be the focus of effective treatment. The assessment of personality disorders is of considerable clinical importance. However, this assessment can also be highly problematic. This article discusses the major issues in the assessment of personality disorders (eg, differentiation from other mental disorders, from normal personality functioning, and gender bias) and summarizes existing research on the convergent and discriminant validity of the semistructured interviews and self-report inventories, which have been developed to improve the reliability and validity of personality disorder assessment.

Psychiatric patient- and informant-reported personality: predicting concurrent and future behavior

The authors investigated the criterion and incremental validity of personality reports from psychiatric patients and knowledgeable informants in predicting patient substance use, social and risky behaviors, and psychological distress. Patient and informant reports of patient personality and behavior were collected from an adult psychiatric sample (N = 94). Hierarchical regressions indicated that patient reports of personality accounted for significant variance in both concurrent (17%-42%) and future behavior assessed 1 year later (17%-40%). Informant reports contributed significantly to the prediction of several behaviors and most strongly to social behaviors. Behaviors were predicted equally well by self-reports and informant reports in prospective as in concurrent regressions. Thus, both patient and informant reports of personality contribute importantly to prediction of behavior, and predictive ability is stable across time.

Psychometric evaluation of the depressive personality disorder inventory

The purpose of this study was to evaluate the psychometric properties of the Depressive Personality Disorder Inventory (DPDI; Huprich, Margrett, Barthelemy, & Fine, 1996). The DPDI was found to have strong internal consistency in both an undergraduate and a veteran, psychiatric outpatient population. The DPDI had significant, positive correlations with other measures of depressive personality, supporting its convergent validity. These relationships remained even after controlling for state-like depression, suggesting that the DPDI has incremental validity. The DPDI also significantly predicted scores on measures of interpersonal loss, even after controlling for state-like depression, suggesting that the DPDI has good construct validity. In support of discriminant validity, the DPDI was more correlated with another measure of depressive personality than it was with measures of other personality disorders. Finally, the DPDI had strong diagnostic efficiency statistics: (a) Sensitivity = .82, (b) Specificity = .80, (c) Positive Predictive Power = .75, (d) Negative Predictive Power = .86, and (e) Overall Diagnostic Power = .81. It appears that the DPDI has good psychometric properties.

Alexithymia in patients with major depressive disorder and comorbid cluster C personality disorders: a 6-month follow-up study

The authors examined the association between alexithymia, cluster C personality disorders (CPD), and severity of depression among 121 outpatients with major depressive disorder (MDD) in a 6-month, follow-up study. Diagnosis of depression and CPD was confirmed by means of the Structured Clinical Interviews for DSM-III-R (SCID I and SCID II). Alexithymia was screened using the 20-item version of the Toronto Alexithymia Scale and severity of depression was assessed using the 21-item Beck Depression Inventory. Results indicated that alexithymic features are common in patients with MDD but often alleviated during recovery from depression. Moreover, comorbid CPD and severity of depression seemed to be associated with poorer recovery from alexithymia. The implications of these findings are discussed.

Issues in the assessment and conceptualization of personality disorders

This article reviews several current issues associated with the definition and assessment of personality disorders (PDs) as defined in the third and fourth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Specifically reviewed are issues associated with classification, PD conceptualizations, and the assessment of these disorders. DSM PD categories are also reviewed in terms of their psychometric properties. A review of the PD assessment literature suggests that DSM conceptualizations and definitions of PDs are problematic at both conceptual and quantitative levels. This article concludes with suggestions for possible alternative approaches to and modifications of DSM PD assessment.