Predictors of success and satisfaction in the practice of psychiatry: a preliminary follow-up study

BACKGROUND

Few studies have examined the predictors of psychiatrists' perceived success and personal satisfaction with their careers. The present study examines self-reported success and personal satisfaction with their careers in a cohort of psychiatrists followed for more than 20 years.

METHODS

A total of 29 psychiatrists, all of whom had participated in a study during their residency 21 to 24 years earlier, completed a self-report questionnaire. The first set of questions addressed the type and characteristics of their professional practice; the second set assessed aspects of their nonprofessional practice; and the third set assessed aspects of their nonprofessional, personal lifestyles. The personality traits of neuroticism and extraversion were assessed during the residency years and were used as predictors. Composite measures of self-perceived external success and personal satisfaction were computed. Regression models were constructed to determine the best predictors of these composite measures.

RESULTS

Neuroticism proved to be a significant predictor of external success but not of personal satisfaction, with higher scores predicting a lower rating of perceived external success. There were 2 practice characteristics--involvement with research and practising from an orientation other than psychoanalytic--that predicted perception of success. One personal lifestyle characteristic--the perception that one's nonprofessional life sustained professional life--also predicted perception of success. The best predictor of personal satisfaction was overall satisfaction with nonprofessional aspects of life.

CONCLUSIONS

Personality, nonprofessional social support, and engaging in research are associated with greater perceived success and personal satisfaction with a career in psychiatry.

Differential pharmacological treatment response in high angry hostile and low angry hostile depressed patients: a retrospective analysis

Fava et al., Am. J. Psychiatry 150 (1993)1158-1163, have recently proposed the existence of a sub-type of depressed patients who experience anger attacks. These investigators hypothesized that patients who experience anger attacks will respond better to a specific selective serotonin reuptake inhibitor (SSRI) medication than will depressed patients who do not experience anger attacks. Using a non-randomized, archival treatment methodology, 158 patients were classified as either high angry hostile (n = 83) or low angry hostile (n = 75). These patients had been treated with either a primarily noradrenergic reuptake inhibitor (desipramine) a SSRI (sertraline or paroxetine), or the combined serotonin and norepinephrine reuptake inhibitor (SNRI), venlafaxine. A 2 (high angry hostile/low angry hostile) x 3 (medication type) analysis of variance (ANOVA) was non-significant, indicating no differential treatment effects.

Personality and symptom profiles of the angry hostile depressed patient

Fava, Rosenbaum, McCarthy, Pava, Steingard and Bless (1991) have recently proposed the existence of a subtype of depressed patients who experience anger attacks. The aim of this study was to assess if depressed patients categorized as high angry hostile have symptoms and personality profiles distinct from depressed patients categorized as low angry hostile. From a sample of 125 depressed outpatients, 26 patients were classified as high angry hostile and 25 patients as low angry hostile. The symptom profiles of these tow groups were remarkably similar, with the high angry hostile patients exhibiting more interpersonal sensitivity. The high angry hostile patients were rated as less interpersonally agreeable and less conscientious than low angry hostile patients. These results provide only partial support for the angry hostile subtype of depression.

Detecting feigned depression and schizophrenia on the MMPI-2

Increasingly, investigations evaluating the effectiveness of the MMPI-2 in the assessment of malingering employ methodologies whereby research participants are asked to feigned specific disorders rather than just to "fake bad." Yet there is little research addressing the issue of whether different validity scales and indicators work differently in the detection of different feigned disorders. In this study the comparative effectiveness of a number of validity scales and indicators on the MMPI-2 to assess feigned depression and feigned schizophrenia were evaluated. Overall, the validity scales and indicators were better at detecting feigned schizophrenia than they were in detecting feigned depression, attributable, most likely, to closer familiarity with depressive experiences. The validity scales F, Fb, and F(p) best distinguish patients with schizophrenia from participants feigning schizophrenia, and F and Fb best distinguish patients with depression from participants feigning depression.

Relationship between the five-factor model of personality and unipolar, bipolar and schizophrenic patients

The purpose of this study was to examine personality differences among three different Axis I disorders-recovered patients with unipolar depression (n = 62), euthymic patients with bipolar disorder (n = 34), and patients with schizophrenia in the residual phase of their illness (n = 41) using the five-factor model of personality (FFM). The dimensions of the FFM-Neuroticism (N), Extraversion (E), Openness (O), Agreeableness (A), and Conscientiousness (C)-were measured with composite scores derived from the NEO Personality Inventory (NEO PI) and the Revised NEO Personality Inventory (NEO PI-R). While no group differences emerged on N or C, the bipolar patients scored significantly higher on the Positive Emotion facet (subscale) of E than the unipolar patients. The schizophrenic patients scored lower on the Feelings, Values and Actions facets of O than did the unipolar and bipolar patients. The unipolar patients scored higher on A than the schizophrenic patients.

Bipolar disorder, unipolar depression and the Five-Factor Model of personality

We examined differences between personality characteristics of euthymic bipolar disorder patients (BD) (n = 34) and recovered unipolar depressed patients (UD) (n = 74) using the taxonomy of the Five-Factor Model of personality (FFM) as measured by composite scales derived from the NEO Personality Inventory (NEO PI) and the revised NEO PI (NEO PI-R). Euthymic BD patients scored significantly higher on the Openness (O) dimension and the Positive Emotions facet of the E dimension than did recovered UD patients. For O, euthymic BD patients scored higher on the Feelings facet. These results suggest not only that euthymic BD patients are more likely to experience positive affects than recovered UD patients, but also that euthymic BD patients are more receptive to their positive and negative feelings than are recovered UD patients.

Seasonal and non-seasonal depression and the five-factor model of personality

The purpose of this study was to compare the personality characteristics of patients with non-psychotic, major depression, seasonal subtype (SAD) to patients with non-psychotic, major depression, without seasonality (non-SAD). The patients were consecutive referrals to a university-affiliated mood disorders outpatient clinic. The personality characteristics were assessed using the five-factor model of personality (FFM) as measured by the revised NEO Personality Inventory (NEO PI-R). Patients were assessed during the acute depressive episode. Controlling for severity of depression, differences were found on only one of the five dimensions, with the SAD patients (n = 43) scoring significantly higher on the Openness dimension than non-SAD patients (n = 57). Based on these results we infer SAD patients may represent a psychologically distinct subgroup of depressed patients-more imaginative, more emotionally sensitive and likely to entertain unconventional ideas than non-SAD patients. This personality constellation may explain why individuals with SAD are more sensitive to and may amplify the mild dysphoria typically associated with winter months.

Dependency, self-criticism and attributional style: a reexamination

The relationship between dependency and self-criticism personality dimensions, as measured by the Depressive Experiences Questionnaire (DEQ), and attributions to content-specific (affiliative, achievement) hypothetical outcome domains on the Expanded Attributional Style Questionnaire (EASQ) was examined. Dependency did not correlate with either affiliative or achievement domains, whereas self-criticism correlated with both. Replicating previous findings there was also no evidence of differential causal assignment across the attributional dimensions. These results add to an accumulating literature suggesting that the DEQ might not be measuring two independent personality types.

Major depression and the self-criticism and dependency personality dimensions

The Depressive Experiences Questionnaire was used to assess the personality dimensions of dependency and self-criticism in 52 depressed patients before and after treatment and in 22 healthy family practice patients. Neither personality dimension was significantly influenced by change in depressed mood, and the recovered depressed patients had higher levels of dependency and self-criticism than the comparison subjects.

A comparison of personality characteristics of seasonal and nonseasonal major depression

During the acute depressive episode, seasonal affective disorder (SAD) patients (N = 24) differ significantly from non-SAD major depressives (N = 17) on five of 13 personality variables measured, although severity of depression appears to be similar. SAD patients score significantly lower on the self-criticism and dependency dimensions of the Depressive Experiences Questionnaire (DEQ) and significantly higher on three personality trait scales (including schizotypal, narcissistic, and avoidant) of the Millon Clinical Multiaxial Inventory (MCMI). Our data suggest that those with seasonal depression may represent a psychologically distinct subgroup of depressives.

An open study of buspirone augmentation of serotonin reuptake inhibitors in refractory depression

BACKGROUND

We evaluated the efficacy of buspirone in the augmentation of antidepressant response to the serotonin reuptake inhibitors.

METHOD

Twenty-five patients with major depressive disorder who had failed several previous treatments for their current depressive episode were included. After failing a trial of fluoxetine or fluvoxamine, they received buspirone in addition to the serotonin reuptake inhibitor for 3 weeks in an open clinical trial.

RESULTS

Seventeen of 25 patients had a marked or complete antidepressant response.

CONCLUSION

These data provide clinical evidence suggesting that buspirone augmentation may be useful clinical alternative in depressed patients who fail to respond to a serotonin reuptake inhibitor.

Diagnostic specificity of the dependent and self-critical personality dimensions in major depression

Validational studies of self-critical and dependent personality dimensions as vulnerability factors for depression have been tested primarily with depressed samples, employing research designs devised to address state vs. trait and trait-situational congruity issues. In this study we examined the diagnostic specificity to depression of these two personality dimensions, comparing Self-Criticism and Dependency scores as measured by the Depressive Experiences Questionnaire (DEQ) in two samples of outpatients: (1) panic disorder with agoraphobia; and (2) non-psychotic, unipolar major depression. As hypothesized, the two groups differed on Self-Criticism, with the depressed group scoring higher, but no differences were found for Dependency. These findings were similar even when depressed mood was partialed out. These results complement a growing body of research associating Self-Criticism, as specifically measured by the DEQ, with depression.