The Objective Behavioral Index: a measure for assessing treatment response of patients with severe personality disorders

A measure that captures the frequency and intensity of experienced dysfunctional behaviors as well as the use of mental health services was developed and tested as part of a treatment controlled trial of patients with borderline personality disorder. The Objective Behavioral Index (OBI) was completed by 136 subjects with the diagnosis of borderline personality disorder before random assignment to treatment and by 35 subjects at each follow-up point. With one exception, the OBI subindexes (Dysfunctional Behaviors and Service Utilization) were not intercorrelated nor were they associated with any of the other patient status measures. Both of the OBI subindexes were sensitive to change after a course of psychotherapy. The OBI measurement system is easy to use and provides important information about behavioral dysfunction and service utilization. Also, contrary to expectations, service utilization is not associated with patient symptomatic and behavioral status.

Relationship between cognitive and social dysfunction in schizophrenia

This cross-sectional study examined the relationships between cognitive functioning, social functioning, and social problem solving in a sample of 30 outpatients with schizophrenia. The cognitive battery included measures of verbal ability, memory, executive functioning, visual-spatial ability, and attention. Social functioning was assessed with the Social Dysfunction Index (SDI) and the Social Adjustment Scale-II (SAS-II). Social problem solving was assessed with a video-based test, the Assessment of Interpersonal Problem-solving Skills (AIPSS). No significant association was found between social functioning as assessed by the SDI and the SAS-II and cognitive functioning. In multiple regression analyses, a measure of attention, the auditory Continuous Performance Test was a significant predictor of processing and sending skills, as assessed by the AIPSS. (F = 16.37, 9.23, p < 0.001).

The contribution of group cohesion and group alliance to the outcome of group psychotherapy

The contribution to outcome of two group-process factors, group cohesion and group therapeutic alliance, was tested in the context of a randomized, controlled treatment trial for borderline personality disorder. Group members from four time-limited groups of an experimental model of group psychotherapy completed measures of group cohesion and group alliance at prespecified intervals across the 30-session therapy. Outcome was measured in terms of psychiatric symptoms, social adaptation, and indicators of behavioral dysfunction. The results showed that cohesion and alliance were correlated significantly and separately contributed to outcome on most of the dependent measures. Stepwise regression analyses showed, however, that when compared with cohesion, alliance accounted for more outcome variance on the dependent measures. The clinical implications of the findings and the limitations of the study are discussed.

The social dysfunction index (SDI) for patients with schizophrenia and related disorders

The social dysfunction index (SDI) is a new measure designed to assess social dysfunction in schizophrenia and other severe mental illnesses. It is intended to serve clinical and research purposes. Raters can be readily trained and there is low respondent burden with its use. Good psychometric properties were identified in three studies (sample sizes 33, 67 and 113). The SDI assesses a wide and comprehensive range of social functioning. It includes objective assessment of dysfunction and subjective client assessment of satisfaction with functioning. It produces a summary score, a satisfaction score and a score for each of the nine components of social functioning assessed. Internal consistency is good (alpha = 0.80). Inter-rater reliability is high (r = 0.96). Use of the component scores was confirmed by factor analysis. There is modest correlation with other measures of social functioning. Evidence of construct validity is demonstrated by findings of differences in social dysfunction between subjects who lived independently vs. those who lived in boarding homes; differences between subjects who were unemployed vs. subjects who were employed; and independence of social functioning from both age and education.

Predicting the one-year course of adolescent major depression

OBJECTIVE

To identify specific clinical and social functioning variables that predict persistence of major depression over a 1-year period of follow-up.

METHOD

The sample consisted of 67 adolescents with major depression, drawn from consecutive referrals to psychiatric clinics in a defined, geographic catchment area. Clinical interviews and questionnaires measuring behaviors, symptoms, and social functioning were administered to both the adolescent and a parent at inception and at follow-up. Discriminant function analyses were used to identify inception variables that predicted clinical course independent of severity of depressive symptoms and global functioning.

RESULTS

At 1-year follow-up, major depression remitted in 66% of subjects. Persisters were characterized at inception as older, more likely to have substance use or anxiety disorders, less involved with fathers, and less responsive to mother's discipline compared with remitters. The effect of these prognostic factors was independent of symptom severity and global functioning.

CONCLUSION

These variables appear to reflect perpetuating and ameliorating factors influencing the short-term course of major depression. The findings suggest that treatments for adolescent depression that aim to enhance parent-adolescent relationships, and that specifically target coexisting disorders, should be evaluated for effectiveness.

Severity as a diagnostic dimension of borderline personality disorder

The purpose of this study was to identify diagnostic and severity subgroups within a cohort of patients with borderline personality disorder (BPD). Of 171 patients clinically diagnosed with BPD, 132 were Diagnostic Interview for Borderlines (DIB) positive. Through a process of random selection, 41 of the DIB positive subjects were also interviewed with the revised version of the DIB (DIBR) and approximately one half with two semi-structured research interviews, the Schedule for Affective Disorders (SADS) and the Personality Disorder Examination (PDE). All subjects completed four self-report measures of problematic behaviours, symptoms and social adaptation. The analyses included examination of: 1. the correspondence of the BPD diagnosis across the DIB, the DIBR and the PDE; 2. the association between DIBR scoring levels and scores on measures of symptoms and behavioural status; and 3. the co-occurrence of BPD with Axis I and other Axis II disorders. Correlations and analyses of variance between both the DIB and DIBR scoring levels and the scores on the four symptom and behavioural measures showed that the scoring levels (DIB 7 to 10; DIBR 8 to 10) could be used to distinguish three subgroups of BPD. The three groups differed in terms of concordance for BPD with the PDE and in terms of patterns of overlap with DSM-III-R, Axis I and other Axis II disorders. This study shows that BPD subgroups can be located on a continuum of symptomatic and behavioural severity and that each subgroup has a specific pattern of overlap with Axis I and other Axis II disorders.

Needs of well siblings of persons with schizophrenia

The practical concerns of well siblings of persons with schizophrenia were examined in a descriptive study that included a needs assessment survey and a workshop designed to increase well siblings' knowledge about schizophrenia. A questionnaire focusing on needs for information, support, and practical skills was completed by 88 well siblings and 19 of their spouses. The results indicated a desire for more specific information about schizophrenia, particularly prognosis, and difficulties in communicating and problem solving with siblings with schizophrenia. Although respondents to the questionnaire were neutral about the need for support from other well siblings, participants at the workshop indicated that they found the opportunity to meet and share experiences with other well siblings to be the workshop's strongest feature. The study indicates that well siblings of persons with schizophrenia have specific needs that may differ from those of other family members.

Group and family treatments for borderline personality disorder

The authors review clinical and empirical studies on the effectiveness of group treatments and family-marital treatments for borderline patients. These studies support the use of the group format in treating borderline patients, but no empirical study has examined whether group treatment combined or sequenced with individual treatment, or individual treatment alone, is better than group treatment alone. Empirical studies of family interventions with borderline patients are lacking, but further research is warranted, since many studies have shown that family pathology, especially physical and sexual abuse, is related to the development of borderline pathology.

Immigrant children: psychiatric disorder, school performance, and service utilization

Data from the Ontario Child Health Study were used to examine the strength of association between child immigrant status and child psychiatric disorder, poor school performance, and use of mental health/social services. Bivariate results indicate that immigrant children are not at increased risk for psychiatric disorder or poor school performance and that they use mental health and social services significantly less often than do their nonimmigrant peers. Implications of the findings are explored.

Ontario Child Health Study: patterns of ambulatory medical care utilization and their correlates

Data from a large epidemiologic survey of Ontario children 4 to 16 years of age are presented concerning the frequency and correlates the use of ambulatory medical care services during a 6-month period in which a universal, first-dollar health insurance plan was used. Patterns of use of ambulatory medical care are described for three settings: doctor's offices, emergency rooms, and hospital outpatient departments. A group of children who are frequent users of ambulatory medical care (defined as using three or more services in 6 months) consumed nearly two thirds of all services. Two regression equations are presented--one predicting use/nonuse of ambulatory medical care and the other predicting the total number of visits for medical care. Although only a small proportion of the variance in use/nonuse and amount of use was explained, the major determinant of both ambulatory medical care use and frequency of use was the child's physical health status as perceived by the parent. Younger child, urban area of residence, the number of chronic medical problems of the child, and higher level of maternal education also contributed to the explanation of use v nonuse. Among ambulatory medical care users, high users were more likely to be described as having mental health problems and have parents who had been treated for "nerves." Family size and socioeconomic variables were not important factors in use, suggesting that universal health insurance reduces some barriers to ambulatory medical care for children.