Replicating the five factor model of personality in a psychiatric sample

In this study we examined whether the factor structure and traits of the five-factor model of personality (FFM), derived from non-clinical samples, could be replicated in a sample of psychiatric patients. The revised NEO Personality Inventory (NEO PI-R) was administered to a study group of psychiatric patients (n=176). The test scores from these patients were intercorrelated, factor analyzed and the obtained factor structure was then compared to the factor structure of the normative data from the NEO PI-R. The factor structure from the psychiatric study group and that from the normative sample were virtually identical, with all five factors showing significant congruence. These results argue favorably for the clinical applicability of the FFM with psychiatric patients.     

To Balance or not to Balance: Confirmatory Factor Analysis of the Affect-Balance Scale

This study examined the psychometric quality of the Affect-Balance Scale (ABS) (Bradburn, 1969) using data collected from 292 middle-aged and older adults, living independently. The dimensionality of the scale was examined, the quality of individual items was tested, and the validity of the ABS was studied. Using a tetrachoric correlation matrix with the robust weighted least squares (WLSMV) estimation method of the Mplus program, we found that two moderately correlated (r = -0.37) constructs are needed to adequately account for the pattern of item scores in the ABS. Two of the 10 ABS items were found to be problematic. When raw sum scores were used in analysis, the correlation between the positive-affect and the negative-affect subscales was lower (r = -0.17), indicating that random and nonrandom measurement error masked the relationship between the two. While affect-balance correlated substantially with five criterion well-being measures, the negative-affect subscale (which constitutes half of the ABS) had a similar pattern of correlations, with only slightly lower magnitude. The theoretical construct of nobreak 'balance' is also questioned. The 'balance' scoring method (subtracting the negative-affect subscale score from the positive-affect subscale score) nets exactly the same score as does summing scores from both subscales together. Accordingly, the summed scores have the very same correlations with other variables as do the balance scores.     

Comparison of outcome in men and women after treatment in psychiatric security hospitals in Germany

Previous research has shown that forensic psychiatric treatment reduces reoffending, rehospitalization and premature mortality. Treatment outcome varies with diagnosis, but little is known about the influence of sex, psychosocial adjustment and aftercare. To assess these variables, we interviewed male and female patients discharged from three psychiatric security hospitals in Germany in the years 2010–2017. Participants were interviewed at discharge (n = 609) and 1 year later (n = 366) about reoffending, readmissions, substance use and psychosocial adjustment. Among patients with substance use disorder (SUD), 14% reoffended, 20% were re-hospitalized and 60% maintained abstinence. Among patients with severe mental disorder, 5% reoffended and 13% were re-hospitalized. Significant sex differences were found in offenders with SUD. The results suggest that sociodemographic and disorder-related risk factors are associated with treatment success and that female patients with SUD might need a specific treatment approach. Sex-specific aspects, diagnosis and psychosocial adjustment should be considered in forensic psychiatric treatment and risk assessment.     

EVALUATION OF AN INPATIENT PROGRAM AIMED AT PREPARING “HARD-TO-PLACE” CHRONICALLY MENTALLY ILL FOR THE COMMUNITY

A program designed to prepare long-stay “hard-to-place” psychiatric inpatients for successful community placement was evaluated. Fifteen patients in the Intensive Learning Center (ILC) program were assessed at 5- and 10-month intervals following baseline. In addition, their functioning was compared to a criterion related comparison group of 26 patients who had been transferred to community placements 18 months earlier. Two informant driven measures were used: The Rehabilitation Evaluation of Hall and Baker (REHAB), (Baker & Hall, 1988) and, Adaptive Behavior Scale (ABS), (Nihira, Foster, Shellhaas, & Leland, 1975). The results indicated significant improvement in the ILC patients adaptive functioning after 5 months, but this improvement was not consistently sustained at the 10 month follow-up. Comparisons between the ILC and community groups were made at 10 months and suggested considerable overlap in functioning between the two groups. The implications of the findings for program development and implementation as well as for discharge planning are discussed.     

Clinical,Studies in Psychiatry by H. S. Sullivan

A structured group therapy approach for psychiatric inpatients is presented. After reviewing the literature indicating that insight-oriented approaches are not effective with severely disturbed patients, the data supporting an interpersonal, cognitive, problem-solving approach with such patients is reviewed. A rationale for combining this cognitive problem-solving approach and Yalom's interpersonal approach with psychiatric inpatients is then presented. This structured group therapy approach, called the problem-solving support group (PSSG) is discussed, defining the nature and composition, screening procedures, methods, and techniques of the PSSG. Its use with psychiatric patients is illustrated by therapy protocols depicting the nature of the therapeutic interactions during the group, while also demonstrating what the group appears to be accomplishing for its members.     

Investigation of the factorial structure and psychometric properties of the Persian version of the Toronto Alexithymia Scale-20 in patients with psychiatric disorders

The aims of this study were to assess the factor structure, validity, and reliability of the Persian translation of the Toronto Alexithymia Scale-20 (TAS-20) and to examine different models of the TAS-20 in Iranian patients with various psychiatric disorders. Participants were 839 patients with psychiatric disorders, including obsessive-compulsive disorder (OCD) (n = 80), schizophrenia (n = 82), bipolar disorder (BD) (n = 100), alcohol dependence (n = 81), major depressive disorder (MDD) (n = 95), psychosomatic disorders (n = 92), anxiety disorders (n = 85), post-traumatic stress disorder (PTSD) (n = 90), attention deficit hyperactivity disorder (ADHD) (n = 55), and suicide attempts (n = 79). Results indicated that the three-factor TAS-16 fit the data well, after removing four items from the externally-oriented thinking (EOT) subscale. In addition, the total score and subscales had strong internal consistency and concurrent validity. An alternative three-factor model and a four-factor model, which both allow the reverse-coded EOT items to load on a separate factor, also had an acceptable fit. The results suggest that after deleting four items from the EOT subscale, the 16-item TAS is a reliable scale among Iranian psychiatric patients. Moreover, the alternative three-factor and four-factor structures may be appropriate to apply among Iranian patients.

     

Social problem-solving in dual diagnosis patients

Social problem-solving skills among dual-diagnosis patients were compared to two control groups: psychiatric patients without substance abuse problems and community volunteers. A standardized, behavioral role-play test consisting of four scenarios representing interpersonal problems yielded two reliable dependent variables: (a) specificity, or elaboration, of the problem-solving response and (b) overall effectiveness of the response. Analyses of covariance (using a measure of intellectual function as the covariate) indicated that both dual-diagnosis patients and psychiatric controls were significantly poorer problem-solvers than were community controls. The overall pattern of the results indicated that deficits observed in a dual-diagnosis sample are not necessarily compounded due to the presence of the coexisting disorders. Implications of these findings, strengths and limitations of this study, and suggestions for future research are discussed.This research was supported in part by Grant DA04593-01 from the National Institute on Drug Abuse.Portions of this article were presented at the 22nd Annual Meeting of the Association for the Advancement of Behavior Therapy during November 1988 in New York.     

Impact of a Suicide‐Specific Intervention within Inpatient Psychiatric Care: The Collaborative Assessment and Management of Suicidality

A growing body of literature indicates that suicidal patients differ from other psychiatric patients with respect to specific psychological vulnerabilities and that suicide‐specific interventions may offer benefits beyond conventional care. This naturalistic controlled‐comparison trial (n = 52) examined outcomes of intensive psychiatric hospital treatment (mean length of stay 58.8 days), comparing suicidal patients who received individual therapy from clinicians utilizing the Collaborative Assessment and Management of Suicidality (CAMS) to patients whose individual therapists did not utilize CAMS. Propensity score matching was used to control for potential confounds, including age, sex, treatment unit, and severity of depression and suicidality. Results showed that both groups improved significantly over the course of hospitalization; however, the group receiving CAMS showed significantly greater improvement on measures specific to suicidal ideation and suicidal cognition. Results are discussed in terms of the potential advantages of treating suicide risk with a suicide‐specific intervention to make inpatient psychiatric treatment more effective in reducing risk for future suicidal crises.     

Perceived stress,life events,dysfunctional attitudes,and depression in adolescent psychiatric inpatients

Hewitt, Flett, and Mosher (1992) examined the factor structure of the Perceived Stress Scale (PSS) and its relation to depression in adult psychiatric patients. This study sought to replicate and extend their findings, using a sample of 203 adolescent psychiatric inpatients. All patients admitted to the adolescent unit in a psychiatric hospital over a 3-year period were administered the PSS, as well as measures of depression, life events, dysfunctional attitudes, and intellectual abilities. Consistent with Hewittet al., two factors were found in the PSS, reflecting perceived distress and perceived coping ability. Regression analyses indicated that, for males, both factors account for independent variance in depression, whereas for females, only the distress factor is related to depression. In addition, for both male and female, dysfunctional attitudes account for significant variance in depression in addition to PSS, but negative life events do not. None of the variables were related to intellectual abilities. Implications for clinical assessment and intervention are discussed.     

Seeking help at an Islamic spiritual healing centre: Malaysia’s perspective

Spiritual healing centre is a popular place to seek help among Malaysians whether for medical, psychiatric or other reasons. This study aims to understand the characteristics and illness perception of those patients who seek help at Islamic spiritual healing centre. A cross-sectional study was conducted at an established Islamic spiritual healing centre with 357 respondents. Younger age (OR .97, 95%CI .94–.99, p?=?.002), higher education level (OR 1.99, 95%CI 1.15–3.45, p?=?.014) and a more threatening view of the illness (OR 1.19, 95%CI 1.13–1.26, p?≤?.001) were found to confer risk of seeking help at this centre among attendees with psychiatric diagnosis. Supernatural attribution to illness is common among the attenders with or without a psychiatric diagnosis. Spirituality is important to bring balance and healing. Collaboration with Islamic spiritual healing practitioners to co-manage patients is recommended.     

The relationship between childhood adversity,psychiatric disorder and clinical severity: results from a multi-centre study

Although several studies have shown a clear association between childhood adversities and later development of a number of psychiatric disorders, a number of recent reports have cast doubts regarding the aetiological role played by abuse, neglect and loss, arguing that they are neither necessary nor sufficient to account for the development of subsequent psychopathology. In this study, we aimed to investigate the associations and predictive power of childhood adversities on later onset of Axis-I &-II psychiatric conditions and the impact on severity of psychiatric presentation in a large sample of patients. This cross-sectional multi-centre study evaluated patients (N = 1136) recruited in fourteen NHS psychotherapy departments in the UK. Patients were assessed using a number of rater-based questionnaires and self-rated measures. Multiple regression analyses showed that childhood experiences of loss and physical abuse were predictive of severe personality disorder and borderline personality disorder, but not of other less severe PD and Axis-I diagnoses. Sexual abuse predicted later onset of Post-traumatic Stress Disorder. In addition, we found that childhood abusive experiences were strongly associated with severity of psychiatric distress, interpersonal problems and global functioning. Having experienced two or more childhood adversities significantly increased severity of psychiatric distress, interpersonal malfunctioning and CORE scores.     

Differentiating Cognitive Content between Depressed and Anxious Outpatients

Quantitative research suggests that depressed and anxious patients can be differentiated based on their cognitive content. This study used qualitative research methods to separate the specific components of open‐ended depressive and anxious thought content in 79 psychiatric outpatients. Patients with major depressive disorder (MDD; n = 36), generalized anxiety disorder (GAD; n = 10), and other psychiatric disorders (PC; n = 33) were instructed to (a) describe their most bothersome problem; (b) imagine the worst possible negative outcome followed by the best possible positive outcome; and (c) describe associated thoughts and emotions for each scenario. The content of patients' responses were coded to examine (a) the types and severity of problems; (b) the presence or absence of hopelessness, catastrophizing, hopefulness, and unrealistic positive expectations; and (c) the presence or absence of particular emotions associated with imagined worst and best outcomes. More GAD patients than MDD and PC patients indicated anticipated anxious emotions associated with imagined worst outcomes, and fewer MDD patients than GAD and PC patients indicated anticipated happiness associated with imagined best outcomes. No group differences emerged for the other variables considered. These findings suggest that depressed and anxious patients differ in their cognitive expectancies about future life events in terms of their own anticipated emotional reactions.     

Characteristics of a French African Caribbean Epidemiological Psychiatric Sample with a History of Suicide Attempt

Research on vulnerability factors among ethnic groups, independent of primary psychiatric diagnosis, may help to identify groups at risk of suicidal behavior. French African Caribbean general psychiatric patients (N = 362) were recruited consecutively and independently of the primary psychiatric diagnosis. Demographic and clinical characteristics and lifetime history of suicide attempts were recorded. Sixty‐five patients (18%) had a history of at least one suicide attempt. Presence of professional qualifications, children, poor social contacts, treatment with benzodiazepine at inclusion, and poor treatment compliance were all associated with a lifetime history of suicide attempts.     

Parental Psychopathology and Paternal Child Neglect in Late Childhood

We aimed at determining the association of both severity of paternal and maternal substance use disorder (SUD) and psychiatric disorders with paternal child neglect severity during late childhood. The sample comprised 146 intact SUD (n=71) and non SUD (n=75) families with a 10–12 year old female or male biological offspring. The average age of fathers, mothers, and children was 44 (SD=5.9), 42 (SD=4.78), and 11 (SD=.79) years, respectively. The ethnic composition was 85% Caucasian and 15% African American. The results showed that paternal and maternal SUD and psychiatric disorders severity was correlated with paternal child neglect severity. However, paternal psychopathology failed to achieve significance in the regression analyses. Severity of maternal, especially severity of antisocial personality disorder symptoms was associated with paternal child neglect. These results are discussed within the framework of evolutionary psychology research examining paternal investment in the offspring. Implications for the necessity of identifying parental psychopathology and an integrated treatment approach are discussed.     

Psychometric properties of the Norwegian version of the Dysfunctional Attitude Scale (Form A)

The present study reports the reliability and validity of the Norwegian version of the Dysfunctional Attitude Scale in non‐clinical and clinical populations. The participants were 344 young male military recruits, 41 healthy controls and 142 psychiatric outpatients. All the participants completed the Dysfunctional Attitude Scale, the Beck Depression Inventory and the Automatic Thoughts Questionnaire. The analysis of the Dysfunctional Attitude Scale revealed a Cronbach's alpha of 0.85, indicating satisfactory reliability. Evidence for the construct validity was obtained by the correlation between the Dysfunctional Attitude Scale and the Beck Depression Inventory (r?=?0.47) and the Dysfunctional Attitude Scale and the Automatic Thoughts Questionnaire (r?=?0.47). Finally, the Dysfunctional Attitude Scale significantly discriminated between clinically depressed, non‐depressed psychiatric patients and healthy controls. The results showed that the Norwegian version of the Dysfunctional Attitude Scale possess satisfactory psychometric properties suggesting that this instrument is appropriate for use as a cognitive measure in a Norwegian cultural context.     

Memory for emotional faces in major depression following judgement of physical facial characteristics at encoding

The aim of the present study was to establish if patients with major depression (MD) exhibit a memory bias for sad faces, relative to happy and neutral, when the affective element of the faces is not explicitly processed at encoding. To this end, 16 psychiatric out-patients with MD and 18 healthy, never-depressed controls (HC) were presented with a series of emotional faces and were required to identify the gender of the individuals featured in the photographs. Participants were subsequently given a recognition memory test for these faces. At encoding, patients with MD exhibited a non-significant tendency towards slower gender identification (GI) times, relative to HC, for happy faces. However, the GI times of the two groups did not differ for sad or neutral faces. At memory testing, patients with MD did not exhibit the expected memory bias for sad faces. Similarly, HC did not demonstrate enhanced memory for happy faces. Overall, patients with MD were impaired in their memory for the faces relative to the HC. The current findings are consistent with the proposal that mood-congruent memory biases are contingent upon explicit processing of the emotional element of the to-be-remembered material at encoding.     

A Therapist‐Assisted Internet‐Based CBT Intervention for Posttraumatic Stress Disorder: Preliminary Results

Posttraumatic stress disorder (PTSD) is a debilitating mental health condition frequently associated with psychiatric comorbidity and diminished quality of life, and it typically follows a chronic, often lifelong, course. Previous research has shown that trauma‐related psychopathology (but not necessarily clinical PTSD) can be effectively treated via the Internet. This study is the first of its kind to report on the online treatment of patients with a Diagnostic and Statistical Manual of Mental Disorders (fourth edition) clinical diagnosis of PTSD with therapist support by e‐mail only. Preliminary findings are presented of an open trial involving a 10‐week Internet‐based therapist‐assisted cognitive behavioural treatment for PTSD (PTSD Online). Pre and posttreatment measures of PTSD and related symptomatology were compared for 16 participants with a variety of trauma experiences. Participants showed clinically significant reductions in PTSD severity and symptomatology, moderate tolerance of the program content, and high therapeutic alliance ratings. No significant change was found on measures of more general psychological symptoms. The results suggest that PTSD Online appears to be an effective and accessible clinical treatment for people with a confirmed PTSD diagnosis.     

Impact of psychiatric illness upon asthma patients’ health care utilization and illness control. Are all psychiatric comorbidities created equal?

The impact of psychiatric illnesses upon asthma patients' functioning is not well understood. This study examined the impact of psychiatric comorbidity upon illness management in asthma patients using empirically-derived psychiatric comorbidity groups. Participants were a clinic sample of Greek-speaking asthma patients (N = 212) assessed using the Patient Health Questionnaire (PHQ) Somatoform, Depression, Panic Disorder (PD), Other Anxiety Disorder, Eating Disorder (ED) and Alcohol sub-scales. The associations between sub-scales were examined using multiway frequency analysis. The following groups were derived: Somatoform disorder and/or Any Depressive disorder (n = 63), Somatoform disorder and/or Other Anxiety disorder (n = 51), Somatoform disorder and/or Any ED (n = 60), and Any Anxiety group including PD and/or Other Anxiety disorder (n = 24). Across all groups, psychiatric illness was associated with significantly worse asthma control (p < .01). Participants in Any Anxiety group, OR = 4.61, 95% CI [1.90, 11.15], Somatoform and/or Any Depressive disorder, OR = 2.06, 95% CI [1.04, 4.09] and Somatoform and/or Other Anxiety disorder, OR = 2.75, 95% CI [1.35, 5.60] were at higher risk for asthma-related Emergency Room (ER) visits compared to controls. However only Somatoform and/or Any Depressive disorder, OR = 3.67, 95% CI [1.60, 8.72], Somatoform and/or Other Anxiety disorder, OR = 5.50, 95% CI [2.34, 12.74], and Somatoform and/or Any ED, OR = 4.98, 95% CI [2.14, 11.60] group membership were risk factors for asthma-related hospitalizations. Results suggest that while comorbid psychiatric disorders generally negatively impact asthma illness management, different psychiatric comorbidities appear to have disparate effects upon illness management outcomes.     

Temperament-Character Profile and Psychopathologies in Patients with Alopecia Areata

The aim of this study is to investigate psychopathologies and the temperament-character profile of Alopecia Areata patients and to compare them with healthy controls. Patients and controls who presented at a dermatology clinic were selected by convenience sampling to respond to Temperament and Character Inventory (TCI), SCL-90-R, and a checklist about the demographic data and their dermatologic and psychiatric history. Patients reported higher harm avoidance and reward dependence than controls (Cohen's d = .93 and = .94). A significant correlation between Harm Avoidance (r = ?0.33, p = .02) and Reward Dependence (r = ?0.28, p = 0.05) with sex was found (females scored higher). Lifetime history of AA relapse was significantly associated with higher psychiatric symptoms; the effect sizes were large for Obsessive-Compulsive (d = .81) and Paranoia Ideation (d = .89). The higher psychological symptoms in AA patients with the history of relapses in this study have a practical message for clinicians.