Development of a Structured Psychiatric Interview for Children: Agreement Between Child and Parent on Individual Symptoms

To test the reliability of children's reporting as compared with that of their mothers, a highly structured psychiatric diagnostic interview was used with 307 subjects, ages 6 through 16. Another interviewer gave each mother a similar interview about the child. Responses of each mother-child pair to 168 questions were compared using the kappa statistic. Highest agreement was found on questions concerning symptoms that are concrete, observable, severe, and unambiguous. Mothers tended to report significantly more behavioral symptoms, and children more subjective symptoms. Reasons for low kappas and asymmetrical reporting of symptoms are discussed.     

Understanding the Relationship Between State Forgiveness and Psychological Wellbeing: A Qualitative Study

Over the last 20 years, increasing attention has been given to associations between dispositional forgiveness and specific mental health problems. However, few studies have assessed whether forgiving real-life interpersonal hurts may be related to diverse psychological health outcomes. The present study addresses this gap by investigating, in depth, relationships between perceptions about state forgiveness and a variety of mental wellbeing outcomes as well as exploring perceptions about the factors that may modify such effects. Developing an understanding of a forgiveness wellbeing relationship is of relevance to healthcare workers, researchers and policy makers with an interest in improving public health. In-depth semi-structured interviews were conducted, and data were analysed using grounded theory methods. From England and Ireland, eleven adults who were affiliated with religious/spiritual and secular/atheist groups were recruited using purposive and convenience sampling methods. Key themes that appeared to be related to the effects of unforgiveness were: increases in negative affect; reduction in cognitive abilities and barriers to psychological and social growth. For the majority of participants, state forgiveness had strong ties to participants perceived sense of mental wellbeing, including reductions in negative affect, feeling positive emotions, positive relations with others, spiritual growth, a sense of meaning and purpose in life as well as a greater sense of empowerment. The data also revealed a number of factors that may positively or negatively influence a forgiveness–wellbeing link such as: viewing an offender as spiritually similar or different, responsibility/karma, blaming, wanting restitution/apology as well as practices such as meditation and prayer. The findings suggest that forgiving a range of real-life interpersonal offences may be an important determinant of psychological wellbeing, particularly among religious/spiritual populations. Further research is, however, needed.     

The Utility of the Megargee-Bohn Typology in a Forensic Psychiatric Hospital

The utility of the Megargee-Bohn MMPI typology (Megargee & Bohn, 1979) was examined in 1007 male forensic psychiatric inpatients. The 10 profile types were identified although the proportions differed as expected fiom the original sample. Comparison of demographic, clinical, and forensic characteristics revealed significant differences between 9 of the profile types. Our fmdings indicate that the typology can reliably and usefully describe different categories of patients in our setting. The typology can also be used to make inferences about treatment needs. Our findings support the continued development of an MMPI-based actuarial system for criminal populations as has been done for psychiatric populations.     

Psychiatric Diagnosis as a Function of Assessor Profession and Sex

Diagnostic impressions formed by 26 clinicians after intake interviews with 200 randomly assigned outpatients at a community mental health center were analyzed by assessor discipline and sex and by patient sex and age level. Professional status was positively related to diagnostic severity among male assessors—nurses, social workers, psychologists, and psychiatrists made increasingly higher proportions of psychotic diagnoses. Female therapists were less likely than their male counterparts to render psychotic diagnoses. This finding was most robust for doctoral interviewers, especially psychologists, and for patients who were female or under 30. Results are discussed in relation to the need for a model of the diagnostic process that allows for the role of practitioner attributes. Previous largely negative findings may have had their source in the failure of contrived analogue procedures to evoke emotions in the rater comparable in intensity to those aroused in the real-life encounter.     

Human Figure Drawings as Predictors of Admission to a Psychiatric Hospital

Blind predictions were made as to admission or non-admission as an overall rating and as to degree of pathology in eight areas of personality, based only on human figure drawings. These drawings were obtained from a sample of 105 individuals presenting for psychiatric hospital admission. The judgments were all in the predicted direction and significant for admission-non-admission, impulsivity, and severity of pathology. Cues utilized in the successful judgments were categorized as structural or content and scaled by degree of pathology. Structural cues predominated. We conclude that HFD's are a useful screening device for clinical judgment of degree of psychopathology. The basis of such judgments can be specified in terms of structural deviations rather than from symbolic content.     

Detection of a Psychiatric Diagnosis in Heart Transplant Candidates with the MBHI

The utility of the Millon Behavioral Health Inventory (MBHI) in screening for the formal diagnosis of a psychiatric disorder was investigated in a sample of 90 heart transplant candidates, a population at risk for psychiatric disturbance. Psychiatric disorders were identified in 71% of patients, the majority being adjustment disorder. Sensitivity and specificity rates of >70% were determined in discriminant function analyses, for presence or absence of a psychiatric condition. When Axis I conditions were differentiated as mild (adjustment reaction only) or severe (all other Axis I conditions, including comorbid Axis II disorders), the MBHI correctly identified every severe case as a probable psychiatric diagnosis. The rate of clinically significant elevations on certain MBHI scales and severity of Axis I psychiatric condition was also significantly associated. These findings suggest that the MBHI may have potential utility in identifying high-risk patients with diagnosable psychiatric conditions and help justify mental health consultation referrals at a time when managed care entities are vigorously rationing ancillary services with medically ill populations.     

Validity of the Brief Psychiatric Rating Scale Within a Forensic Inpatient Hospital

Although the Brief Psychiatric Rating Scale(BPRS) has been utilized across several clinical settings, its potential utility within forensic psychiatric hospitals has not yet been investigated. Given the diversity of training and background among correctional mental health workers (i.e., psychiatrists, psychiatric nurses, occupational therapists, recreation therapists, psychologists, social workers,etc.) it is possible that the uniform use of the BPRS among the correctional staff would require extensive training and that substantial “refresher” training may be required to maintain the integrity of rater practices. The present study examined the ability of previously trained forensic mental health professionals to accurately assess psychopathology using the BPRS. Overall,experienced raters demonstrated relatively high concordance rates with “gold standard” ratings across three BPRS training videos (Case 1, Case2 and Case 3). No overall “rater drift” was apparent. However, raters were found to make significantly more errors when rating behavioral observation ratings than for ratings based on self-report patient statements. Findings suggest that ratings done by forensic mental health workers are relatively accurate when compared to “gold standard” ratings established for assessment of community and forensic psychiatric patients. This revised version was published online in July 2006 with corrections to the Cover Date.     

Translating CBM-I Into Real-World Settings: Augmenting a CBT-Based Psychiatric Hospital Program

Cognitive bias modification for interpretation (CBM-I) is an appealing augmentation to cognitive-behavioral therapy (CBT) because it targets cognitive bias efficiently via computerized training. Few studies have tested the combination of CBM-I and CBT, and none have translated lab-based CBM-I protocols to an acute psychiatric setting. The present study describes the development and implementation of CBM-I as an augmentation to a CBT-based partial hospital. We developed a transdiagnostic CBM-I based on the word–sentence association paradigm (WSAP), which reinforces individuals for endorsing benign interpretations and rejecting negative interpretations of ambiguous sentences. Over two iterations of development, we randomly assigned patients (N = 127; M age = 34.21; 58% female, 40% male, 2% nonbinary) to either CBM-I or a control group (Phase 1: neutral WSAP task; Phase 2: treatment as usual). CBM-I comprised daily sessions (10 minutes) completed during program hours, and number of sessions varied naturalistically according to patient length of stay. Primary outcomes included feasibility, acceptability, and target engagement (interpretation bias). CBM-I was feasible and acceptable to acute psychiatric patients, and successfully shifted interpretation for novel stimuli. Patient feedback suggested that participants viewed CBM-I as bolstering their primary CBT-based care. Exploratory analyses examining clinical benefit revealed a small between-group effect on anxiety severity (d = 0.378), but no group differences on depression outcomes (d = 0.008). Findings indicate that CBM-I is a feasible and acceptable augmentation to CBT-based partial hospital care. Future studies are warranted to determine who is most likely to benefit from this low-intensity approach.     

Relationship Between Specific Adverse Life Events and Psychiatric Disorders

This study examines whether certain psychiatric disorders are associated more closely with adverse life events than other disorders are, and whether some adverse life events are associated with a specific group of disorders (e.g., depressive disorders), but not with other disorders (e.g., anxiety disorders). A probability sample of youth aged 9–17 at 4 sites is used (N = 1,285). Univariate and multivariate logistic regressions identify specific relationships between 25 adverse life events and 9 common child and adolescent psychiatric disorders, measured by the Diagnostic Interview Schedule for Children. Conduct Disorder, Oppositional Defiant Disorder, Major Depressive Disorder, and Dysthymia are significantly associated with many of the adverse life events examined, whereas Attention Deficit/Hyperactivity Disorder, Agoraphobia, and Social Phobia are related to very few. This study suggests that certain psychiatric disorders may be more closely associated with adverse life events than other psychiatric disorders are, and that some adverse life events seem to be related to specific types of disorders.     

Crisis Assessment and Psychiatric Hospitalization of Children and Adolescents in State Custody

We investigated the clinical characteristics and placement decisions among a group of children who were wards of the state and had been evaluated for a crisis assessment. The sample consisted of 383 children and adolescents (ages 2-20 years) who were wards of the Illinois Department of Children and Family Services (DCFS). This study retrospectively reviewed the symptoms, risk factors, functioning and co-morbid variables, and placement or system characteristics of these children using a structured assessment tool, the Childhood Severity of Psychiatric Illness (CSPI). Results indicated that risk behaviors as rated on the CSPI, including suicidality, dangerousness, and runaway tendency, were significant predictors of psychiatric hospitalization. The importance of more widespread usage of standardized assessment tools in evaluating children's mental health needs is discussed.     

An Approach to the Study of the Small Group in a Psychiatric Day Hospital

Adults in midlife can be significantly helped through group treatment that is sensitive to the developmental issues of the age period. The author suggests that the developmental crisis of midlife—Generativity versus Stagnation—can, through unconscious processes, become a group crisis as well. A group state of stagnation, enveloping the members as well as the leader, if understood and worked through, can significantly facilitate the developmental progress of its midlife members. A clinical example demonstrates how a therapist helped his midlife group move out of stagnation and toward generativity.     

Group Leader-Recorder Relationship in a State Hospital: A Learning Tool

The process group for staff and trainees in institutional settings has become increasingly unpopular as a resource, although ironically, the need for such a group has grown. The author presents the idea that the process group is not used more often because of a general lack of understanding of the nature of such groups as well as a failure to clearly distinguish process groups from traditional psychotherapy groups. The author goes on to give a clear definition of the task and the boundaries of a process group and, using knowledge of systems thinking, discusses special techniques for running such groups with illustrative examples.     

Psychiatric and Psychological Morbidity as a Function of Adaptive Disability in Preschool Children with Aggressive and Hyperactive-Impulsive-Inattentive Behavior

Children with high levels of aggressive-hyperactive-impulsive-inattentive behavior (AHII; n = 154) were subdivided into those with (n = 38) and without (n = 116) adaptive disability (+AD/–AD) defined as a discrepancy between expected versus actual adaptive functioning. They were compared to each other and a control group of 47 normal children. Both AHII groups were more likely to have attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder than control children; more symptoms of general psychopathology; greater social skills deficits; more parental problems; and lower levels of academic achievement skills. Compared to AHII – AD children, AHII + AD children had (1) more conduct disorder; (2) greater inattention and aggression symptoms; (3) more social problems, less academic competence, and poorer self-control at school; (4) more severe and pervasive behavior problems across multiple home and school settings; and (5) parents with poorer child management practices. Thus, adaptive disability has utility as a marker for more severe and pervasive impairments in AHII children.