Validity of the Personality Diagnostic Questionnaire-4 (PDQ-4+) among mentally ill prison inmates in Singapore

We examined the validity of the Personality Diagnostic Questionnaire--4+ (PDQ-4+) as a screening instrument for personality disorders among mentally ill prison inmates in Singapore. A total of 313 prison inmates completed the PDQ-4+ and the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). The subjects were 303 (96.8%) males and 10 (3.2%) females with a mean (SD) age of 40.7 (8.8) years. Kappa agreement between PDQ-4+ and SCID-II for the presence at least one personality disorder was moderate with high sensitivity and low specificity. For specific personality disorders and clusters, we found that the PDQ-4+ diagnosed more subjects as having each of the personality disorders than SCID-II with high negative predictive values. The area under the curve indicated moderate discriminatory capabilities. Our results suggest that the PDQ-4+ could be used as a potential screening instrument for personality disorders in prison inmates.     

The cross-cultural generalizability of Axis-II constructs: an evaluation of two personality disorder assessment instruments in the People's Republic of China

We examined the reliability, cross-instrument validity, and factor structure of Chinese adaptations of the Personality Diagnostic Questionnaire (PDQ-4+; N = 1,926) and Personality Disorders Interview (PDI-IV; N = 525) in psychiatric patients. Comparisons with data from Western countries suggest that the psychometric properties of these two instruments are comparable across cultures. Low to modest agreement between the PDQ-4+ and PDI-IV was observed for both dimensional and categorical personality disorder evaluations. When the PDI-IV was used as the diagnostic standard, the PDQ-4+ showed higher sensitivity than specificity, and higher negative predictive power than positive predictive power. Factor analyses of both instruments replicated the four-factor structure O'Connor and Dyce (1998) found in Western samples. Results suggested that conceptions and measures of DSM-IV personality disorders are cross-culturally generalizable to Chinese psychiatric populations.     

Maladaptive personality traits in adolescence: Psychometric properties of the Personality Diagnostic Questionnaire-4+

The Personality Diagnostic Questionnaire-4+ (PDQ-4+) is a self-report used for the assessment of personality disorder traits, however, its psychometric characteristics have yet to be tested in community samples of adolescents. The main goal was to analyze the psychometric properties of the PDQ-4+ scores in a large sample of non-clinical adolescents (N = 1,443; M = 15.9 years; SD = 1.2). The PDQ-4+ scores showed adequate psychometric properties. Reliability of the subscales, incorporating a Likert-type 5-point response format, ranged from .62 to .85. The study of the internal structure at item level revealed that the PDQ-4+ subscales were essentially one-dimensional. Analysis of the internal structure at the subscale level by means of exploratory factor analysis and exploratory structural equation modeling yielded a possible three-dimensional solution. The PDQ-4+ subscales correlated moderately with emotional and behavioural variables measured by the Strengths and Difficulties Questionnaire. The results have clear implications for the understanding of maladaptive personality traits in adolescents.     

The Iowa Personality Disorder Screen: development and preliminary validation of a brief screening interview

The length and expense of comprehensive personality disorder interviews makes them unwieldy for routine use. A brief but sensitive screen could eliminate administration of longer instruments in many instances. We describe the development of the Iowa Personality Disorder Screen (IPDS)--a mini-structured interview which can be completed in less than 5 minutes. Retrospective analyses using 1,203 SIDP-R interviews suggested that the IPDS items should provide good sensitivity and specificity. We present results from a prospective validation study, using a mixed group of 52 nonpsychotic inpatients and outpatients who were diagnosed using the SIDP-IV. Blind administration of the IPDS yielded excellent sensitivity (92%) and good specificity (79%), using a subset of five screening items. Addition of two more items leads to an estimated sensitivity of 79% and specificity of 86%. The IPDS shows promise as a quick personality disorder screen for use in research settings or standard clinical interviews.     

A screening measure for BPD: the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD)

Borderline personality disorder (BPD) is a common psychiatric disorder that is often overlooked in treatment settings. This report describes the validation of a new self-report screening measure for DSM-IV BPD--the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). Two hundred subjects with treatment histories whose ages ranged from 18 to 59 filled out the MSI-BPD. Each subject was then interviewed, blind to MSI-BPD results, with the BPD module of the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV; Zanarini, Frankenburg, Sickel, & Yong, 1996). Of these 200 subjects, 139 (69.5%) met DSM-IV criteria for BPD as assessed by the BPD module of the DIPD-IV and the remaining 61 subjects (30.5%) did not. Using logistic regression analyses, an MSI-BPD cutoff of 7 or more of the measure's 10 items was judged to be the best cutoff. This was so because it yielded both good sensitivity (.81; percentage of correctly identified cases) and specificity (.85; percentage of correctly identified noncases) for the diagnosis of DSM-IV BPD. For younger subjects, diagnostic efficiency was even greater. For example, sensitivity was .90 and specificity was .93 at a cutoff of 7 for the 63 subjects who were 25 years old or younger. The results of this study suggest that the MSI-BPD may be a useful screening instrument for the presence of DSM-IV borderline personality disorder.     

Development and first results of the Borderline Personality Inventory: a self-report instrument for assessing borderline personality organization.

This article reports the development of a short 53-item true-false self-report instrument, the Borderline Personality Inventory (BPI). The BPI is based on Kernberg's (1984) concept of borderline personality organization. However, the diagnostic criteria are compatible with both the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) and Gunderson's (Gunderson & Kolb, 1978) concept of borderline personality disorder (BPD). The BPI contains scales for assessing identity diffusion, primitive defense mechanisms, and reality testing. Another scale refers to the fear of closeness. The construction of the scales is based on the results of a factor analysis. As a result of several studies, a cutoff score is proposed to make the diagnosis of a BPD. Thus, the BPI combines dimensional and categorical models of BPD. The BPI was tested in several studies. According to the results, internal consistency and retest reliability are satisfactory (Cronbach's alpha = .68-.91, rtt = .73-.89). Results for sensitivity are .85 to .89, and results for specificity .78 to .89. The BPI identifies borderline patients in high agreement with Kernberg's criteria of borderline personality organization, Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) criteria of BPD and Gunderson's criteria of BPD. The BPI is recommended as a screening instrument for borderline personality organization and BPD and for dimensional research of borderline features in Axis I and Axis II disorders.     

Where is (im)balance? Necessity and construction of evaluated cut‐off points for effort‐reward imbalance and overcommitment

The use of cut‐off values is common in research on the effort‐reward imbalance (ERI) model. They are often used to identify health risk situations or behaviour at work, although little is known about their diagnostic properties. The aim of the study was to investigate empirically cut‐off points for the effort‐reward ratio and the overcommitment (OC) scale. The study was based on a sample of 302 teachers. According to the International Classification of Mental and Behavioural Disorders‐10 (ICD‐10), 115 subjects suffered from a mood disorder. The control group consisted of 187 matched healthy subjects. Receiver‐operating characteristic analyses were conducted using the ERI ratio and OC as diagnostic variables. A mood disorder served as gold standard reference test. Results demonstrated the ability of the effort‐reward ratio and OC to discriminate between diseased and healthy individuals. However, a comparison of the areas under the curve revealed a significantly higher diagnostic power for the effort‐reward ratio. According to the Youden index, optimal cut‐off points were ERI>0.715 and OC>16. Furthermore, sensitivity and specificity for different cut‐off values are presented. Results point to shortcomings in the ERI literature using established approaches to define cut‐off points. Validating cut‐off values is of particular importance in order to ensure valid results in ERI research.     

The SCL-90-R as a screening instrument for severe personality disturbance among outpatients with mood and anxiety disorders

Our objective was to examine whether the SCL-90-R, a widely used self-report measure of distress and psychopathology, could screen for personality disorders in general and for severe personality disturbance (SPD) in particular, at the time when patients seek treatment for a state (mood or anxiety) disorder. The SCL-90-R was administered to 112 consecutive outpatients with various mood and anxiety disorders. The personality severity index (PSI) score, defined as the mean value of the scores on the SCL-90-R subscales of interpersonal sensitivity, hostility, and paranoid ideation, was compared with the current symptom index (CSI) score, defined as the mean value of the scores on the remaining six SCL-90-R subscales. A positive screen was considered if PSI > CSI. SPD was defined as the presence of any DSM-III-R Cluster A and/or Cluster B personality disorder. The accuracy of the screen was verified by means of the Structured Clinical Interview for DSM-III-R Personality Disorders. The sensitivity of the PSI > CSI criterion to screen for SPD was 89.4%, while its sensitivity to screen for any DSM-III-R personality disorder was 72.9%. The SCL-90-R subscales that contributed the most to the screening discriminability of this SCL-90-R-derived screening measure were hostility, paranoid ideation, somatization, and obsessive-compulsive behavior. The SCL-90-R may be used to screen for SPD in routine work with outpatients with mood and anxiety disorders, but the results of the screening need to be verified because of the possibility of false negatives and false positives, although that possibility is apparently low. These findings may have important prognostic and treatment implications.     

Psychometric properties of the Spanish version of the self-report Personality Diagnostic Questionnaire -4+ (PDQ-4+) in psychiatric outpatients

We examined the psychometric properties of the Spanish version of the self-report Personality Diagnostic Questionnaire-4+ (PDQ-4+) in a sample of 437 psychiatric outpatients. Psychometric properties were assessed through internal consistency analysis, exploratory factor analysis (EFA) and concurrent validity. Results indicate that the Spanish version of the PDQ-4+ has moderate internal consistency, which was acceptable for 7 of the 12 self-report scales. The factor structure roughly replicated the DSM-IV clusters. The presence of Personality Disorders was associated with the character dimensions of the Temperament and Character Inventory (TCI).     

Diagnostic efficiency among psychiatric outpatients of a self-report version of a subset of screen items of the Structured Clinical Interview for DSM-IV-TR Personality Disorders (SCID-II)

This article describes the identification of a 10-item set of the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) items, which proved to be effective as a self-report assessment instrument in screening personality disorders. The item selection was based on the retrospective analyses of 495 SCID-II interviews. The psychometric properties were studied in a prospective validation study in a random sample of Dutch adult psychiatric outpatients, using the SCID-II interview as the gold standard. First, all patients completed the short questionnaire. One week later, they were interviewed with the full SCID-II. After another week, the short questionnaire was readministered. According to the scores obtained with the full SCID-II, 97 patients (50%) had a personality disorder. The set of 10 SCID-II items correctly classified 78% of all participants. The sensitivity, specificity, and positive and negative power were 0.78, 0.78, 0.78, and 0.78, respectively. The results based on the retrospectively obtained data were rather similar to those obtained in the prospective validation study. Therefore, it is concluded that the set of 10 SCID-II items can be useful as a quick self-report personality disorder screen in a population of psychiatric outpatients.     

Comparison of Three Self-Report Measures of Personality Pathology

Levels of convergence were examined among three personality instruments: the Personality Diagnostic Questionnaire-4+ (PDQ-4+), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders Questionnaire (SCID-IIQ) and the Multi-source Assessment of Personality Pathology (MAPP). Each personality questionnaire was administered three times in an alternating sequence over nine consecutive weekdays to a sample of college students. There was some degree of convergence among the three instruments, but there were also substantial empirical differences between them. The data suggest three related conclusions: (1) in general, the self-report version of the MAPP is more conservative than the other two questionnaires, (2) these questionnaires are not interchangeable measures of personality disorders, and (3) the breadth of measurement provided varies as a function of both the questionnaire and the personality disorder being measured.     

Screening of personality disorders among chinese college students by Personality Diagnostic Questionnaire-4+

Four thousand eight hundred and eleven students were sampled from 26 universities in 21 cities of China and evaluated using the Personality Diagnostic Questionnaire-4+(PDQ-4+). Results showed that male students obtained significantly higher scores than female students on paranoid, schizotypal, antisocial, narcissistic, passive-aggressive, and depressive personality disorder scales, and lower scores on the borderline scale. Students from rural areas scored higher than those from urban areas on the schizoid, schizotypal, narcissistic, avoidant, compulsive-obsessive, passive-aggressive, and depressive personality disorder scales, and lower on the paranoid and dependent scales. Singleton students obtained significantly higher scores than nonsingletons on paranoid, antisocial and dependent scales, and lower on schizoid, avoidant, compulsive-obsessive, passive-aggressive, depressive scales. Students from single-parent families scored significantly higher on the schizotypal scales; and students from foster families scored significantly higher on the antisocial, passive-aggressive, and depressive scales. Students from poor families scored significantly higher than those from average or wealthy families on schizoid, schizotyal, antisocial, borderline, narcissistic, avoidant, obsessive-compulsive, passive-aggressive, and depressive personality disorders. The results suggest that low family income, low social status, and parental style contribute to the development of personality disorders.     

Assessing cognitive impairment in Indigenous Australians: Re‐evaluation of the Kimberley Indigenous Cognitive Assessment in Western Australia and the Northern Territory

The Kimberley Indigenous Cognitive Assessment (KICA) was initially developed and validated as a culturally appropriate dementia screening tool for older Indigenous people living in the Kimberley. This paper describes the re‐evaluation of the psychometric properties of the cognitive section (KICA‐Cog) of this tool in two different populations, including a Northern Territory sample, and a larger population‐based cohort from the Kimberley. In both populations, participants were evaluated on the KICA‐Cog tool, and independently assessed by expert clinical raters blinded to the KICA scores, to determine validity and reliability of dementia diagnosis for both groups. Community consultation, feedback and education were integral parts of the research. for the Northern Territory sample, 52 participants were selected primarily through health services. Sensitivity was 82.4% and specificity was 87.5% for diagnosis of dementia, with area under the curve (AUC) of .95, based on a cut‐off score of 31/32 of a possible 39. for the Kimberley sample, 363 participants from multiple communities formed part of a prevalence study of dementia. Sensitivity was 93.3% and specificity was 98.4% for a cut‐off score of 33/34, with AUC = .98 (95% confidence interval: 0.97–0.99). There was no education bias found. The KICA‐Cog appears to be most reliable at a cut‐off of 33/39.     

Diagnostic efficiency of the Iowa personality disorder screen items in a nonclinical sample

The diagnostic efficiency of the 11-item Iowa Personality Disorder Screen (IPDS; Langbehn et al., 1999) was evaluated in a nonclinical sample of young adults, 35% of whom met DSM-III-R criteria for a personality disorder, in a retrospective analysis of SIDP-R data. Results indicated that two IPDS item sets (i.e., combinations of items) produced hit rates of more than 80% along with good sensitivity, specificity, positive predictive power, and negative predictive power. Combined with the findings of Langbehn et al. (1999), these results suggest that the IPDS may be useful as a screening measure for personality disorder in both clinical and nonclinical populations.     

The Brief Cognitive Impairment Scale (BCIS): preliminary investigation of a severe-stage dementia test emphasizing cognitive processing and interpersonal tolerance

We describe the development and validation of The Brief Cognitive Impairment Scale (BCIS), a cognitive screening instrument designed for persons with severe-stage dementia. Psychometric analyses were performed on neuropsychological data from long-term care residents (N = 247) who completed a brief battery of tests, including the BCIS. A principle component analysis yielded three factors that provide insight into how persons with severe dementia cognitively process information and may tolerate specific aspects of social stimulation, such as during personal care. A BCIS cut score can be used to identify severe dementia with a sensitivity of .82, a specificity of .84, and an area under the curve of .89. It may be used by clinicians or caregivers when advanced dementia is suspected, as an alternative to measures with suspected floor effects, when residents cannot tolerate more demanding assessment tools, and as part of non-pharmacologic treatment plans for behavior disturbances associated with dementia.     

The CORE‐10: A short measure of psychological distress for routine use in the psychological therapies

Background: There is a need for a generic, short, and easy‐to‐use assessment measure for common presentations of psychological distress in UK primary care mental health settings. This paper sets out the development of the CORE‐10 in response to this need. Method: Items were drawn from the CORE‐OM and 10 items were selected according to a combination of usefulness, coverage of item clusters, and statistical procedures. Three CORE‐OM datasets were employed in the development phase: (1) a primary care sample, (2) a sample from an MRC platform trial of enhanced collaborative care of depression in primary care, and (3) a general population sample derived from the Office of National Statistics Psychiatric Morbidity Follow‐up survey. A fourth dataset comprising a sample from an occupational health setting was used to evaluate the CORE‐10 in its standalone format. Results: The internal reliability (alpha) of the CORE‐10 was .90 and the score for the CORE‐10 correlated with the CORE‐OM at .94 in a clinical sample and .92 in a non‐clinical sample. The clinical cut‐off score for general psychological distress was 11.0 with a reliable change index (90% CI) of 6. For depression, the cut‐off score for the CORE‐10 was 13 and yielded sensitivity and specificity values of .92 (CI=.83–1.0) and 0.72 (CI=.60–.83) respectively. Conclusion: The CORE‐10 is an acceptable and feasible instrument that has good psychometric properties and is practical to use with people presenting with common mental health problems in primary care settings.     

Distancing oneself from God: relationships with borderline personality symptomatology

Self-harm behaviour traditionally has been associated with borderline personality disorder. In this study, we examined the relationship between borderline personality symptomatology and intentionally distancing oneself from God as self-punishment, based on the assumption that such self-punishment may represent a form of self-harm behaviour. Data from four previous samples of primary care outpatients collected over a two-year period were combined (N?=?1511). Borderline personality was assessed with two measures: the borderline personality scale of the Personality Diagnostic Questionnaire-4 (PDQ-4) and the Self-Harm Inventory (SHI). Point-biserial correlation coefficients revealed that those who endorsed distancing oneself from God as punishment scored relatively higher on both the PDQ-4 (r?=?0.40, p?<?0.001) and the SHI (r?=?0.46, p?<?0.001). Similarly, when compared to respondents who denied ever having distanced themselves from God as punishment, those who did were more likely to exceed the clinical cut-off score on the PDQ-4 (47.3% vs. 10.9%, X^{2 ?}=?152.53, p?<?0.001) and the SHI (57.3% vs. 11.4%, X^{2 ?}=?224.12, p?<?0.001). Findings support our hypothesis that distancing oneself from God as punishment may be a form of self-harm behaviour associated with borderline personality symptomatology.     

Screening HIV-Infected Patients with Chronic Pain for Anxiety and Mood Disorders with the Beck Anxiety and Depression Inventory-Fast Screens for Medical Settings

The Beck Anxiety (BAI-FS) and Depression (BDI-FS) Inventory-Fast Screens for Medical Settings were administered to 63 HIV-infected outpatients seeking treatment at a chronic pain clinic to evaluate how effectively these 7-item instruments would, respectively, differentiate those who were and were not diagnosed with DSM-IV anxiety, mood, or both disorders. The Anxiety and Mood Modules from the Primary Care Evaluation of Mental Disorders (PRIME-MD) were employed to establish the diagnoses. The coefficient 's for the BAI- and BDI-FS were, respectively, .80 and .84. A BAI-FS cut-off score of 4 and above yielded 82% sensitivity and 59% specificity rates for identifying patients with and without anxiety disorders, whereas a BDI-FS cut-off score of 4 and above had 90% sensitivity and 74% specificity rates for detecting patients with and without mood disorders. It was concluded that the BDI-FS was a useful instrument for screening HIV-infected patients with chronic pain for mood disorders.     

Curriculum-based measurement of oral reading (R-CBM): A diagnostic test accuracy meta-analysis of evidence supporting use in universal screening

A great deal of research over the past decade has examined the appropriateness of curriculum-based measurement of oral reading (R-CBM) in universal screening. Multiple researchers have meta-analyzed available correlational evidence, yielding support for the interpretation of R-CBM as an indicator of general reading proficiency. In contrast, researchers have yet to synthesize diagnostic accuracy evidence, which pertains to the defensibility of the use of R-CBM for screening purposes. The overall purpose of this research was to therefore conduct the first meta-analysis of R-CBM diagnostic accuracy research. A systematic search of the literature resulted in the identification of 34 studies, including 20 peer-reviewed articles, 7 dissertations, and 7 technical reports. Bivariate hierarchical linear models yielded generalized estimates of diagnostic accuracy statistics, which predominantly exceeded standards for acceptable universal screener performance. For instance, when predicting criterion outcomes within a school year (≤ 9 months), R-CBM sensitivity ranged between .80 and .83 and specificity ranged between .71 and .73. Multiple moderators of R-CBM diagnostic accuracy were identified, including the (a) R-CBM cut score used to define risk, (b) lag in time between R-CBM and criterion test administration, and (c) percentile rank corresponding to the criterion test cut score through which students were identified as either truly at risk or not at risk. Follow-up analyses revealed substantial variability of extracted cut scores within grade and time of year (i.e., fall, winter, and spring). This result called into question the inflexible application of a single cut score across contexts and suggested the potential necessity of local cut scores. Implications for practices, directions for future research, and limitations are discussed.     

Risk Factors for Attempting Suicide in Prisoners

We wished to examine determinants of suicidal behavior in prisoners. 903 male prisoners had a psychiatric interview which included various psychometric tests. Suicide attempters were compared with prisoners who had never attempted suicide. Significantly more of the attempters had a history of psychiatric disorder, substance abuse, a family history of suicidal behavior, convictions for violent crime, had exhibited aggressive behavior in jail, and had higher BGLHA aggression scores. A similar pattern of risk factors was found for prisoners with suicidal ideation. A lifetime history of attempting suicide, or of having suicidal ideation, is frequent in prisoners. Risk factors include family, developmental, aggression, personality, psychiatric, and substance abuse factors.