Discriminant Validity of the General Behavior Inventory: An Outpatient Study

Recent studies have provided strong support for the convergent validity of the General Behavior Inventory (GBI), a case identification inventory for chronic subsyndromal affective disorders (cyclothymia and dysthymia). Fewer data are available, however, on the ability of the GBI to distinguish chronic subsyndromal affective disorders from other forms of psychopathology. In order to address this issue, outpatients with cyclothymia (n = 9), dysthymia (n = 26), nonchronic major depression (n = 16), and nonaffective psychiatric disorders (n = 30) were compared on the GBI. Diagnoses were derived blind to GBI scores using structured diagnostic interviews and DSM-III criteria. The inventory significantly discriminated cyclothymes and dysthymes from patients with nonchronic major depressions and nonaffective disorders. Using the cutoff score that maximized GBI-diagnosis concordance, the inventory correctly classified 88% of the sample. All of the cyclothymes, 92% of the dysthymes, 87% of the patients with nonaffective psychiatric disorders, and 75% of the nonchronic major depressives were correctly classified by the inventory. These data provide strong support for the discriminant validity of the GBI.     

Social adjustment in the offspring of parents with bipolar affective disorder

The social adjustment of the adolescent offspring of parents with bipolar affective disorder (n=41) was compared to that of the offspring of parents with nonaffective psychiatric disorders (n=22) and the offspring of normal controls (n=26). In addition, the relationship between social adjustment and cyclothymia in offspring was determined. Social adjustment was assessed using the Life Activities Inventory, a new measure developed to assess social functioning in adolescents and young adults. Cyclothymia was assessed with the General Behavior Inventory. As a group, the offspring of bipolar parents did not differ significantly from either control group on social adjustment. However, the cyclothymic offspring of bipolar parents exhibited significantly poorer social adjustment than the noncyclothymic offspring of bipolars and the offspring of psychiatric and normal controls. These findings suggest that poor social functioning in the adolescent offspring of parents with bipolar illness may be associated with the early manifestations of affective disorder. In addition, these data indicate that despite its subsyndromal intensity, cyclothymia can result in significant social impairment.This study was supported in part by National Institute of Mental Health (NIMH) Research Grant MH-39782 to Daniel N. Klein and NIMH Grants MH-33083 and MH-37195 to Richard A. Depue.     

General behavior inventory identification of unipolar and bipolar affective conditions in a nonclinical university population

Validated the General Behavior Inventory (GBI), revised to identify unipolar as well as bipolar affective conditions, in a nonclinical sample (n = 201) against naive, interview-derived diagnoses. For bipolar and unipolar conditions, respectively, the GBI had high positive (.94, .87) and negative (.99, .93) predictive power with the effect of prevalence considered, adequate sensitivity (.78, .76), high specificity (.99, .99), and adequate selection ratios for sampling of affective and nonaffective subjects from nonclinical populations for research purposes. The utility of the GBI in several different research contexts is discussed.     

Identifying Positive Dissimulation by Substance-Abusing Individuals on the Personality Assessment Inventory: A Cross-Validation Study

The accuracy of a classification equation (which combined scores on the Drug Problems, Alcohol Problems, and Positive Impression scales from the Personality Assessment Inventory [PAI], Morey, 1991), developed by Fals-Stewart (1996) to identify test-taking response sets among substance-abusing individuals, was evaluated. As in the Fals-Stewart (1996) study, three groups of participants completing the PAI were assessed: (a) substance-abusing patients administered the inventory under standard instructions (n = 25); (b) substance-abusing patients asked to respond defensively (n = 25) combined with a group of individuals suspected of abusing drugs, referred for art evaluation by the criminal justice system, who had reasons to conceal their drug use (n = 25); and (c) non-substance-abusing respondents administered the test under standard instructions (n = 25). Significant validity shrinkage in the classification equation was found when applied to the new sample; only 68% of participants were correctly classified into their respective groups, compared to 82% of participants correctly assigned in the Fals-Stewart (1996) investigation.     

The Depressive Experiences Questionnaire: a further evaluation

The Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976b) was designed to assess the introjective and anaclitic personality dimensions hypothesized by Blatt (1974) to underlie different forms of depression. Welkowitz, Lish, and Bond (1985) revised the DEQ (RDEQ) in order to simplify its scoring and facilitate cross-gender comparisons. The study described herein explored the relation between the original and revised forms of the DEQ and assessed the reliability and validity of the Welkowitz et al. (1985) version of the inventory. Two samples were employed: (a) 163 psychiatric outpatients; and (b) 144 adolescent and young-adult offspring of patients with major affective disorders, chronic physical diseases, and normal controls. The results indicated that the three scales comprising the RDEQ were highly correlated with the corresponding scales from the original DEQ, however, the original and revised forms of the inventory exhibited different patterns of intercorrelations between scales. The RDEQ was internally consistent and stable over a 6-month period. In addition, it exhibited the predicted patterns of relationships with interview and self-report measures of depression and depressive personality traits and cognitive styles. Finally, the RDEQ was significantly associated with the course of depression in a 6-month follow-up study. The findings were generally similar across samples and genders. Overall, these results support the reliability and validity of the RDEQ, but indicate that there are important structural differences between the original and revised forms of the inventory.     

Comparison of DSM-III-R chronic major depression and major depression superimposed on dysthymia (double depression): validity of the distinction

The nosology of chronic depression has become increasingly complex since the publication of the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987), but there are few data available to evaluate the validity of the distinctions between the subtypes of chronic depression. The validity of the distinction between DSM-III-R chronic major depression (CMD) and major depression superimposed on dysthymia (double depression, DD) was examined. Participants were 635 patients with chronic depression in a 12-week trial of antidepressant medications. Patients with CMD, DD, and a 3rd group with a chronic major depressive episode superimposed on dysthymia (DD/CMD) were compared on demographic and clinical characteristics, family history, and response to treatment. Few differences were evident, although the depression of patients with DD/CMD tended to be more severe.     

The Depressive Experiences Questionnaire: A Further Evaluation

The Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976b) was designed to assess the introjective and anaclitic personality dimensions hypothesized by Blatt (1974) to underlie different forms of depression. Welkowitz, Lish, and Bond (1985) revised the DEQ (RDEQ) in order to simplify its scoring and facilitate cross-gender comparisons. The study described herein explored the relation between the original and revised forms of the DEQ and assessed the reliability and validity of the Welkowitz et al. (1985) version of the inventory. Two samples were employed: (a) 163 psychiatric outpatients; and (b) 144 adolescent and young-adult offspring of patients with major affective disorders, chronic physical diseases, and normal controls. The results indicated that the three scales comprising the RDEQ were highly correlated with the corresponding scales from the original DEQ, however, the original and revised forms of the inventory exhibited different patterns of intercorrelations between scales. The RDEQ was internally consistent and arable over a 6-month period. In addition, it exhibited the predicted patterns of relationships with interview and self-report actuates of depression and depressive personality traits and cognitive styles. Finally, the RDEQ was significantly associated with the course of depression in a 6-month follow-up study. The findings were generally similar across samples and genders. Overall, these remits support the reliability and validity of the RDEQ, but indicate that there are important structural differences between the original and revised forms of the inventory.     

A goal-striving life event and the onset of hypomanic and depressive episodes and symptoms: perspective from the behavioral approach system (BAS) dysregulation theory

On the basis of the behavioral approach system (BAS) dysregulation theory of bipolar disorder, this study examined the relation between occurrence of a BAS activation-relevant life event--goal striving--and onset of hypomanic and depressive episodes and symptoms. In particular, the authors examined the relation between preparing for and completing final exams (a goal-striving event) and onset of bipolar spectrum episodes and symptoms in college students with bipolar II disorder or cyclothymia (i.e., "soft" bipolar spectrum conditions). One hundred fifty-nine individuals with either a bipolar spectrum disorder (n=68) or no major affective psychopathology (controls; n=91) were further classified on the basis of whether they were college students (i.e., completed final exams). Consistent with the BAS dysregulation theory, preparing for and completing final exams was associated with an increase in hypomanic but not depressive episodes and symptoms in individuals with a soft bipolar spectrum diagnosis. Furthermore, self-reported BAS sensitivity moderated the presence of certain hypomanic symptoms during final exams.     

Marital dissatisfaction and psychiatric disorders: results from the National Comorbidity Survey

The association between marital dissatisfaction and 12-month prevalence rates of Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev., 1987) Axis I psychiatric disorders was examined in married respondents from the National Comorbidity Survey (N = 2,538). Results indicate that marital dissatisfaction was associated with the presence of any disorder, any mood disorder, any anxiety disorder, and any substance-use disorder; dissatisfaction was also associated with 7 of 12 specific disorders for women and 3 of 13 specific disorders for men. To evaluate the unique association between marital dissatisfaction and psychiatric disorders, analyses were conducted controlling for comorbid disorders. Covariance analyses generally attenuated the bivariate associations between marital dissatisfaction and specific disorders and groupings of disorders. Results indicate that marital dissatisfaction was uniquely related to major depression and posttraumatic stress disorder for women and dysthymia for men.     

Major depression, double depression and personality disorders

Personality disorders are much more common among depressive patients than among normal people. Until now, little research has been conducted into the prevalence of personality disorders among patients with both major depression and dysthymia (double depression). The subject of this study is whether depressive patients with dysthymia have more personality disorders than those with no dysthymia. The Vragenlijst voor Kenmerken van de Persoonlijkheid (a Dutch self-report based on the International Personality Disorder Examination) was completed for 211 outpatients with major depression. Approximately 60% of the patients suffer from one or more personality disorders. Depressive patients with dysthymia differ little from the patients without dysthymia, but patients with dysthymia have more cluster A disorders and are more avoidant. Depressive patients without dysthymia do not differ from the patients with dysthymia in terms of symptoms. Depressive patients with personality disorders have significantly more symptoms than the patients without these disorders. There is no interaction between dysthymia and personality disorder.     

A family study of outpatients with borderline personality disorder and no history of mood disorder

While several studies have examined psychiatric disorders in the relatives of individuals with borderline personality disorder, many of these studies have not employed a family study methodology and suffer from other methodological shortcomings. Thus, the conclusions from family data addressing the validity of borderline personality disorder, its relation to other conditions, and its distinction from mood disorders, continue to be debated. The present investigation employed a family study design with direct interviews with relatives, structured diagnostic interviews with both probands and relatives, and blind assessment of relatives. Rates of psychiatric disorders were examined in 563 relatives of outpatients with mood disorders (n = 119), 54 relatives of outpatients with borderline personality disorder and no history of mood disorder (n = 11), and 229 relatives of never psychiatrically ill controls (n = 45). Results indicate increased rates of mood disorders and personality disorders in the relatives of borderline probands compared with never psychiatrically ill controls. Familial aggregation of psychiatric disorders was generally similar for borderline personality and the mood disorder comparison group. The results suggest there may be common etiological factors between borderline personality disorder and mood disorders.     

Chronic stress and depressive disorders in older adults

Current and lifetime rates of Diagnostic and Statistical Manual (rev. 3rd ed.) disorders were compared in 86 older adults caring for a spouse with a progressive dementia and 86 sociodemographically matched control subjects. Dementia caregivers were significantly more dysphoric than non-care givers. The frequencies of depressive disorders did not differ between groups in the years before care giving, and there were no group differences in first-degree relatives' incidence of psychiatric disorder. During the years they had been providing care, 30% of care givers experienced a depressive disorder (major depression, dysthymia, or depression not otherwise specified) versus 1% of their matched controls in the same time period. Only two care givers who met criteria during care giving had met criteria for a depressive disorder before care giving, and family history was not even weakly related to the identification of at-risk care givers. In contrast to these group differences in depressive disorders, there were no significant differences in other Axis I disorders either before or during care giving. Thus, the chronic strains of care giving appear to be linked to the onset of depressive disorders in older adults with no prior evidence of vulnerability.     

Surgery for psychiatric disorders

The modern therapeutic approach to most psychiatric diseases involves a combination of well-supervised psychotherapy, pharmacotherapy, and electroconvulsive therapy. Patients who fail to adequately respond to these modern treatment methods and remain severely disabled may be considered for surgical intervention. Cingulotomy, capsulotomy, subcaudate tractotomy, and limbic leucotomy are the most common psychosurgical procedures performed today, with response rates in the 35% to 65% range. Modern stereotactic techniques have reduced complication rates, but controversy remains regarding the optimal surgical procedure. The major psychiatric diagnostic categories that might respond to surgery include treatment-refractory major affective disorders, obsessive-compulsive disorder, and chronic anxiety states. Surgery should be considered as one part of an entire treatment plan and must be followed by an appropriate psychiatric rehabilitation program. It should only be carried out by an expert multidisciplinary team consisting of a neurologist a neurosurgeon, and a psychiatrist with experience in these disorders. Surgical intervention remains a reasonable therapeutic option for select patients with a disabling psychiatric disease and may be underutilized.     

Family Functioning and Mental Illness: A Comparison of Psychiatric and Nonclinical Families

The primary objective of the present investigation was to examine adaptive functioning in the families of patients with a wide range of psychiatric disorders. Seven dimensions of family functioning, as measured by the Family Assessment Device (FAD), were compared across families of patients with a schizophrenia spectrum disorder (n = 61 ), bipolar disorder (n = 60 ), major depression (n = 111 ), anxiety disorder (n = 15 ), eating disorder (n = 26 ), substance abuse disorder (n = 48 ), and adjustment disorder (n = 46 ). Families in each psychiatric group were also compared to a control group of nonclinical families (N = 353 ). Results indicated that regardless of specific diagnosis, having a family member in an acute phase of a psychiatric illness was a risk factor for poor family functioning compared to the functioning of control families. However, with few exceptions, the type of the patient's psychiatric illness did not predict significant differences in family functioning. Thus, having a family member with a psychiatric illness is a general stressor for families, and family interventions should be considered for most patients who require a psychiatric hospitalization for either the onset of, or an acute exacerbation of, any psychiatric disorder.     

Psychopathology in children of parents with recurrent depression

We examined the prevalence of psychopathology in children of parents with recurrent major depression (n=61)and children of normal control parents (n=46).Rates of psychopathology in the children of depressed parents were consistently higher when compared either with the control children or with rates of disorder reported for nonclinically referred children from other studies. Forty-one percent of high-risk children met criteria for at least one psychiatric disorder compared with 15% of low-risk children. Significant differences between groups were found for affective disorders and attention deficit disorder, and a nonsignificant trend was noted for anxiety disorder, all of which were more prevalent in the children of depressed parents.This work was supported, in part, by a W. T. Grant Foundation Faculty Scholar Award, No. 8308700.     

Psychoaffective immaturity in psychiatric disorders

This study investigated the prevalence of psychoaffective immaturity and tested the hypothesis that it associated with bad prognosis. For 135 psychiatric patients meeting criteria for personality, neurotic, affective, substance use, or psychotic disorders emotional immaturity was rated using the 1985 diagnostic criteria of Doutheau, Dubertret, Moutin, and Barrois. 58 subjects (42.96%, 95% Confidence Interval: 34.61-51.31) were classified as immature. Scores of the Nonimmature and Immature groups were compared for the Beck Depression Inventory and the Professional and Social Functioning Assessment Scale. Scores were, respectively, significantly higher and lower in those patients classified as Immature than those who were classified Nonimmature. When depression was controlled by a covariance analysis, the mean difference on the Professional and Social Functioning Assessment Scale remained significant. It appears that psychoaffective immaturity is a factor associated with severity of psychiatric disorders.     

MMPI-2 clinical scale differences between dysthymia and major depression

Though dysthymia is considered less severe and more chronic than major depressive disorder, it is unclear whether the two disorders are truly different. In this study, MMPI-2 scales of 21 patients with dysthymia and 30 patients with major depressive disorder were compared. The average scores on Scales 2, 4, 6, 7, and 8 were in the clinical range for both groups. However, sizable differences between the two groups were found for Scale 1 and Scale 3. Smaller but reliable differences were found for Scale 2 and mean clinical scale T score with major depressives scoring higher on all of these measures. Results indicate that not only is major depressive disorder more severe than dysthymia, but also contains more physical/somatic symptoms than dysthymia.