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.     

Psychiatric sequelae of low birth weight at 6 years of age

The study examined the association between low birth weight (LBW) (2,500 g) and attention deficit hyperactivity disorder (ADHD) in two socioeconomically disparate populations. LBW and normal birth weight (NBW) children from the 1983 to 1985 newborn lists of an urban and a suburban hospital in Southeast Michigan were randomly selected. A total of 823 children, 473 LBW and 350 NBW, participated. Data were gathered in 1990 to 1992, when the children were 6 to 7 years of age. The National Institute of Mental Health Diagnostic Interview Schedule for children—Parent version (DISC-P) was used to elicit information on DSM-III-R diagnoses of simple phobia, overanxious, separation anxiety, oppositional defiant, and ADHD. Teachers' ratings of behavior problems were obtained. LBW was associated with ADHD but not with childhood anxiety disorders or oppositional defiant disorder. The association was stronger in the urban than in the suburban population. Data from teachers' ratings revealed an association between LBW and attention problems. The prognostic significance of the observed psychopathology at 6 years of age requires follow-up assessment as the children mature.This research was supported by NIMH research grant MH-44586 and NIMH Research Scientist Development Award MH-00380 to Dr. Breslau.     

Use of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0–3R) with Canadian Infants and Young Children Prenatally Exposed to Substances

The current study examined the mental health diagnostic profiles of infants and young children prenatally exposed to substances using the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC:0–3R) diagnostic system. Participants were 46 biological mother–infant dyads who were engaged in a clinical program for mothers with substance‐use problems and their young children (aged 10–41 months). Diagnostic information was reported for each of the five axes listed in the DC:0–3R diagnostic system based on file reviews. In addition, the children's socioemotional and adaptive behaviors were assessed using the Child Behavior Checklist, Infant–Toddler Social Emotional Assessment, the Social‐Emotional Scale, and the Adaptive Behavior Assessment System (2nd ed.). In this sample of young children with prenatal substance exposure, a broad range of socioemotional symptoms were evident, with almost one third of the children meeting criteria for at least one Axis I mental health diagnosis. In addition, the majority of dyads demonstrated features of a disordered relationship. Children in more problematic relationships demonstrated higher levels of socioemotional and adaptive functioning difficulties and were more likely to have an Axis I diagnosis than were children in adapted relationships. The importance of early intervention efforts aimed at infants with prenatal substance exposure and their biological mothers is highlighted, with a particular focus on enhancing the quality of the mother–child relationship.     

Phenomenology,psychopathology, and short‐term therapeutic outcome of 102 infants aged 0 to 12 months consecutively referred to a community‐based 0 to 3 mental health clinic

Infants ages 0 to 1 year consecutively referred for psychiatric treatment during the year 2005 were followed, and variables associated with diagnosis and short‐term outcome were assessed. Infants were evaluated using the Psychiatric Infant Navigator Chart and Evaluation that includes nosological diagnoses [Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, (DC 0–3), Zero to Three, 1994] as well as risk and protective factors, treatment procedure, and outcomes. Seventy‐six percent of the infants had an Axis I diagnosis, with anxiety disorders and a mixed disorder of emotional expressiveness being the most frequent. Twenty‐five percent had an Axis II diagnosis. Multiple correspondence analyses showed that two dimensions corresponding grossly to DC 0–3 Axes I and II emerged. They emphasized three clinical profiles characterized by (a) good infant functioning, parent's awareness of their own difficulties, and a good outcome; (b) moderate child symptoms, overinvolved relating, and a good/intermediate outcome; (c) severe child symptoms, underinvolved relating, and a less favorable short‐term outcome, signaling the risk for developmental disorders. Among the associated risk factors were cumulative parental stress, maternal psychopathology, and family dysfunction. Clinical implications of these findings indicated that infants under the age of 1 year who are referred for mental health evaluation and intervention are a heterogeneous group in terms of both severity and prognosis. Clinicians should differentiate subgroups of young children to detect those infants at risk for persistent psychopathology.     

Psychologists' and social workers' self-descriptions using DSM-IV psychopathology

There is limited information on mental health of psychologists and social workers despite their rendering mental health services, so their subjective perception of mental disorder was explored via a self-evaluation survey in which they self-diagnosed the presence of DSM-IV disorders within themselves. The sample of 128 professionals included 63 psychologists and 65 social workers. The presence of Axis I traits was reported by 81.2%, the three most frequent traits being mood, obsessive-compulsive disorder, and eating disorder. Axis II traits were reported by 73.4% of subjects, the three most frequent conditions being narcissistic, avoidant, and obsessive-compulsive personality traits. While a high percentage of subjects reported the presence of either an Axis I or Axis II disorder, the average severity reported was low. More psychologists reported on mood, social phobia, and eating problems than social workers, while the latter reported more on psychotic problems. Psychologists reported more Axis II traits, especially paranoid, narcissistic, and avoidant subtypes. More women than men reported eating problems, while more men reported schizoid and avoidant personality traits. In conclusion, manifestations of subthreshold psychiatric conditions were prominently reported. These findings suggest encouraging mental health care professionals to explore treatment for problems if present.     

Judgmental relativism as a validity threat to standardized psychiatric rating scales

Judgemental relativism is a threat to the replicability and validity of measures of client behavior from direct rating scales whenever raters are exposed to different levels of client functioning since the internal standards, or anchor points, used to judge dimensional continua may vary on the basis of prior experience. Traditional interrater reliability indexes fail to identify such effects. The influence of judgmental relativism on summated ratings from the Nurses Observational Scale for Inpatient Evaluation (NOSIE-30) for 1040 adult mentally ill clients was examined with clinical staff raters from 24 treatment units in which the Time-Sample Behavioral Checklist (TSBC) provided full-week objective measures of actual client functioning via hourly direct observational coding (DOC). Regression analyses found that the same level of objective performance received higher or lower ratings across treatment units dependent on the raters'exposure to client groups that differed in level of functioning. Analyses of rating errors found that clients with better levels of functioning relative to others within treatment units were rated even higher than performance warranted. The operation of halo and contrast effects is explored and guidelines are provided for determining when judgmental relativism may produce or nullify significant differences. DOC assessments should be used instead of retrospective ratings to support most decisions in residential settings. Specific recommendations for the application of rating scales and improving data quality are provided.This study was the basis of a master's thesis at the University of Houston by Betty E. Rich under the direction of Gordon L. Paul and Marco J. Mariotto. Richard M. Rozelle, to whom appreciation is expressed for helpful comments, served on the examination committee. This study was partially supported by grants to Gordon L. Paul from the National Institute of Mental Health, Public Health Service (MH-15353; MH-25464); the Illinois Department of Mental Health and Developmental Disabilities; the Joyce Foundation; the MacArthur Foundation; the Owsley Foundation; the Cullen Foundation; and the Center for Public Policy, University of Houston.     

Diagnostic profiles of offenders in substance abuse treatment programs

This study examined the association of Axis I and Axis II disorders among offenders who were in prison-based substance abuse treatment in a national multi-site study. Participants (N = 280) received a psychosocial assessment and a structured diagnostic interview in two separate sessions. Logistic regression models examined the association between lifetime mood and anxiety disorders with two personality disorders, and the relationship of Axis I and Axis II disorders (alone and in combination) to pre-treatment psychosocial functioning. Over two-thirds of the sample met criteria for at least one mental disorder. Borderline personality disorder was strongly associated with having a lifetime mood disorder (odds ratio = 7.5) or lifetime anxiety disorder (odds ratio = 8.7). Individuals with only an Axis II disorder, or who had both Axis I and Axis II disorders, had more severe problems in psychosocial functioning than those without any disorder. Clinical treatment approaches need to address this heterogeneity in diagnostic profiles, symptom severity, and psychosocial functioning.     

Frequency of borderline personality disorder among psychiatric outpatients in Shanghai

The objective of this study was to investigate the frequency, clinical characteristics, and comorbidity of borderline personality disorder (BPD) among psychiatric outpatients in two clinics at Shanghai Mental Health Center. A cross-sectional investigation was conducted. From 3,075 outpatients screened using the Personality Diagnostic Questionnaire-IV+, 2,284 patients positive for a personality disorder were assessed using the Structured Clinical Interview for DSM-IV Personality Disorders. The frequency of BPD among the psychiatric outpatients was 5.8%, with a frequency of 3.5% among males and 7.5% among females (p < .01). BPD was found to have extensive comorbidity with Axis I and II disorders. This study proves that BPD does occur in China. The detected frequency among outpatients is lower than that reported in North America.     

Adolescent Satisfaction with School-Based Mental Health Services

Examining adolescents' satisfaction with mental health services is an important program evaluation activity. Their perceptions of whether services were beneficial and resulted in improved functioning are indices of treatment quality. Assessment of adolescent satisfaction with school-based mental health programs has been limited. In our study, adolescents receiving services from a School Mental Health Program (SMHP) completed satisfaction surveys. Participants were predominantly minority youth residing in an urban area. Results indicated that students were highly satisfied with their mental health services. Students valued the therapeutic relationship, catharsis associated with therapy, and skills they learned during therapy. Several factors influenced satisfaction ratings including clinician training and availability.     

Modifications of Treatment Approaches for Axis I Disorders in Patients Who Also Have a Concurrent Axis II Disorder

Personality disorders have been an area of active interest in psychiatry for many years. Mental health professionals have suspected that these disorders retard the treatment of Axis I disorder and a comorbid personality (Axis II) disorder represents a special clinical challenge. This report draws from empirical literature in the field and the experience of the author to provide one possible theoretical framework to use in viewing these patients as well as practical suggestions to improve management of patients with these comorbid conditions.     

Psychiatric disorders and dissatisfaction with social relationships: does type of relationship matter?

The specificity of the association between 9 Axis I psychiatric disorders and quality of the relationship with spouse, relatives, and friends was evaluated for married participants who completed the Ontario Health Survey Mental Health Supplement (N = 4,933). When the authors controlled for the quality of other social relationships, not getting along with one's spouse was related to 6 disorders, with the strongest associations found for generalized anxiety disorder, major depression, panic, and alcohol problems; 4 associations remained significant when they controlled for comorbid disorders. Not getting along with relatives and friends was generally unrelated to psychiatric disorders when they controlled for the other social relationships. Results indicate that the association between marital quality and psychiatric disorders is not an artifact of general social dissatisfaction and that this association is significant for several disorders.     

Does obsessive-compulsive personality disorder belong within the obsessive-compulsive spectrum?

It has been proposed that certain Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I disorders share overlapping clinical features, genetic contributions, and treatment response and fall within an "obsessive-compulsive" spectrum. Obsessive-compulsive personality disorder (OCPD) resembles obsessive-compulsive disorder (OCD) and other spectrum disorders in terms of phenomenology, comorbidity, neurocognition, and treatment response. This article critically examines the nosological profile of OCPD with special reference to OCD and related disorders. By viewing OCPD as a candidate member of the obsessive-compulsive spectrum, we gain a fresh approach to understanding its neurobiology, etiology, and potential treatments.     

Behavioral Characteristics of DSM-IV ADHD Subtypes in a School-Based Population

From an ethnically diverse sample of 2,744 school children, 221 attention deficit hyperactivity disorder (ADHD) [123 (4.5%) predominantly inattentive (IA), 47 (1.7%) predominantly hyperactive/impulsive (HI), and 51 (1.9%) combined type (C)] were identified using teacher ratings on a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) symptom checklist. Subjects were compared to 221 controls on teacher ratings of behavioral, academic, and social functioning. The results revealed relatively independent areas of impairment for each diagnostic group. The IA children were impaired in all areas, but were rated as displaying more appropriate behavior and fewer externalizing problems than HI or C children. The HI group displayed externalizing and social problems, but was rated as no different than controls in learning or internalizing problems. The C group demonstrated severe and pervasive difficulties across domains. These findings support the validity of the DSM-IV ADHD subtypes; all ADHD groups demonstrated impairment relative to controls, but show different patterns of behavioral characteristics.     

Psychopathy and the DSM-IV criteria for antisocial personality disorder

The Axis II Work Group of the Task Force on DSM-IV has expressed concern that antisocial personality disorder (APD) criteria are too long and cumbersome and that they focus on antisocial behaviors rather than personality traits central to traditional conceptions of psychopathy and to international criteria. We describe an alternative to the approach taken in the rev. 3rd ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987), namely, the revised Psychopathy Checklist. We also discuss the multisite APD field trials designed to evaluate and compare four criteria sets: the DSM-III-R criteria, a shortened list of these criteria, the criteria for dyssocial personality disorder from the 10th ed. of the International Classification of Diseases (World Health Organization, 1990), and a 10-item criteria set for psychopathic personality disorder derived from the revised Psychopathy Checklist.     

Child,mother, and father evaluations of depression in psychiatric inpatient children

The agreement among children and their parents in evaluating the children's depression was examined in 48 families. Newly admitted inpatient children (ages 6–13) and their mothers and fathers independently completed selfreport and interview measures to assess severity and duration of the children's depression. The results indicated that different measures of depression completed by the same rater (child, mother, or father) were highly intercorrelated. Yet there was little or no relationship between childmother and child-father ratings of the children's depression for the same or related measures of depression. Children independently diagnosed (DSM III) as depressed rated themselves and were rated by their parents as more depressed than nondepressed children. Even so, children consistently rated themselves as less depressed across the measures than did their parents. Parent ratings of the children's depression and the correspondence of child-parent ratings varied as a function of several child and family variables, including child IQ, gender, race, and family welfare status.This investigation was supported in part by a Research Scientist Development Award (1 K02 MH00353) to the first author from the National Institute of Mental Health and by a Clinical Research Center Grant for the Study of Affective Disorders (5 P50 MH30915-05) from the National Institute of Mental Health. The authors are grateful to the clinical research team of the Child Psychiatric Treatment Service.     

Screening and assessment of psychosocial dysfunction in a private pediatric practice

Fifty-one mother-infant pairs were screened at birth and at one month of age using the Neonatal Perception Inventories (NPI). This instrument identified 20 infants who were judged at high risk for the development of subsequent emotional disorder. Evaluation of the study group at 14–17 months of age, using the Infant Mental Health Profile, documented impairment in the areas of attachment, confidence and coping in 80–95% of those infants with high risk NPI ratings. The use of the NPI as a screening instrument in a primary care private pediatric setting is discussed.     

A proposed adaptation of DC: 0‐3R for primary care,developmental research,and prevention of mental disorders

The development of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0‐3; Zero to Three: National Center for Clinical Infant Programs, 1994) has been an important step in the field of infant mental health. In this paper, we propose some additions to the existing classification system. These additions include the development of criteria for infant, toddler, and family strengths, and the development of criteria for symptomatology that represents risk for disorder, but not fully manifest disorder. These additions will give DC: 0‐3R greater potential for use in the primary health care of children, thereby increasing the system's utility in diagnosing and preventing infant mental health problems.     

青少年人际关系能力对社交自卑感和心理健康的影响:社会适应性的作用

目的:探讨人际关系能力对青少年社交自卑感和心理健康的影响以及社会适应性的中介作用。方法:采用人际关系能力问卷、社会适应性因素量表、社交自卑感量表和一般健康问卷对841名中学生进行施测。采用中介模型的潜变量路径分析、偏差校正的百分位Bootstrap法、多样本恒等性检验等进行数据处理。结果:(1)人际关系能力能够预测青少年的社交自卑感和心理健康;(2)社会适应性在人际关系能力与社交自卑感之间起部分中介作用;(3)社会适应性在人际关系能力与心理健康之间起部分中介作用。结论:应重视人际关系能力这种基本人格特质对青少年社交自卑感和心理健康的影响,并充分考虑到社会适应性在这种关系机制中的中介作用。     

An investigation of the effects of comorbid Axis II pathology on outcome of inpatient treatment for unipolar depression

DSM-based research on comorbidity has suggested thatdepression andpersonality disorder frequently occur together and that the combination of syndromes is associated with a poor response to treatment for depression. The present study was designed to explore the effect of comorbid Axis II pathology for a sample of 45 inpatients who received treatment for major depression. Both categorical and dimensional ratings of personality disorder were used in the statistical analysis. Positive categorical diagnosis of Cluster C (anxious-avoidant) disorder, as well as higher dimensional rating of Cluster A (odd-eccentric) pathology, was predictive of a poor response to treatment (p<.05), as measured by change in pre-post clinical ratings on the Montgomery-Asberg Depression Rating Scale. These results were construed as indicative of a significant Axis II comorbidity effect in the context of an inpatient, multimodal treatment setting for depression. The results also spotlight the influence of techniques of measurement in determining the outcome of statistical analysis.     

Adult Outcomes of Child Conduct Problems: A Cohort Study

The present study assessed the mental health and criminal records of 6,449 males and 6,268 females who presented conduct problems as children by examining an unselected birth cohort followed up to age 30. Conduct problems were defined by teacher ratings of behavior problems and/or antisocial behavior in the community. There was little overlap in the children identified by teachers and by the community. These two groups of children were at differential risk for adult mental disorder. Seventy-six percent of the males and 30% of females with childhood conduct problems had either a criminal record, a mental disorder, or both by age 30. Risk ratios for adult criminality and/or mental disorders, however, were greater for females than for males with a history of childhood conduct problems. Almost all of the mental disorders were severe substance abuse. Mental disorders and crime were strongly associated among males with a history of childhood conduct problems.