Using the Millon Clinical Multiaxial Inventory's Scale B and the MacAndrew Alcoholism Scale to identify alcoholics with concurrent psychiatric diagnoses

The ability of the MacAndrew Alcoholism Scale (MAC) and Scale B of the Millon Clinical Multiaxial Inventory (MCMI) to discriminate independently defined alcoholics with psychiatric diagnoses from other psychiatric patients was examined for males and all alcoholics, using three different criteria of alcoholism. The MAC identified from 80% to 87% of male alcoholics and 76% to 82% of all alcoholics, and from 25% to 52% of male nonalcoholics and 55% to 75% of all nonalcoholics, resulting in a large number of false positives. Scale B identified from 31% to 60% of male alcoholics and 33% to 43% of all alcoholics, and from 73% to 85% of male nonalcoholics and 85% to 94% of all nonalcoholics. The operating characteristics of Scale B showed that it was not as efficient in identifying alcoholics as previous work had indicated. We suggest that Scale B should not be used and the MAC should be used cautiously to discriminate alcoholics with psychiatric disorders from patients without alcoholism.     

A comparison of primary alcoholics, secondary alcoholics, and nonalcoholic psychiatric patients on the MacAndrew Alcoholism Scale

The MacAndrew Alcoholism (MAC) and Sc scales of the Minnesota Multiphasic Personality Inventory (MMPI) were examined in four groups of 20 male patients. Comparisons were made among primary alcoholics, secondary alcoholics (i.e., alcoholic psychiatric patients), nonalcoholic psychiatric patients (mixed diagnoses), and conservatively defined, nonalcoholic schizophrenics. Primary alcoholics scored higher on the MAC scale than did secondary alcoholics and other groups; schizophrenics scored lower than all other groups. Primary alcoholics were lower on the Sc scale than schizophrenics but did not differ from other groups. The results support MacAndrew's (1981) distinction between primary and secondary alcoholics and suggest that the MAC scale may enhance differentiation among diagnoses other than alcoholism.     

Behavioral,psychological, and historical correlates of MacAndrew scale scores among male alcoholics

Male alcoholic veterans (N=194) were divided into four groups on the basis of their scores on the MacAndrew scale (MAC) of the Minnesota Multiphasic Personality Inventory (MMPI) and compared on psychological and sociodemographic measures and self-reported alcohol, drug, and legal histories. Nineteen subjects scored in the nonalcoholic (NA) range of the MAC (i.e., false negatives, MAC23). Remaining subjects, scoring in the alcoholic range of the MAC, were divided into thirds by MAC scores (lowest third, L-MAC=24–28,n=53; middle third, M-MAC=29–31,n=63; highest third, H-MAC>31,n=59). Groups did not differ on age, any important sociodemographic variables, or scores on the Profile of Mood States, State-Trait Anxiety Inventory, Symptom Checklist-90, or Rod and Frame Test. Significant group differences were obtained on several MMPI scales. Lower MAC scores were associated with higher scores onL, K, D, andR, and lower scores onMa. There was also a tendency for subjects with lower MAC scores to score higher onSi. NA subjects began drinking and heavy drinking later than other subjects, although groups did not differ on duration, quantity, or frequency of drinking. Subjects with higher MAC scores more often reported drinking in bars, drinking liquor straight, alcohol-related job disruptions, and previous use of marijuana, hallucinogens, and barbiturates. Subjects with higher MAC scores had more often been arrested, convicted, fined, and jailed for alcohol-related offenses but not for other offenses. Results are examined with respect to MacAndrew's distinction between primary and secondary alcoholics and with respect to the possible relations of MAC to important person variables such as sensation seeking.The authors wish to thank Craig MacAndrew for his helpful critical reading of an early draft of this paper. We also thank Theresa Hilliard, Shirley White, Vicki Brumbelow, and Pam Thompson for editorial assistance and Audrey Jefferson for help with data preparation.     

Inherited predisposition to alcoholism: characteristics of sons of male alcoholics

Sons of male alcoholics (SOMAs) are at markedly heightened genetic risk for the development of alcohol abuse. Study of SOMAs could therefore conceivably increase the efficiency of research aimed at uncovering those heritable factors that predispose to alcoholism. SOMAs manifest observable behavioral, cognitive, and psychophysiological abnormalities while sober and react idiosyncratically to alcohol intoxication. They are most commonly described as conduct disordered and hyperactive, appear heir to a variety of deficits in verbal and abstract cognition, and perform more poorly in the academic environment. SOMAs are characterized by abnormal patterns of cued psychophysiological response, and appear more sensitive to the putatively reinforcing aspects of alcohol intoxication. Various methodological weaknesses permeate the relevant literature. Some straightforward improvements are suggested.     

Application of the MacAndrew Alcoholism Scale to Alcoholics With Psychiatric Diagnoses

The MacAndrew Alcoholism scale scores of 140 mate patients from a large VA hospital were examined to assess whether the MAC scale can detect alcoholism among patients with psychiatric diagnoses. There were five diagnostic groups, each with 28 patients: alcoholics, alcoholics with neurotic disorders, alcoholics with personality disorders, nonalcoholic patients with neurotic disorders, and nonalcoholic patients with personality disorders. The MAC scale was able to differentiate alcoholics and nonalcoholic psychiatric patients, but was unable to differentiate either of the alcoholic psychiatric groups from its nonalcoholic psychiatric counterpart. Thus, it appears that the MAC scale may be unable to identify alcoholism among patients with combined alcoholic-psychiatric diagnoses.     

MMPI experimental scale correlates of the MAACL--R with male alcoholics.

Concurrent and discriminative validity of the MAACL--R scales were studied by means of correlations with selected MMPI experimental scales (AR, DR, HOS, Poor Morale, and ES) for a sample of 88 male VA alcoholics. Concurrent validity of Anxiety, Depression, Hostility and PASS, and discriminative validity of the Anxiety scale were confirmed.     

Convergence of parent checklists and child psychiatric diagnoses

This study examined the correlation between the Childrens' Behavior Questionnaire by Rutter, Tizard, and Whitmore (1970) and clinical diagnoses in a total of 1,468 in-and outpatients. The following diagnoses were considered: conduct disorder, emotional disorder, mixed disorder of conduct and emotions, and the hyperkinetic syndrome. In general, correlations were low, but subscores indicating conduct or neurotic disorders had somewhat higher correlation with these respective disorders than the hyperactivity subscore. Sensitivity figures (i.e., percentage of true positives) were moderate to low, while specificity figures (i.e., percentage of true negatives) were high. It is concluded that convergence of parent checklists and child psychiatric diagnoses in unselected samples is only moderate.     

Distribution of DSM-II diagnoses in a child psychiatric setting

While DSM-II contains more diagnostic categories related specifically to children than did the earlier DSM-I, clinical utilization studies of the various categories have not been extensive. The present study reports data on the distribution of diagnoses of childhood disorders and analyzes relationships among several diagnostic categories and subject variables. Results indicate that clinicians are using a wide range of DSM-II diagnoses for childhood disorders, including some which were intended for use with adults as well as those which were designed specifically for children. Transient Situational Disorders and Behavior Disorders are assigned almost equally to two-thirds of the sample. Chi-square analyses revealed a relationship between diagnostic categories and subject variables of age and sex. These data suggest that boys, particularly between the ages of 6 and 13, are more frequently than girls categorized as Behavior Disorder, and that the Transient Situational Disorder category is overutilized for adolescents, both male and female.The authors are indebted to James H. Johnson for his valuable contributions in all phases of this study and to Peggy Louro for her assistance in data collection.     

The construct validity of the MMPI alexithymia scale with psychiatric inpatients

Relatively few studies have addressed the issue of the Minnesota Multiphasic Personality Inventory (MMPI) alexithymia scale's construct validity. In this study, the validity of the scale is supported by the finding of a significantly lower percentage of alexithymic individuals in a large sample of psychiatric inpatients than in samples of patients with a variety of physical disorders (i.e., migraine headaches, asthma bronchitis/emphysema, and hypertension). Validity of the scale is further supported through a comparison of the alexithymic and nonalexithymic psychiatric inpatients on a series of Rorschach and MMPI variables. As predicted, alexithymics were less verbally productive, displayed less ability to fantasize, and demonstrated greater defensive pseudonormality. Results suggest the measure may be of value in studies of psychiatric patients as well as those with physical disorders.     

The rhetoric of transformation in the healing of alcoholism: The twelve steps of alcoholics anonymous

Close attention to spirituality and change are necessary for a fuller understanding of how Alcoholics Anonymous (AA) works. This paper draws upon the conceptual tools of the anthropology of religious healing to interpret AA's program for recovery, the Twelve Steps. The Twelve Steps are described as a fundamental component of AA discourse, and as a rhetoric of transformation. The Twelve Steps outline a rhetorical process which moves the alcoholic from drinking to sobriety by means of a rhetoric of predisposition, of empowerment, and of transformation. AA discourse is spiritual, in that members are persuaded to interpret the world, their lives, and their affliction in sacred terms. Healing is not cure, but a new way of attending to the world and engaging with others, including God, or a ‘Power greater than ourselves’.

There is a God, and it's not me.     

A brief scale to assess cognitive impairment in psychiatric patients

The Screen for Cognitive Impairment in Psychiatry(SCIP) is a brief instrument designed to assess cognitive deterioration in patients with psychiatric disorders, for example, schizophrenia. This study presents the first results obtained with the Spanish version of the SCIP in its three parallel forms with a sample of university students, these results being compared with those obtained with the English version. It is concluded that although there are no form effects, and that therefore the different forms can be used without distinction, there are certain practice effects on some of the instrument's sub-scales. There is also a language effect that may be due to sample and/or cultural characteristics. Finally, in both versions intra-class correlation coefficients and factorial structure are very similar.     

Methodological considerations in the evaluation of the convergence of psychiatric diagnoses and parent-informant checklists

Psychiatric diagnoses and objective parent checklists are alternative ways to describe child adjustment problems. There has recently been interest in evaluating the degree of agreement or convergence between these sources of information. This paper addresses three issues neglected by researchers in this area. The appropriateness of the use of indices of sensitivity and specificity to describe the correspondence of diagnoses and checklist scores is questioned. Implications of failure to consider the reliability of diagnoses in interpreting diagnosis-checklist agreement are discussed. Also, possible parameters of diagnosis-checklist agreement that should be identified by researchers are reviewed. Suggestions for improving research in this area are offered.     

Meta-analysis of the brief psychiatric rating scale factor structure

A meta-analysis (N=17,620; k=26) of factor analyses of the Brief Psychiatric Rating Scale (BPRS) was conducted. Analysis of the 12 items from Overall et al.'s (J. E. Overall, L. E. Hollister, & P. Pichot, 1974) 4 subscales found support for his 4 subscales. Analysis of all 18 BPRS items found 4 components similar to those of Overall et al. In a 5-component solution, a 5th activation component emerged but was best supported among samples of schizophrenic patients. The first 4 components appear to form the core of the BPRS factor structure. Results of the meta-analysis suggest 5 subscales (with items in parentheses): Affect (anxiety, guilt, depression, somatic); Positive Symptoms (thought content, conceptual disorganization, hallucinatory behavior, grandiosity); Negative Symptoms (blunted affect, emotional withdrawal, motor retardation); Resistance (hostility, uncooperativeness, suspiciousness); and Activation (excitement, tension, mannerisms-posturing).     

Brief report: Psychometric properties of the adaptive behavior scale with psychiatric inpatients

This study investigated the psychometric properties of the Adaptive Behavior Scale (ABS) with a sample of chronic psychiatric inpatients. Patients (N = 117) on extended care wards of a state hospital were assessed with the ABS. An orthogonal principal-components analysis revealed three underlying factors (independent functioning, general maladaptation, and inappropriate social behavior). Evidence for construct validity was demonstrated by analyses demonstrating that the ABS could discriminate among patients according to age, diagnosis, and length of hospitalization. The results are consistent with previous data which suggest that the ABS can be appropriately used with psychiatric patients. Implications of the results for suggestions regarding possible revision of the ABS are discussed.