Theoretical Value of Psychological Testing

Apart from their diagnostic value, psychological tests, especially the Rorschach test, have an important theoretical value for understanding psychopathology. They present a picture of a living person, in contrast to a picture of forces and agencies within the person. This rests on 2 advantages of tests over the usual psychiatric and psychoanalytic interviews: Tests are ahistorical and they present information primarily of a formal kind.     

The diagnostic accuracy of questions about past experiences of being mechanically restrained in a population of psychiatric patients

Information about stressful life experiences obtained from patients during diagnostic interviews is an important foundation for clinical decision making. In this study self-reports from 115 committed psychiatric patients of experiences of mechanical restraint were compared with medical records. The sensitivity of patient self-reports was 73% (11/15) and the specificity was 92% (92/100). No clear relationship between psychiatric symptoms and reliability of self-reports was identified. The results highlight the subjective qualities of narratives about past experiences.     

Clinical diagnostic and sociocultural dimensions of deliberate self-harm in Mumbai, India

Patients' accounts complement psychiatric assessment of deliberate self-harm (DSH). In this study we examined psychiatric disorders, and sociocultural and cross-cultural features of DSH. SCID diagnostic interviews and a locally adapted EMIC interview were used to study 196 patients after DSH at a general hospital in Mumbai, India. Major depression was the most common diagnosis (38.8%), followed by substance use disorders (16.8%), but 44.4% of patients did not meet criteria for an enduring Axis-I disorder (no diagnosis, V-code, or adjustment disorder). Psychache arising from patient-identified sociocultural contexts and stressors complements, but does not necessarily fulfill, criteria for explanatory psychiatric disorders.     

Knowledge and attitude of Malaysia’s Muslim faith healers in dealing with the mentally ill

Muslim faith healers are often sought by the Malaysian public as an avenue to address psychological distress. “Ruqyah” refers to the recitation of verses from the Qur'an and/or sayings of Prophet Muhammad (PBUH) and is used by Muslim faith healers as a method of treatment. This study was conducted to assess the knowledge and attitude of Muslim faith healers in dealing with psychiatric patients in Malaysia. Seven Muslim faith healers were interviewed. The interviews were transcribed verbatim, and analysed qualitatively using thematic content analysis. The authors identified four themes: understanding of psychiatric illnesses, diagnostic competence, patients' referral, and integrating “ruqyah” into mainstream psychiatry. It was found that the respondents had limited knowledge of psychiatric illness, focusing on “ruqyah” as the main intervention in treating psychiatric illness. Recognizing the important role played by Muslim faith healers in the treatment of psychiatric illness in Malaysia, collaboration between them and fellow psychiatrists is deemed highly necessary.     

Left ear (right temporal hemisphere) advantage and left temporal hemispheric dysfunction in schizophrenia.

In this study, to investigate the right or left ear advantages in psychiatric patients. the durations of hearing for right and left ears were assessed in 61 psychiatric patients, 26 with schizophrenia, 17 with depressive disorder, 13 with bipolar affective disorder, and 5 with brief psychotic disorder, plus 24 controls. Diagnoses were made on the basis of information provided from clinical interviews and the Structured Clinical Interview for DSM-IV (SCID). Schizophrenia was associated with a left ear advantage, and both depressive disorder and brief psychotic disorder were associated with right ear advantage as well as controls. These results suggest that their schizophrenia may be associated with a left temporal lobe dysfunction.     

The value of auditory evoked brain stem potentials in the diagnosis of circulatory disorders in the area of vertebrobasilar circulation

The acoustically-evoked brain-stem potential in patients with vertebrobasilar insufficiency has enjoyed a varied diagnostic evaluation in the literature. Our own examinations reveal an advantage in subdividing AEBP changes into normal and marginal, slight and pronounced, within a group of patients with blood supply disorders in the vertebrobasilar region. AEBP permits inferences to be made on the extent of the damage. However, one should be chary of referring AEBP change of vascular origin to any particular section on the basis of these deductions alone. Only the comprehensive consideration of clinical symptoms, AEBP findings, and neuroradiological examination leads to a valid opinion on extent and location.     

Impaired positive inferential bias in social phobia

People with social phobia report anticipatory and retrospective judgments about social situations that appear consistent with a negative interpretative bias. However, it is not at all clear that biased interpretative inferences are made "on-line;" that is, at the time that ambiguous information is first encountered. In a previous study, volunteers who were anxious about interviews were found to lack the positive on-line inferential bias that was characteristic of nonanxious controls but also failed to show a bias favoring threatening inferences (C. R. Hirsch & A. Mathews, 1997). This finding was confirmed in the present study, in which social phobic patients showed no evidence of making on-line emotional inferences, in contrast with socially nonanxious controls who were again clearly biased in favor of positive inferences. The authors concluded that nonanxious individuals are characterized by a benign on-line inferential bias, but that this is impaired in people with social phobia.     

Associative and causal reasoning accounts of causal induction: Symmetries and asymmetries in predictive and diagnostic inferences

Associative and causal reasoning accounts are probably the two most influential types of accounts of causal reasoning processes. Only causal reasoning accounts predict certain asymmetries between predictive (i.e., reasoning from causes to effects) and diagnostic (i.e., reasoning from effects to causes) inferences regarding cue-interaction phenomena (e.g., the overshadowing effect). In the experiments reported here, we attempted to delimit the conditions under which these asymmetries occur. The results show that unless participants perceived the relevance of causal information to solving the task, predictive and diagnostic inferences were symmetrical. Specifically, Experiments 1A and 1B showed that implicitly stressing the relevance of causal information by having participants review the instructions favored the presence of asymmetries between predictive and diagnostic situations. In addition, Experiment 2 showed that explicitly stressing the relevance of causal information by stating the importance of the causal role of events after the instructions were given also favored the asymmetry.     

Personality profiles and the prediction of categorical personality disorders

Personality disorders (PDs) are usually construed as psychiatric categories characterized by a unique configuration of traits and behaviors. To generate clinical hypotheses from normal personality trait scores, profile agreement statistics can be calculated using a prototypical personality profile for each PD. Multimethod data from 1,909 psychiatric patients in the People's Republic of China were used to examine the accuracy of such hypotheses in the Interpretive Report of the Revised NEO Personality Inventory. Profile agreement indices from both self-reports and spouse ratings were significantly related to PD symptom scores derived from questionnaires and clinical interviews. However, accuracy of diagnostic classification was only modest to moderate, probably because PDs are not discrete categorical entities. Together with other literature, these data suggest that the current categorical system should be replaced by a more comprehensive system of personality traits and personality-related problems.     

Discussion of Difficult Assessment Cases: Psychodynamic Perspectives

I discuss the papers of Kleiger (this issue), Husain (this issue), and Bram (this issue), each of whom described their personality assessment of a very challenging case. Each case illustrates the way in which experienced personality assessors integrate psychoanalytic theory with clinical reasoning, multi-method assessment, and an understanding of the patient–examiner relationship when evaluating patients with serious psychiatric needs. The discussion elaborates particular aspects of each case and integrates the different estuaries through which personality assessors use psychoanalytic theory to develop diagnostic and treatment inferences.     

Diagnostic causal reasoning with verbal information

In diagnostic causal reasoning, the goal is to infer the probability of causes from one or multiple observed effects. Typically, studies investigating such tasks provide subjects with precise quantitative information regarding the strength of the relations between causes and effects or sample data from which the relevant quantities can be learned. By contrast, we sought to examine people’s inferences when causal information is communicated through qualitative, rather vague verbal expressions (e.g., “X occasionally causes A”). We conducted three experiments using a sequential diagnostic inference task, where multiple pieces of evidence were obtained one after the other. Quantitative predictions of different probabilistic models were derived using the numerical equivalents of the verbal terms, taken from an unrelated study with different subjects. We present a novel Bayesian model that allows for incorporating the temporal weighting of information in sequential diagnostic reasoning, which can be used to model both primacy and recency effects. On the basis of 19,848 judgments from 292 subjects, we found a remarkably close correspondence between the diagnostic inferences made by subjects who received only verbal information and those of a matched control group to whom information was presented numerically. Whether information was conveyed through verbal terms or numerical estimates, diagnostic judgments closely resembled the posterior probabilities entailed by the causes’ prior probabilities and the effects’ likelihoods. We observed interindividual differences regarding the temporal weighting of evidence in sequential diagnostic reasoning. Our work provides pathways for investigating judgment and decision making with verbal information within a computational modeling framework.     

Negativity and positivity effects in person perception and inference: Ability versus morality

The present paper deals with negativity and positivity effects in trait inferences and impression formation. In the first experiment we tested the suggestion of Skowronski and Carlston (1987) that in the domain of morality negative information is more diagnostic, will therefore receive more weight and result in a negativity effect whereas in the domain of abilities, positive information is more diagnostic resulting in positivity effects. Results of our first experiment support these predictions: negative behavioural information leads to more certain inferences concerning morality and positive behavioural information leads to more certain inferences concerning ability. In a second experiment, we investigated the relative weight of positive versus negative ability-and morality-related traits in an impression formation task. We counterposed traits from both morality and ability domains to see which was the most dominant in determining evaluative impressions. Findings of this second experiment showed strong negativity effects but also revealed that information related to morality is more influential in forming an evaluative impression than equally extreme information related to ability. Theoretical implications of these findings are discussed.     

Families in China: an undervalued resource for mental health?

This article is based on 37 interviews with patients and family members in a psychiatric hospital in Hubei, the People's Republic of China. The main goal was to investigate the explanatory models that families used in understanding the causes of mental illness. Case material is provided to illustrate some of the issues concerning family dynamics and problems. Families use a holistic framework for understanding psychiatric disturbance. Doctors' explanatory framework is largely medical and they show no interest in family relationships. Equally, families make it clear that they need more information and support from medical practitioners, which is not forthcoming.     

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.     

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.     

The Last-Weiss Rorschach Ego-Strength Scale as a prognostic measure for psychiatric outpatients

This study tested the hypothesis that the Last and Weiss (1976) Rorschach Ego-Strength Scale (sigma E) would predict outcome among a representative sample of never-hospitalized psychiatric outpatients. 78 patients were assessed with structured symptom, psychiatric history, and social data interviews at the time of initial clinic contact and at 2-yr. follow-up. Outcome measures included the Menninger Health-Sickness Scale, a multidimensional variable involving social and work functioning and recent symptom level, symptom measures, and an index of diagnostic severity. sigma E, controlled for number of responses, correlated significantly with Health-Sickness, neurotic symptoms, diagnostic severity, and psychotic symptomatology. Among the components of sigma E, M+, and FC+ had significant relationships or contributed to significant relations with outcome variables. Considered with an earlier study of inpatients, in which S+ sigma E component correlated inversely with outcome, this study suggested that sigma E components have differing prognostic significance, depending on adaptational level of the patient.     

Patients' desire to participate in decision-making in psychiatry: a questionnaire survey in Japan

Japanese national sentiment has been described as paternalistic, which has potentially wide-ranging implications for the manner in which psychiatric patients should participate in medical decision-making. To examine the extent and possible determinants of the desire to participate in medical decision-making among Japanese people, we distributed a packet of questionnaires to 747 (nonmedical) university students and 114 of their parents. The questionnaires included an imaginary case vignette of psychotic depression. The participants were asked whether they would want various types of medical information, i.e., diagnosis, aetiology, treatment, outcomes, medical charts, etc., disclosed to them were they in such a psychiatric condition. Also included was the 1995 Scale for Independent and Interdependent Construal of the Self by Kiuchi. More than half of the participants wanted all the types of medical information disclosed to them. Those participants who wanted to have all types of information disclosed to them (n = 413) as compared to those who did not want to know at least one type of information (n = 445), tended to be male and to have an educational background in psychiatry (9.7% vs 5.4%) as well as an assertive attitude as indicated by a higher score on Independence on the Scale for Independence and Interdependent Construal of the Self. These results suggest that the Japanese in this sample are more likely to want to make an autonomous contribution to the psychiatric decision-making process and that less desire for information can be predicted by some demographic and personality factors.     

Pregnant Genetic Counselors in an Era of Advanced Genomic Tests: What Do the Experts Test Prenatally?

Advanced genomic tests in pregnancy, such as chromosomal microarray analysis (CMA), provide higher detection rates yet often produce probabilistic and uncertain information. This study aimed to understand how the most knowledgeable patients, i.e., pregnant genetic counselors, act in their own pregnancies, thereby gaining insight into the impact of patients’ knowledge on the diagnostic process. Seventeen interviews were conducted with Israeli genetic counselors, either pregnant or up to 2 years post-pregnancy. A third of the participants chose not to have CMA while two thirds underwent it despite no detected abnormalities. Although knowledge was the main motivation, counselors varied in the desired degree of information. Two thirds of those opting for CMA wished to have all findings identified whereas roughly one third asked for a targeted platform seeking to avoid uncertain results. Counselors were not quick to adopt new tests such as whole-exome sequencing. Being knowledgeable was described as promoting a sense of control yet also being a source of stress and moral dilemmas. While the basic premise of informed consent is crucial, it does not always make things easier for educated patients. Consequently, raising levels of patient knowledge is only a limited step forward in the search for best practice.     

Contributions of Discriminant Analysis to Differential Diagnosis by Self-Report

We used discriminant function analyses of the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1983), Millon Clinical Multiaxial inventory (MCMI; Milton, 1983), MCMI-II (Millon, 1987), and Symptom Checklist Ninety-Revised (SCL-90-R; Derogatis, 1983) profiles from a heterogenous group of 272 psychiatric inpatients to classify patients as depressed, manic, and/or psychotic, Most functions generated from these tests significantly discriminated depressed, manic (not MCMI-II), and psychotic (not MCMI) subjects from psychiatric controls. However. there was little improvement in diagnostic efficiency over the use of single scale elevations at specified cut scores. Functions derived from the MCMI for mania and the MCMI-II for psychosis show the most promise but require replication. The difficulty of using group profile differences for the diagnosis of individual psychiatric patients is discussed.