Evidence-based assessment of personality disorders

The purpose of this article is to provide a foundation for the development of evidence-based guidelines for the assessment of personality disorders, focusing in particular on integrated assessment strategies. The general strategy recommended herein is to first administer a self-report inventory to alert oneself to the potential presence of particular maladaptive personality traits followed by a semistructured interview to verify their presence. This strategy is guided by the existing research that suggests particular strengths of self-report inventories and semistructured interviews relative to unstructured clinical interviews. However, the authors also consider research that suggests that further improvements to the existing instruments can be made. The authors emphasize, in particular, a consideration of age of onset, distortions in self-perception and presentation, gender bias, culture and ethnicity, and personality change.     

Best clinical practice with ziprasidone IM: update after 2 years of experience

Acute agitation is a common psychiatric emergency often treated with intramuscular (i.m.) medication when rapid control is necessary or the patient refuses to take an oral agent. Conventional i.m. antipsychotics are associated with side effects, particularly movement disorders, that may alarm patients and render them unreceptive to taking these medications again. Ziprasidone (Geodon) is the first second-generation, or atypical, antipsychotic to become available in an i.m. formulation. Ziprasidone IM was approved by the Food and Drug Administration in 2002 for the treatment of agitation in patients with schizophrenia. In October 2004, a roundtable panel of physicians with extensive experience in the management of acutely agitated patients met to review the first 2 years of experience with this agent. This monograph, a product of that meeting, discusses clinical experience to date with ziprasidone IM and offers recommendations on its use in various settings. In clinical trials, patients treated with ziprasidone IM demonstrated significant and rapid (within 15-30 minutes) reduction in agitation and improvement in psychotic symptoms, agitation, and hostility to an extent greater than or equal to that attained with haloperidol i.m. Tolerability of ziprasidone IM was superior to that of haloperidol IM, with a lower burden of movement disorders. Clinical trials have also shown that ziprasidone IM can be administered with benzodiazepines without adverse consequences. Transition from i.m. to oral ziprasidone has been well tolerated, with maintenance of symptom control. The most common adverse events associated with ziprasidone IM were insomnia, headache, and dizziness in fixed-dose trials and insomnia and hypertension in flexible-dose trials. No consistent pattern of escalating incidence of adverse events with escalating ziprasidone doses has been observed. Changes in QTc interval associated with ziprasidone at peak serum concentrations are modest and comparable to those seen with haloperidol IM. Results of randomized clinical trials of ziprasidone IM have been corroborated in studies in real-world treatment settings involving patients with extreme agitation or a recent history of alcohol or substance abuse. In these circumstances, clinically significant improvement was seen within 30 minutes of ziprasidone IM administration, without regard to the suspected underlying etiology of agitation. Agents with a good safety/tolerability profile, such as ziprasidone IM, may be more cost effective long term than older agents, due to reduced incidence of acute adverse effects (eg, acute dystonia) that often require extended periods of observation. Additional trials of ziprasidone IM in agitated patients in a variety of clinical setting are warranted to generate comparative risk/benefit data with conventional agents and other second-generation antipsychotics.     

Analysis of individual differences in multidimensional scaling via an n-way generalization of “Eckart-Young” decomposition

An individual differences model for multidimensional scaling is outlined in which individuals are assumed differentially to weight the several dimensions of a common “psychological space”. A corresponding method of analyzing similarities data is proposed, involving a generalization of “Eckart-Young analysis” to decomposition of three-way (or higher-way) tables. In the present case this decomposition is applied to a derived three-way table of scalar products between stimuli for individuals. This analysis yields a stimulus by dimensions coordinate matrix and a subjects by dimensions matrix of weights. This method is illustrated with data on auditory stimuli and on perception of nations.     

The relationship between creativity and psychosis-proneness

One-hundred and fifteen undergraduates were repeatedly administered a battery measuring schizotypal personality type and creativity (remote associations). Principal Components Analysis found a two-factor model to be most parsimonious. The pattern of results suggests that magical ideation and perceptual aberration items are represented by one factor and suspiciousness by the second. Analysis of consistent versus inconsistent high scorers on the schizoptypia measure indicated that inconsistent high scorers on the suspiciousness factor scored significantly higher than consistent high scorers on the creativity measure.     

Hexagram 4 of the I Ching: Analytical Psychology and Jung's Developmental Process

Theories, as well as history itself, are subject to their archetypal underpinnings, as well as to synchronicity, cyclic and sequential change. Some of Jung's early life experiences, his theories, and their permutations in his followers are considered in relation to Hexagram 4 of the I-Ching.
Jung's infantile wounds, his lack of adequately mirroring and metabolizing parents gave rise to a Puer Aeternus complex. This complex is explored as it is brought out through the lines of Hexagram 4 in the I-Ching. The complex is considered as pertinent to some problematical parts of Jung's theory and its impact on analytic history and behavior. Jung's genius and adaptive healing use of the building blocks of this complex are also discussed.
It is proposed that the descendants of Freud and Jung internalize the problems of their forefathers in much the same way that patients internalize the problems of their parents. Particular theories suggest similar personal affinities (and even histories) in their followers. Jung's childhood problems are considered for the way they may reverberate in Jungian practice today.     

In these pages...

The American Journal of Psychoanalysis -     

The relation between feelings of knowing and the number of neighboring concepts linked to the test cue

We investigated whether feeling-of-knowing judgments are influenced by the number of different neighboring concepts linked to the test cue in long-term memory as measured using association norms. The purpose was to evaluate contrasting predictions made by the partial-retrieval hypothesis and the competition hypothesis. The partial-retrieval hypothesis assumes the more neighboring concepts activated by the test cue, the higher the feeling of knowing. In contrast, the competition hypothesis assumes that feelings of knowing are sensitive to competition between neighboring concepts, and it predicts that the fewer neighboring concepts activated by the cue, the higher the feeling of knowing. The findings were compatible with the competition hypothesis showing that both feeling-of-knowing and prediction-of-knowing ratings always were higher, the fewer different concepts were linked to the test cue. We obtained an identical pattern of results using different kinds of cues including taxonomic category names, ending sounds, and meaningfully related associates. We consider different ways that these findings could be reconciled with the partial-retrieval hypothesis, and we also discuss implications for other explanations of feeling-of-knowing effects.     

A computer program for automated scoring of exteroceptive suppression periods

Exteroceptive suppression (ES) of temporalis muscle activity has received recent attention as a method of investigating central mechanisms in the pathogenesis of chronic headache disorders. Unfortunately, the resolution of conflicting findings has been hampered by the use of different assessment and scoring methodologies across laboratories, which has limited the direct comparison of findings across studies. A computer program was developed with the goal of providing an automated and reliable method of scoring ES responses. Processing an ES response with this software provides both visual and quantitative information relating to various response parameters. Multiple levels of smoothing the raw waveform data are available, and the software offers scoring on the basis of multiple depth-of-suppression criteria. The program also generates values for a variety of ES parameters: latency, duration, area, maximum level of suppression with its corresponding time (msec), and baseline level of muscle activity. It is likely that a reliable and standardized scoring protocol would enhance comparability of ES data generated across different settings.