Observed behaviors during clinical interviews predict improvement in depression

A considerable percentage of depressed patients do not respond to antidepressive treatment. Early indicators of prognosis are needed. The aims of this study are to examine (a) whether the interpersonal behavior of patients and psychiatrist, as assessed by means of direct observation of behavior during a baseline clinical interview, might have predictive value with respect to therapeutic outcome and (b) which predictive potency measures of psychomotor activation, as assessed by less refined methods, such as global clinical judgment, might have. In the analysis used, speech-pause behavior was taken as the basic structure of the interaction. The relations of other behaviors such as looking and hand and head movement with this structure were determined. Evidence is presented that in a group of 31 depressives, improvement after a period of 10 weeks was related to observed behaviors during a baseline interview. The behaviors of the patients are interpreted as relational or nonrelational. The relational behaviors (i.e., looking yesnodding, gesturing) occur less in patients who will improve, whereas the nonrelational behaviors (i.e., intensive body touching, head movements) occur more in these patients. The nonrelational behaviors are presumed to be indicative of the state of arousal. The predictive potency of these variables could not be explained by their relationship with the baseline severity of depression, which in itself also predicted improvement. Moreover, global clinical assessment of psychomotor activation (i.e., retardation and agitation) could not be related to outcome.     

Anger and irrational thought: Questionnaire and interview ratings

From an initial pool of 96 students, 36 subjects were selected based on Novaco Anger Scale scores to form high-, moderate-, and low-anger groups (n=12). They completed self-report questionnaires and participated in a structured interview designed to elicit cognitive and affective responses to hypothetical situations involving interpersonal conflict. High- and moderate-anger groups scored significantly higher than low-anger subjects on a questionnaire measure of irrational thinking. High-anger subjects scored higher than low-anger subjects on general anxiety, suspiciousness, fear of negative evaluation, hostility, and criticism of themselves and others. Interview ratings showed that there were no group differences in self-reports of anger or ability to cope with conflict, yet raters judged high-anger subjects to display more anger than low-anger subjects in their stated response actions. Estimates of coping ability varied inversely with reports of anger experienced. Generally, results support a relationship between irrational thinking patterns and anger in feeling and action. Implications for treatment are discussed.     

An introduction to organic brain syndromes

Organic brain syndromes are of forensic interest for several reasons. First, patients with organic brain syndromes may require judicial determination of competence in any of a number of areas, e.g., testamentary capacity, need for financial guardianship, or competence to make medical decisions. Second, any patient whose mental state is of legal interest will need evaluation for contributing organic factors; uncovering these factors may have considerable medical and legal consequence. Third, the discovery of organic factors may be decisive in the outcome of a judicial proceeding, where “hard” biological data are often accorded more weight, and are thus more persuasive, than “soft” psychological data. This article provides an introductory overview of the organic brain syndromes. For each syndrome, the clinical features are described and are illustrated with a case vignette, the more common etiologies are presented, and selected aspects to the evaluation are highlighted. In addition, since the detectian of malingered mental illness is a key component in many forensic contexts, characteristics are described which help to distinguish actual from malingered mental illness.     

The effects of perceived parental rearing style on the development of Type A pattern

The aetiological antecedents of the Type A pattern have not been studied widely. In the present study the effects of parental rearing practices on the development of Type A pattern were evaluated. Perceived parental rearing style was assessed by the EMBU and Type A pattern by the JAS. Subjects were drawn from a random sample of residents (older than 21 years) of a Dutch community. Results suggested that a significant amount of variance of Type A behaviour can be accounted for by perceived parental characteristics, especially rejection and lack of emotional warmth. It is suggested that lack of emotional warmth and negative evaluation of children by their parents may lead to an internalized maladaptive cognitive set in the children which may be a developmental antecedent for eliciting the competitiveness, achievement striving, and sense of time urgency characteristic of Type A adults.     

The use of structured multi-domain job analysis for the construction of assessment center methods and procedures

This article addresses the defensibility of the assessment center based on a content oriented validation strategy. One reason for the confusion in this area is the fact that there are no agreed upon methods for constructing the assessment procedures. Therefore, the purpose of this article is to describe how structured multi-domain job analysis information can be used to develop an assessment center which is well grounded with regard to content validity.     

Multifactor measurement of bodily feelings: Conceptual development,scale construction,and empirical validation

A series of studies is described demonstrating a coherent exploratory and confirmatory factor-analytic approach to the scaling of self-reported bodily feelings. This approach attempts to optimize the orthogonality, parsimony, and meaningfulness of a multifactor inventory. Psychometric properties of the resulting 35-item Bodily Feeling Scale (BFS) are presented and its comparability with other inventories is discussed. A validity study using item-content-based scales of the Minnesota Multiphasic Personality Inventory showed both concurrent and discriminative validity of the BFS. Implications for clinical and research utility are discussed.Portions of this research were conducted while the first author was supported by a University Graduate Fellowship awarded by the Graduate School of Arts and Sciences at Vanderbilt University.Professor Nunnally passed away in August 1982. His major contributions to the several stages of this research program are recognized through coauthorship.     

Adjustment to hemodialysis treatment through behavioral controls

The present study was conducted to examine the hypothesis that compliant chronically ill patients, typically described as adjusted, reinforce more positive social environments using behavioral controls than noncompliant patients, typically described as maladjusted. Specifically, it is hypothesized that diet-compliant chronic hemodialysis patients emit significnatly more active involvement-in-treatment behaviors and more social behaviors than diet-noncompliant chronic hemodialysis patients. Subjects, who ranged in age from 30 to 77 years, were outpatients at a kidney center. Behavioral observations were conducted to assess the occurrence or frequency of (1) four involvement-in-treatment behaviors that are routinely taught to all patients and (2) two social behaviors, which were patient verbalizations and smiles. The results showed that compliant patients emitted significantly more involvement-in-treatment behaviors and smiles than noncompliant patients. Results support the proposed control framework that compliant, in contrast to non-compliant, chronically ill patients have recourse through positive behavioral controls when adjusting to the stresses of illness. It was proposed that through these controls, compliant patients reinforce positive environments rather than simply respond to life circumstances as given.     

Millon Clinical Multiaxial Inventory (MCMI) computer-generated diagnoses: How do they compare to clinician judgment?

During the past several decades, computers have achieved increasing prominence in psychological assessment procedures. This is particularly true for computer-based test interpretation and diagnosis. This study reports on a study designed to compare the accuracy of computer-based diagnoses with clinician-generated diagnoses. The Millon Clinical Multiaxial Inventory (MCMI) was administered to 151 consecutively admitted inpatients at a large private psychiatric hospital. The computer-generated diagnoses were compared with those generated by admitting psychiatrists. The results indicated that the MCMI diagnostic impressions underestimated the severity of depressive disorders when compared with clinician diagnoses on Axis I. Specifically, clinicians diagnosed major depression much more frequently than did the MCMI. In addition, clinicians diagnosed anxiety disorders much less frequently than did the MCMI.