Assessing personality disorders using a systematic clinical interview: evaluation of an alternative to structured interviews

The aim of this study was to assess interrater reliability and provide initial data bearing on the validity of a method of assessing personality disorders (PDs) that does not presume that patients can accurately self-report personality pathology. In a sample of 24 outpatients, two clinician-judges independently applied the Shedler-Westen Assessment Procedure-200 (SWAP-200; Westen & Shedler, 1999a, 2000), a 200-item Q-sort procedure for assessing personality pathology, to data from the Clinical Diagnostic Interview (Westen, 2002), a systematic clinical interview that mirrors and standardizes methods used by experienced clinicians to diagnose personality. In 16 of the 24 cases, the treating clinician also independently described the patient using the SWAP-200 Q-sort, based on longitudinal knowledge of the patient over the course of treatment, blind to the interview data. Interrater reliability was uniformly high, with median correlations between interviewers at r > .80. Interviewer-treating clinician correlations were also high, with median convergent validity coefficients at r > .80. Diagnostic overlap (discriminant validity) was moderate for dimensional DSM-IV diagnoses, reflecting extensive comorbidity among disorders, but minimal for empirically derived diagnoses identified in prior research. Treating clinicians' dimensional PD diagnoses using this method also strongly predicted interviewer-rated measures of adaptive functioning. The findings provide preliminary support for the reliability and validity of an alternative to structured interviews for diagnosing personality pathology, and suggest that the way to improve validity of personality diagnosis may not be to minimize clinical inference but to quantify it using psychometric instruments.     

Stability as a distinction between Axis I and Axis II disorders

Temporal stability has served as a conceptual basis for the distinction between the clinical syndromes of Axis I disorders and the Axis II personality disorders, the latter being viewed as lifelong enduring patterns. However, comparisons of the stability of Axis I and II disorders have been limited. The present review examines findings from three naturalistic longitudinal studies that utilize similar methodology: the Collaborative Longitudinal Personality Disorders Study (CLPS; Gunderson et al., 2000), the Collaborative Depression Study (CDS; Katz & Klerman, 1979), and the Harvard/Brown Anxiety Research Program (HARP; Keller et al., 1994). Using a definition of remission/recovery as having no or minimal symptoms for 8 consecutive weeks, the courses of personality, depressive, and anxiety disorders were compared. Though remission/recovery rate at the 2-year follow-up was highest for mood disorders, the probability of recurrence was also particularly high. Personality disorders, with remission rates higher than the anxiety disorders, appear to be less stable than conceptualized. The anxiety disorders had remarkably low recovery rates even beyond 5 years of prospective follow-up. Factors that may explain these findings, as well as implications for future conceptualization of DSM, are discussed.     

Static scene analysis for the perception of heading

In the current study, we explored observers' use of two distinct analyses for determining their direction of motion, or heading: a scene-based analysis and a motion-based analysis. In two experiments, subjects viewed sequentially presented, paired digitized images of real-world scenes and judged the direction of heading; the pairs were presented with various interstimulus intervals (ISIs). In Experiment 1, subjects could determine heading when the two frames were separated with a 1,000-ms ISI, long enough to eliminate apparent motion. In Experiment 2, subjects performed two tasks, a path-of-motion task and a memory-load task, under three different ISIs, 50 ms, 500 ms, and 1,000 ms. Heading accuracy decreased with an increase in ISI. Increasing memory load influenced heading judgments only for the longer ISI when motion-based information was not available. These results are consistent with the hypothesis that the scene-based analysis has a coarse spatial representation, is a sustained temporal process, and is capacity limited, whereas the motion-based analysis has a fine spatial resolution, is a transient temporal process, and is capacity unlimited.     

The Prospective and Retrospective Memory Questionnaire (PRMQ): Normative data and latent structure in a large non-clinical sample

The Prospective and Retrospective Memory Questionnaire (PRMQ; Smith, Della Sala, Logie, & Maylor, 2000) was developed to provide a self-report measure of prospective and retrospective memory slips in everyday life. It consists of sixteen items, eight asking about prospective memory failures, and eight concerning retrospective failures. The PRMQ was administered to a sample of the general adult population (N = 551) ranging in age between 17 and 94. Ten competing models of the latent structure of the PRMQ were derived from theoretical and empirical sources and were tested using confirmatory factor analysis. The model with the best fit had a tripartite structure and consisted of a general memory factor (all items loaded on this factor) plus orthogonal specific factors of prospective and retrospective memory. The reliabilities (internal consistency) of the Total scale and the Prospective and Retrospective scales were acceptable: Cronbach's alpha was 0.89, 0.84, and 0.80, respectively. Age and gender did not influence PRMQ scores, thereby simplifying the presentation and interpretation of normative data. To ease interpretation of scores on the PRMQ, tables are presented for conversion of raw scores on the Total scale and Prospective and Retrospective scales to T scores (confidence limits on scores are also provided). In addition, tables are provided to allow users to assess the reliability and abnormality of differences between an individual's scores on the Prospective and Retrospective scales.     

Strength of hindsight bias as a consequence of meta-cognitions

Hindsight bias is the tendency of people to falsely believe that they would have correctly predicted the outcome of an event once it is known. The present paper addresses the ongoing debate as to whether the hindsight bias is due to memory impairment or biased reconstruction. The memory impairment approach maintains that outcome information alters the memory trace of the initial judgement, whereas the biased reconstruction approach assumes that people who have forgotten their initial judgements are forced to guess and, in the presence of outcome information, are likely to use this information as an anchor. Whereas the latter approach emphasises the role of meta-cognitive considerations, meta-cognitions are not included in the memory impairment explanation. Two experiments show that the biased reconstruction approach provides a better explanation for empirical findings in hindsight bias research than does the memory impairment explanation.     

Semantic categorization in the human brain: spatiotemporal dynamics revealed by magnetoencephalography

We examined the cortical representation of semantic categorization using magnetic source imaging in a task that revealed both dissociations among superordinate categories and associations among different base-level concepts within these categories. Around 200 ms after stimulus onset, the spatiotemporal correlation of brain activity elicited by base-level concepts was greater within than across superordinate categories in the right temporal lobe. Unsupervised clustering of data showed similar categorization between 210 and 450 ms mainly in the left hemisphere. This pattern suggests that well-defined semantic categories are represented in spatially distinct, macroscopically separable neural networks, independent of physical stimulus properties. In contrast, a broader, task-required categorization (natural/man-made) was not evident in our data. The perceptual dynamics of the categorization process is initially evident in the extrastriate areas of the right hemisphere; this activation is followed by higher-level activity along the ventral processing stream, implicating primarily the left temporal lobe.     

Phenomenal characteristics of cryptomnesia

Qualitative characteristics of cryptomnesia, or unintentional plagiarism were investigated. In Experiment 1 we compared accurate and inaccurate source attributions in terms of their level of confidence using instructions that did not require a fixed number of responses. Confidence was lower for plagiarised responses than for correct responses. Nevertheless, participants provided high ratings of certainty for a large proportion of their plagiarised responses. In Experiment 2 the phenomenological differences between plagiarised recall and veridical recall were compared by using an adaptation of the memory characteristics questionnaire (Johnson, Foley, Suengas, & Raye, 1988). Correct responses were associated with more experiential detail than plagiarised responses. However, a considerable number of plagiarised responses were accompanied by a confident memory of at least one qualitative characteristic. Results are discussed in terms of the source monitoring framework developed by Johnson, Hashtroudi, and Lindsay (1993).     

What is meant by telling the truth: Bonhoeffer on the ethics of disclosure

This article explores Dietrich Bonhoeffer's writings on truth telling with reference to the problem of medical error in the US, the UK, and other developed nations, with particular attention to physicians' resistance to disclosing their own mistakes to injured patients and their families. The brief essay 'What is Meant by "Telling the Truth"?' and its historical context--Bonhoeffer's imprisonment and interrogation in 1943--is proposed as a text for medical ethicists and others seeking to overcome the barrier of the 'hidden curriculum' within the culture of medicine, which encourages medical students and physicians to conceal their errors and to fear disclosure.     

Stress applied during primary immunization affects the secondary humoral immune response in the rat: involvement of opioid peptides

The effect of unpredictable, inescapable and uncontrollable electric tail shocks (ES) on the humoral immune response to bovine serum albumin (BSA) was investigated in the rat. Contributions of the procedures that accompany shock delivery, such as witnessing the ES procedure (stress witnessing, SW) and exposure to the apparatus for shock delivery (apparatus control, AC) to the changes in specific immunity induced by ES were also tested. All procedures were applied during primary and/or secondary immunization. It was demonstrated that exposure to ES during primary immunization with BSA significantly suppressed specific anti-BSA antibody production after secondary and tertiary immunization with the same antigen. Exposure to the SW procedure during primary immunization with BSA enhanced the specific antibody level after secondary immunization, while exposure to the apparatus alone did not influence the development of either the primary or secondary humoral immune response to BSA. Both ES-induced suppression and SW-induced potentiation of the humoral immune response were partially inhibited by prior treatment with the opioid receptor antagonist naloxone. Additionally, treatments with the opioid peptides methionine- and leucine-enkephalin decreased anti-BSA antibody level, mimicking to some extent the effects of ES. It is suggested that ES and endogenous opioid peptides had long-term effects on humoral immunity through mechanisms involving immunologic memory.