Analysis of long-term stress reactions in emergency room patients: An initial study

The psychological stress reactions of 44 family medicine patients who were treated in the emergency room were examined approximately a year after the event. Patients were assessed on several psychological measures, including one for posttraumatic stress disorder (PTSD), and on their perception of how stressful the event was initially and now. Results show continuing stress reactions related to the emergency room event. Three patients endorsed symptoms indicating full PTSD and 13 appeared to have at least partial PTSD. Age appeared to be a factor in the presence of stress symptoms and in degree of perceived communication with the physician.     

Three years follow-up of panic disorder patients: A naturalistic study

Forty Danish panic disorder patients participating in a placebo controlled study of alprazolam and imipramine (The Cross National Collaborative Panic Study, Phase II) were followed up by a telephone interview three years later, with essentially the same battery of evaluation procedures applied at baseline, end of study, and follow-up. The main finding was that panic disorder is a chronic disorder, but fluctuating in form and severity in the course of time. Twenty-five percent of the patients no longer fulfilled the DSM-III criteria for panic disorder, but had substantial disability due to a variety of symptoms, including panic attacks at infrequent rate, generalized anxiety symptoms, affective symptoms, and phobic avoidance behavior. Nearly three fourths of the patients were under treatment at follow-up. Benzodiazepines were the drugs most often prescribed, usually in combination with supportive psychotherapy. It was concluded that the different types of treatment offered were insufficient. Variables predicting panic disorder or substantial disability at 3-years follow-up were few.     

Personality disorder correspondence between the million behavioral health inventory (MBHI) and the minnesota multiphasic personality inventory (MMPI)

The MBHI and MMPI personality disorder scales were analyzed for convergent and discriminant validity. Correlational data demonstrated that six of the eight scales were significantly related, while the remaining two scales approached significance. Further analyses of these data, however, demonstrated that none of the scales correlated significantly better with its convergent scale compared to nonconvergent scales. The MBHI classified significantly more of the sample as personality disordered (93%) compared to the MMPI personality disorder scales (17%). Furthermore, the MBHI tended to describe the sample as falling within the Anxious cluster of personality disorders, whereas the MMPI described them within the Dramatic cluster. Single scale codetype correspondence was found to be 15%, while two-point concordance was 12.5%, indicating very low congruence between personality style codetypes. These two measures do not appear to be measuring the same personality style constructs.     

THE TREATMENT OF COVERT SELF-INJURY THROUGH CONTINGENCIES ON RESPONSE PRODUCTS

Assessment and treatment of covert self-injurious behavior are complicated because it is difficult to quantify and apply differential consequences to covert responses. In this study, both tangible and social reinforcers were identified using reinforcer assessment methods. These reinforcers were then provided contingent upon the absence of tissue damage identified during physical examinations, resulting in near 100% success in physical assessment checks that was maintained over 10 months.     

SEQUENTIAL APPLICATION OF MAJOR HABIT-REVERSAL COMPONENTS TO TREAT MOTOR TICS IN CHILDREN

In this study, we sequentially administered up to four components of the habit-reversal treatment to 4 children with motor tics within a multiple baseline design. The habit-reversal components included (a) awareness training; (b) awareness training and self-monitoring; (c) awareness training, self-monitoring, and social support; and (d) awareness training, social support, and the use of a competing response. Results demonstrated that the combined use of awareness training, social support, and competing response training was effective in eliminating motor tics in 2 of 4 children, that awareness training alone was effective for 1 child, and that a combination of awareness training and self-monitoring was effective for the 4th child. The treatment and ensuing improvement were found to be socially valid. We discuss possible explanations for these results and recommend directions for future research.     

Cognitive Impairment and Its Relationship to Psychopathic Tendencies in Children with Emotional and Behavioral Difficulties

This study investigated whether performance on the card playing task (Newman, Patterson, & Kosson, 1987) and the moral/conventional distinction measure predict level of childhood conduct problems as indexed by the Psychopathy Screening Device (Frick & Hare, in press). The card-playing task indexes the child's sensitivity to changes in reinforcement rate. The moral/conventional distinction measure indexes the child's sensitivity to the difference between moral transgressions which result in harm to another from conventional transgressions which more usually result in social disorder. The Psychopathy Screening Device indexes a behavioral syndrome that consists of two dimensions: affective disturbance and impulsive and conduct problems. Thirty-nine children with emotional and behavioral difficulties were presented with both measures. Performance on both measures did predict extent of behavioral disturbance. Moreover, there was a significant association between performance on the card playing tasks and the moral/conventional distinction. The results are interpreted within the response set modulation and violence inhibition mechanism models and by reference to recent work at the anatomical level.     

Diagnosing posttraumatic stress disorder with the MMPI clinical scales: A review of the literature

A review of the literature resulted in 21 published studies that reported mean MMPI profile patterns for PTSD patients. Of these, six (29%) reported that the mean 8-2 profile pattern significantly differentiated PTSD patients from non-PTSD patients. The majority of studies found additional PTSD profile patterns reflecting nearly all of the MMPI clinical scales. The data indicate some common group profile patterns for inpatient veterans, prisoner's of war, and inpatient veteran substance abusers. The results also support the hypothesis that there is a continuum from inpatient to outpatient and veteran to civilian populations that corresponds with both symptom and stressor severity. It is concluded that although there is some typicality in similar populations, clinicians should expect heterogeneous MMPI profiles from PTSD patients representing a diversity of clinical symptoms and styles.     

Psychopathy and structure of primary mental abilities

The Comprehensive Ability Battery (CAB) was used to assess 18 primary mental abilities in 53 white, male prison inmates for whom highly reliable ratings of psychopathy were available. None of the correlations between ratings of psychopathy and scores on the CAB tests was significant, and the overall pattern or structure of abilities was the same for inmates with low and high ratings of psychopathy. The possibility is raised that the personality characteristics of psychopaths make them appear to be brighter and more creative than they actually are. Compared with norms for male high school students, the inmates as a group generally performed well, falling near the 50th percentile on 11 of the tests. The inmates performed significantly better than the normative sample on tests of verbal ability, esthetic judgment, aiming, and representational drawing, and significantly worse on tests of ideational fluency, spontaneous flexibility, and word fluency.This research was supported by Grant MT-4511 from the Medical Research Council of Canada.     

Personality diagnostic questionnaire-revised (PDQ-R) personality disorder scores and negative life events independently predict changes in hopkins symptom checklist (SCL-90) Psychopathology Scores

The present study employed a prospective design to investigate whether Personality Diagnostic Questionnaire—Revised (PDQ-R) scores and/or Hassles Scale—Revised (HS-R) scores predict changes in Axis I psychopathology levels over 1 month, in a nonclinical sample of young adults. The PDQ-R, HS-R, and Hopkins Symptom Checklist (SCL-90) were administered to a mixed-sex sample of 100 undergraduate students on two occasions separated by 1 month. Hierarchical multiple regression analyses indicated that (1) time 1 PDQ-R composite scores predicted changes in scores on 11 SLC-90 scales; (2) time 1 PDQ-R impairment/distress index scores predicted changes in SCL-90 general symptom index scores; (3) only one of the individual PDQ-R personality disorder subscales—the schizotypal personality disorder subscale—predicted changes in SCL-90 general symptom index scores; (4) HS-R scores predicted changes in scores on 9 SCL-90 scales; and (5) in only 3 of the 27 analyses conducted did the statistical interaction between PDQ-R and HS-R scores predict changes in SCL-90 scores. These findings indicate that personality disorder symptomatology and negative life events may independently predict changes in Axis I psychopathology levels and, thus, support the continued inclusion of Axis II and Axis IV in future versions of the Diagnostic and Statistical Manual of Mental Disorders.     

Are Individuals Always Aware of Their Trauma-Related Intrusive Thoughts? A Study of Meta-Awareness

Individuals are not always aware of their mental content. We tested whether lack of awareness occurs in those who have experienced trauma, with and without posttraumatic stress disorder (PTSD). We also examined the role of proposed cognitive mechanisms (working memory and inhibition) in explaining unnoticed intrusions. Individuals with PTSD (n = 44), and varying levels of symptoms (high posttraumatic stress [PTS]: n = 24; low PTS: n = 37) reported on intrusive thoughts throughout a reading task. Intermittently, participants responded to probes about whether their thoughts were trauma related. Participants were “caught” engaging in unreported trauma-related thoughts (unnoticed intrusions) for between 24 and 27% of the probes in the PTSD and high PTS groups, compared with 15% of occasions in the low PTS group. For trauma-related intrusions only, participants lacked meta-awareness for almost 40% of probes in the PTSD group, which was significantly less than that observed in the other groups (～60%). Contrary to predictions, working memory and response inhibition did not predict unnoticed intrusions. The results suggest that individuals who have experienced significant trauma can lack awareness about the frequency of their trauma-related thoughts. Further research is warranted to identify the mechanisms underpinning the occurrence of unnoticed intrusions.