Examining the inventory of interpersonal problems as a tool for conducting analogue studies of mechanisms underlying Borderline Personality Disorder

Despite recent advancements in the treatment of Borderline Personality Disorder (BPD), little is known about the underlying mechanisms in the development and maintenance of the disorder. To examine these issues, it is first necessary to identify a brief screening measure that can be used to assess factors underlying BPD. Considering this need, the current investigation examined the utility of a BPD-related composite consisting of the Inventory of Interpersonal Problems-Interpersonal Sensitivity (IIP-IS) and Aggression (IIP-Ag) subscales of the IIP in a sample of college students (n=78) and a sample of individuals seeking residential drug use treatment (n=78). Data indicated that score on this composite measure (IIP-BPD) was positively related to scores on measures tapping BPD-related symptomotology, as well or better than the IIP total score in all cases. These data suggest the specificity of the IIP-BPD and support its use in analogue studies to better understand the mechanisms underlying the disorder.     

Beyond generalized anxiety disorder: Psychometric properties of the GAD-7 in a heterogeneous psychiatric sample

BackgroundAlthough developed as a screener for Generalized Anxiety Disorder (GAD) in primary care, the GAD-7 is now commonly used as a measure of general anxiety symptoms across various settings and populations. However, little is known about its psychometric properties when used in such heterogeneous samples. We examined the internal consistency, convergent validity, sensitivity and specificity, sensitivity to change, and structure of the GAD-7 in patients receiving brief, intensive CBT treatment in a partial hospital setting. We also examined the properties of a modified version that assessed symptoms over the past 24-h.MethodsParticipants (n = 1082) completed the GAD-7 upon admission and discharge from a partial hospital program. They also completed measures of worry, depression, and well being and a structured diagnostic interview. We examined psychometric properties in the total sample and separately for patients with GAD, post-traumatic stress disorder, Social Anxiety Disorder (SAD), and panic disorder.ResultsInternal consistency and convergent validity were good for the total sample and each anxiety disorder group. The GAD-7 demonstrated poor specificity and a high false positive rate for all anxiety disorders. Sensitivity to change was generally good. Factor analysis revealed that a one-factor structure did not fit the data well. The 24-h version performed similarly to the original version.ConclusionsThe GAD-7 performed well as a measure of anxiety symptom severity, but not as a screener in this psychiatric sample. It is a useful outcome measure for hetereogenous samples, but it may not perform as well specifically for individuals with SAD. A modified version of the GAD-7 that assessed anxiety symptoms over the past 24-h appears to be a reliable and valid modification.     

Replication of factor structure of Wechsler Adult Intelligence Scale-III Chinese version in Chinese mainland non-clinical and schizophrenia samples

The aim of the present study was to evaluate the construct validity of the special four-factor structure of the Wechsler Adult Intelligence Scale (WAIS)-III Chinese version in a clinical sample of inpatients with schizophrenia as well as a sample of healthy adults. A sample of 114 inpatients with schizophrenia and a sample of 114 close-matched non-clinical adults on the Chinese mainland were studied with the measures of the WAIS-III Chinese version. Four competing hypothetical models of factors were tested for model fit and parsimony in both research samples, using maximum likelihood confirmatory factor analysis. Confirmatory factor analysis indicated that a four-factor model of Verbal Comprehension, Perceptual Organization, Working Memory, and Processing Speed best fit the data from both the schizophrenia sample and the healthy adult sample, and also fitted the data from both samples better than alternative models, which is similar to that reported by the developers and revisers of this scale. These empiric analyses and results support the construct validity of the WAIS-III Chinese version in patients with schizophrenia and healthy adults on the Chinese mainland.     

Evaluating the Factor Validity of the Children’s Organizational Skills Scale in Youth with ADHD

Children and adolescents with ADHD often have difficulties with organization, time management, and planning skills, and these skills are a common target of intervention. A limited array of tools for measuring these abilities in youth is available, and one of the most prominent measures is the Children’s Organizational Skills Scale (COSS). Although the COSS fills an important need, a replication of the COSS factor structure outside of initial measure development has not been conducted in any population. Given that the COSS is frequently used in ADHD research, the current study evaluated the factor structure of the parent-rated COSS in a sample (N = 619) of adolescents with ADHD. Results indicated that the original factor structure could be replicated, although the use of item parcels appeared to affect model fit statistics. An alternative bi-factor model was also tested that did not require the use of parcels, with results suggesting similar model fit in comparison with the original factor structure. Exploratory validity tests indicated that the domain-general factor of the bi-factor model appears related to broad executive functioning abilities.     

Comparison of Assertive Community Treatment Fidelity Assessment Methods: Reliability and Validity

Assertive community treatment is known for improving consumer outcomes, but is difficult to implement. On-site fidelity measurement can help ensure model adherence, but is costly in large systems. This study compared reliability and validity of three methods of fidelity assessment (on-site, phone-administered, and expert-scored self-report) using a stratified random sample of 32 mental health intensive case management teams from the Department of Veterans Affairs. Overall, phone, and to a lesser extent, expert-scored self-report fidelity assessments compared favorably to on-site methods in inter-rater reliability and concurrent validity. If used appropriately, these alternative protocols hold promise in monitoring large-scale program fidelity with limited resources.     

Validity and reliability of an inpatient severity of psychiatric illness measure

Inpatient psychiatric severity measures are often used but few psychometric data are available. This study evaluated the psychometric properties (reliability and validity) of a measure used to assess severity of psychiatric illness among inpatients. Using the severity measure, minimally trained raters conducted retrospective patient record reviews to assess medical necessity for psychiatric hospitalization. The data analysis compared 135 civilly committed psychiatric inpatients with a heterogeneous group of 248 psychiatric inpatients at a general hospital. The severity measure showed acceptable inter-rater reliability in both populations. Two-way analysis of variance showed that the intra-class correlation coefficient for the total score was 0.65 for general hospital subjects and 0.63 for civilly committed subjects. Differences in mean scores were substantial (15 out of a possible 75 points for general hospital subjects versus 42 for civilly committed subjects, Mann-Whitney U = 562, p < 0.001). As expected, all civilly committed subjects were well above admission cut-off score of 12, versus only 64% of the general hospital patients. The measure is appropriate for retrospective severity assessment and may also be useful for pre-admission screening.     

Assessment of beliefs about psychotropic medication and psychotherapy: development of a measure for patients with anxiety disorders

OBJECTIVE: This study presents the psychometric properties of a brief measure to assess beliefs about psychotropic medications and psychotherapy among patients with anxiety disorders. METHOD: Data were collected on a large sample of primary care patients with a range of anxiety disorders, as part of the Collaborative Care for Anxiety and Panic study. Factor analyses using principal axis factoring with Varimax rotations were used to determine the factor structure of the beliefs scale. Internal consistency, concurrent validity and predictive validity of the resulting subscales were examined. RESULTS: Two subscales emerged, one reflecting beliefs about psychotropic medications and the other assessing beliefs about psychotherapy. Both showed strong internal consistency and concurrent validity. The beliefs about psychotropic medication demonstrated strong predictive validity. CONCLUSIONS: This measure may be a useful tool for assessing treatment beliefs among patients with anxiety disorders toward the provision of more quality treatment for this population. Its brevity may make it particularly useful in primary health care settings.     

Intensive care in psychiatry

Psychiatric intensive care is supposed to offer treatment and to hold patients with psychiatric illness, if they pose a threat to themselves or to others. Besides treating the underlying psychiatric diagnoses, it is also necessary to take care of severe somatic comorbidity, which is often impeded by patients’ limited ability to cooperate. Treatment often requires the administration of sedative medication and occasionally the use of medical restraints. Involuntary commitment, involuntary treatment and the usage of physical restraints is regulated by national mental health laws. Medical professionals working in the field of psychiatric intensive care must have expert knowledge in the fields of psychopharmacology and intensive care medicine. Treatment concepts should be aimed to provide optimized care for psychiatric inpatients in a potentially life-threatening phase of their illness. This article outlines current clinical practice at the psychiatric intensive care unit of the Medical University of Vienna (Austria). Furthermore, we present diagnoses, diagnostic procedures and specific treatments of a sample of 100 consecutive inpatients treated in the years 2008 and 2009 at this ward.     

The Cardiff Anomalous Perceptions Scale (CAPS): a new validated measure of anomalous perceptual experience

The study describes the Cardiff Anomalous Perceptions Scale (CAPS), a new validated measure of perceptual anomalies. The 32-item CAPS measure is a reliable, self-report scale, which uses neutral language, demonstrates high content validity, and includes subscales that measure distress, intrusiveness, and frequency of anomalous experience. The CAPS was completed by a general population sample of 336 participants and 20 psychotic inpatients. Approximately 11% of the general population sample scored above the mean of the psychotic patient sample, although, as a group, psychotic inpatients scored significantly more than the general population on all CAPS subscales. A principal components analysis of the general population data revealed 3 components: "clinical psychosis" (largely Schneiderian first-rank symptoms), "temporal lobe disturbance" (largely related to temporal lobe epilepsy and related seizure-like disturbances) and "chemosensation" (largely olfactory and gustatory experiences), suggesting that there are multiple contributory factors underlying anomalous perceptual experience and the "psychosis continuum."     

Assessing child and adolescent anxiety in psychiatric samples with the Child Behavior Checklist

The Child Behavior Checklist's (CBCL) is often used as a screening instrument at first contact in standard child and adolescent psychiatric settings adding valuable information to the diagnostic process. However, its correspondence to clinical, in particular anxiety, diagnoses has not always been clear. Using parent reports from 2763 outpatients and 888 inpatients referred for psychiatric services, CBCL-anxiety scales were examined regarding their predictive validity and potential use as screening devices for anxiety disorders.Symptom scores across four diagnostic groups (anxiety disorder, emotional disorder, other psychiatric disorder and no psychiatric disorder) were calculated and compared; in addition ROC-analyses for the anxiety-disordered group were performed. Support for the validity of the “Anxiety Problems” scale (Achenbach et al., 2003) was found. However, AUC-values were only in the medium range (.71–.72) with substantial misclassification numbers proposing a limited utility of the scale as a screening instrument in our samples.Adding valuable information to the diagnostic process, the CBCL's associations with clinical anxiety diagnoses seem only moderate suggesting the additional use of other anxiety-specific instruments in clinical routine.     

Construct validity of the Schwartz Outcome Scale: validation using a 28-day inpatient chemical rehabilitation patient sample

The Schwartz Outcome Scale-10 (SOS-10) is a 10-item self-report that measures quality of life and psychological well-being. It is easy to administer and score, and past research has revealed its utility, validity, and reliability with different samples (i.e., clinical and nonclinical) and in different clinical settings (i.e., inpatient, outpatient, nonpsychiatry medical settings). The present study looks to investigate the utility of the SOS-10 in measuring psychological well-being and quality of life with the 28-day inpatient chemical dependency sample. In addition, the current study looks to investigate its ability to be used as a treatment outcome measure for chemical-dependent inpatients. The results revealed that the SOS-10 was associated with aspects of interpersonal dependency and alexithymia in predicted ways. The SOS-10 was positively associated to "Healthy Dependence" and negatively related to alexithymia and "Destructive Overdependence" and "Dysfunctional Detachment." The results also showed that the SOS-10 showed healthy change from admission to discharge and that this change was paralleled by healthy change in interpersonal dependency and alexithymia.     

Psychometric properties of the Japanese version of the Clinical Outcomes in Routine Evaluation-Outcome Measure

This study examined the reliability and validity of the Japanese version of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), a standardized, brief, but comprehensive outcome measurement. The target population consisted of 1684 Japanese company employees, hospital staff, and university students. A confirmatory factor analysis proved that our data fit the factor structure of the original CORE-OM. We also examined its internal consistency, test-retest reliability, convergent validity, and sensitivity in discriminating between clinical and nonclinical samples. After demonstrating these results, we discuss how the Japanese version of the CORE-OM can be used both in clinical and research settings.     

Factorial validity and measurement equivalence of the Client Assessment of Treatment Scale for psychiatric inpatient care - a study in three European countries

Patients' views of inpatient care need to be assessed for research and routine evaluation. For this a valid instrument is required. The Client Assessment of Treatment Scale (CAT) has been used in large scale international studies, but its psychometric properties have not been well established. The structural validity of the CAT was tested among involuntary inpatients with psychosis. Data from locations in three separate European countries (England, Spain and Bulgaria) were collected. The factorial validity was initially tested using single sample confirmatory factor analyses in each country. Subsequent multi-sample analyses were used to test for invariance of the factor loadings, and factor variances across the countries. Results provide good initial support for the factorial validity and invariance of the CAT scores. Future research is needed to cross-validate these findings and to generalise them to other countries, treatment settings, and patient populations.     

Do patients with schizophrenia distinguish between attitudes toward antipsychotic medication and pharmacotherapy in general? Validation of the Beliefs About Medication Questionnaire

Attitudes toward medication are important predictors of medication adherence in schizophrenia. However, monitoring their strength and influence in clinical settings is challenged by the absence of assessments separating them from adherence and subjective response and distinguishing between attitudes toward pharmacotherapy in general and antipsychotic medications. This study examined the applicability of the Beliefs about Medication Questionnaire (BMQ) in outpatients with schizophrenia (N = 131). Confirmatory factor analysis (CFA) could not support the original four-factor structure. A subsequent exploratory factor analysis revealed the factors Antipsychotics Necessity, Antipsychotics Concern, and Pharmacotherapy Distrust were supported by an acceptable fit of a completing CFA. These subscales have satisfactory internal reliability, test-retest reliability, and local fit indices. Modest correlations with insight and illness perception indicate construct validity. Criterion validity was supported by a significantly higher medication adherence of accepting patients compared with skeptical patients. The BMQ is a psychometrically sound and valid measure of attitudes toward medication in outpatients with schizophrenia.     

A review of the reliability and validity of OPCRIT in relation to its use for the routine clinical assessment of mental health patients

The OPCRIT program is a symptom checklist with accompanying algorithms producing operationally defined diagnoses. We undertook a review of studies which had used OPCRIT and had reported statistics concerning its reliability and validity, producing summary measures from 44 studies. The first main measure of interest was inter‐rater reliability where mean kappa values indicated that agreement between raters was “substantial” with a marginal improvement at the diagnostic (0.76) versus individual item (0.69) level. The second main measure of interest was convergent validity – the agreement between OPCRIT and clinical diagnoses. Most studies reported these figures as concordance rates suggesting mean agreement, unadjusted for chance, of 69%. Very few studies used the chance‐adjusted kappa statistic but where this was used agreement was “fair” (0.39). Agreement between OPCRIT and other research diagnoses was “moderate” (0.60). We also considered differences between the way OPCRIT has traditionally been used in research settings and the naturalistic manner in which it will be employed in the hospital ward. This review provides a summary of the reliability and validity of OPCRIT, which will be considered during the preparation for its use in the routine characterization of mental health patients in clinical settings. Copyright © 2013 John Wiley & Sons, Ltd.     

The Basic Structure of Community Early Intervention Programs for Children with Autism: Provider Descriptions

Autism researchers have identified a set of common effective practice elements for early intervention (EI) (e.g., intensive programming). The current study examined the reported use of common elements of effective interventions in community EI settings. Eighty EI providers reported about their programs. The majority of participants reported using common effective elements, however, the depth and quality of the use of these elements was highly variable. Taking community program structure into account in future research will facilitate the development of methodologies, which immediately fit into the context of community programming rather than requiring program adaptation for use in the real world. Recommendations for using current community program structure to improve use of evidence-based practices are discussed.     

Measurement of social climate within neurobehavioural rehabilitation services using the EssenCES

In forensic mental health settings, quality of social climates is associated with a range of therapeutic assets. An essential characteristic of neurobehavioural rehabilitation services is provision of an enriched environment which reverses contingencies that maintain challenging behaviour. The concept of social climate is therefore equally important to these services. Criticisms of existing measures of social climate led to development of the EssenCES. This was initially validated in German forensic mental hospitals, and subsequently an English translation in equivalent UK services. To determine if EssenCES can be used to measure social climate in neurobehavioural rehabilitation units, responses from 114 staff and patients were analysed using statistical methods from classical test theory. Results were similar to those obtained previously. Rasch analysis was also used to test the assumption that EssenCES comprises a true interval-scale measurement tool. Item–person misfit, erratic responding, redundant response categories and disordered thresholds undermined this assumption. Rating scale recalibration, item reduction, and removing respondents who continued to demonstrate poor fit resulted in a measure with good internal construct validity but questionable external construct validity. Relative merits of modifying EssenCES for use with patients with cognitive impairment versus designing a measure conceptualised for use in neurobehavioural rehabilitation services are discussed.     

Measurement of social climate within neurobehavioural rehabilitation services using the EssenCES

In forensic mental health settings, quality of social climates is associated with a range of therapeutic assets. An essential characteristic of neurobehavioural rehabilitation services is provision of an enriched environment which reverses contingencies that maintain challenging behaviour. The concept of social climate is therefore equally important to these services. Criticisms of existing measures of social climate led to development of the EssenCES. This was initially validated in German forensic mental hospitals, and subsequently an English translation in equivalent UK services. To determine if EssenCES can be used to measure social climate in neurobehavioural rehabilitation units, responses from 114 staff and patients were analysed using statistical methods from classical test theory. Results were similar to those obtained previously. Rasch analysis was also used to test the assumption that EssenCES comprises a true interval-scale measurement tool. Item-person misfit, erratic responding, redundant response categories and disordered thresholds undermined this assumption. Rating scale recalibration, item reduction, and removing respondents who continued to demonstrate poor fit resulted in a measure with good internal construct validity but questionable external construct validity. Relative merits of modifying EssenCES for use with patients with cognitive impairment versus designing a measure conceptualised for use in neurobehavioural rehabilitation services are discussed.     

Construct Validity of the Montreal Cognitive Assessment (MoCA)

The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment. The present study aims to assess the construct related validity of the MoCA through the establishment of the factorial, convergent, and discriminant related validities, and the reliability of data. In a Portuguese sample of 830 participants, several models were tested using Confirmatory Factor Analysis. Although all tested models showed a good fit, the six-factor model based on the conceptual model proposed by the MoCA's authors showed a significantly better fit. The results allowed us to establish the factorial, convergent, and discriminant validity of this six-dimensional structure. An overall psychometric adequacy of the items, and a good reliability were also found. This study contributes to overcome an important gap in the construct related validity of this instrument. The present findings corroborate the six-dimensional structure of the MoCA and provide good evidence of the construct related validity. The MoCA has proved to be an appropriate measure for cognitive screening taking into account different cognitive domains, which will enable clinicians and researchers to use this test and its six latent dimensions to achieve a better understanding of the individuals' cognitive profile.