Normal Personality Assessment in Clinical Practice: The NEO Personality Inventory.

The Liebowitz Social Anxiety Scale (LSAS) is one of the most commonly used measures of social anxiety symptoms. To date, no study has examined its psychometric properties in a Latino sample. The authors examined the reliability, temporal stability, and convergent validity of the LSAS in 73 Lati- nos diagnosed with an anxiety disorder. The original LSAS subscales showed excellent internal consistency and temporal stability over a 1-year period. Participants with social anxiety disorder (SAD) scored significantly higher on all LSAS subscales than participants without SAD, supporting the convergent validity of the LSAS. Similar results were obtained for four subscales pro- posed by Safren and colleagues. Results have implications for the use of the LSAS as a measure of severity or outcome when comparing diverse populations.

Psychometric Properties of the

• In 1988, the MacArthur Foundation Research Network on the Psychobiology of Depression convened a task force to examine the ways in which change points in the course of depressive illness had been described and the extent to which inconsistency in these descriptions might be impeding research on this disorder. We found considerable inconsistency across and even within research reports and concluded that research on depressive illness would be well served by greater consistency in the definition change points in the course of illness. We propose an internally consistent, empirically defined conceptual scheme for the terms remission, recovery , relapse , and recurrence . In addition, we propose tentative operational criteria for each term. Finally, we discuss ways to assess the usefulness of such operational criteria through reanalysis of existing data and the design and conduct of new experiments.

Conceptualization and Rationale for Consensus Definitions of Terms in Major Depressive Disorder: Remission, Recovery, Relapse, and Recurrence

Background To our knowledge, this is the first prospective natural history study of weekly symptomatic status of patients with bipolar I disorder (BP-I) during long-term follow-up. Methods Analyses are based on ongoing prospective follow-up of 146 patients with Research Diagnostic Criteria BP-I, who entered the National Institute of Mental Health (Bethesda, Md) Collaborative Depression Study from 1978 through1981. Weekly affective symptom status ratings were analyzed by polarity and severity, ranging from asymptomatic, to subthreshold levels, to full-blown major depression and mania. Percentages of follow-up weeks at each level as well as number of shifts in symptom status and polarity during the entire follow-up period were examined. Finally, 2 new measures of chronicity were evaluated in relation to previously identified predictors of chronicity for BP-I. Results Patients with BP-I were symptomatically ill 47.3% of weeks throughout a mean of 12.8 years of follow-up. Depressive symptoms (31.9% of total follow-up weeks) predominated over manic/hypomanic symptoms (8.9% of weeks) or cycling/mixed symptoms (5.9% of weeks). Subsyndromal, minor depressive, and hypomanic symptoms combined were nearly 3 times more frequent than syndromal-level major depressive and manic symptoms (29.9% vs 11.2% of weeks, respectively). Patients with BP-I changed symptom status an average of 6 times per year and polarity more than 3 times per year. Longer intake episodes and those with depression-only or cycling polarity predicted greater chronicity during long-term follow-up, as did comorbid drug-use disorder. Conclusions The longitudinal weekly symptomatic course of BP-I is chronic. Overall, the symptomatic structure is primarily depressive rather than manic, and subsyndromal and minor affective symptoms predominate. Symptom severity levels fluctuate, often within the same patient over time. Bipolar I disorder is expressed as a dimensional illness featuring the full range (spectrum) of affective symptom severity and polarity.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/206451/YOA20425.pdf

The long-term natural history of the weekly symptomatic status of bipolar I disorder.

Data were collected on the point and lifetime prevalences, 1-year incidence, and comorbidity of depression with other disorders (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]) in a randomly selected sample (n = 1,710) of high school students at point of entry and at 1-year follow-up (n = 1,508). The Schedule for Affective Disorders and Schizophrenia for School-Age Children was used to collect diagnostic information; 9.6% met criteria for a current disorder, more than 33% had experienced a disorder over their lifetimes, and 31.7% of the latter had experienced a second disorder. High relapse rates were found for all disorders, especially for unipolar depression (18.4%) and substance use (15.0%). Female subjects had significantly higher rates at all age levels for unipolar depression, anxiety disorders, eating disorders, and adjustment disorders; male subjects had higher rates of disruptive behavior disorders.

Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students.

• The Longitudinal Interval Follow-up Evaluation (LIFE) is an integrated system for assessing the longitudinal course of psychiatric disorders. It consists of a semistructured interview, an instruction booklet, a coding sheet, and a set of training materials. An interviewer uses the LIFE to collect detailed psychosocial, psychopathologic, and treatment information for a six-month follow-up interval. The weekly psychopathology measures ("psychiatric status ratings") are ordinal symptom-based scales with categories defined to match the levels of symptoms used in the Research Diagnostic Criteria. The ratings provide a separate, concurrent record of the course of each disorder initially diagnosed in patients or developing during the follow-up. AnyDSM-IIIor Research Diagnostic Criteria disorder can be rated with the LIFE, and any length or number of follow-up intervals can be accommodated. The psychosocial and treatment information is recorded so that these data can be linked temporally to the psychiatric status ratings.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/494064/archpsyc_44_6_009.pdf

The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies

The influence of the clinically depressed state on personality assessment was evaluated by comparing self-report personality inventories of patients while clinically depressed and at follow-up 1 year later. The authors examined two groups from the National Institute of Mental Health (NIMH)-Clinical Research Branch Collaborative Program on the Psychobiology of Depression: Clinical Studies--patients whose symptoms had completely remitted and those who had not recovered. The clinically depressed state strongly influenced assessment of emotional strength, interpersonal dependency, and extraversion. Assessment of rigidity, level of activity, and dominance did not change after symptomatic recovery.

Assessing personality: effects of the depressive state on trait measurement.

The authors, as part of the ongoing NIMH Collaborative Study on the Psychobiology of Depression, used an analysis of variance design and videotaped interviews to explore the effects of sources of variance on the reliability of the measures being used by the NIMH study. In spite of substantial differences among interviewers in background or orientation, the authors found that diagnoses and symptom ratings were made with a high level of reliability. These results suggest that the use of structured interviews and diagnostic criteria, when combined with a careful and systematic training program, can lead to good levels of diagnostic reliability.

Pat McDonald-Scott

Papers

The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies

Assessing personality: effects of the depressive state on trait measurement.

Assessment of reliability in multicenter collaborative research with a videotape approach