Comparison between the Psychopathy Checklist-Revised and the Comprehensive Assessment of Psychopathic Personality in a representative sample of Spanish prison inmates.

In the field of psychopathy, there is an ongoing debate about the core traits that define the disorder, and that therefore must be present to some extent in all psychopaths. The main controversy of this debate concerns criminal behaviour, as some researchers consider it a defining trait, while others disagree. Using a representative sample of 204 Spanish convicted inmates incarcerated at the Pereiro de Aguiar Penitentiary in Ourense, Spain, we tested two competing models, the Psychopathy Checklist-Revised (PCL-R), which includes criminal behaviour items, versus the Comprehensive Assessment of Psychopathic Personality (CAPP), which does not. We used two different PCL-R models, one that includes criminal items and another that does not. PCL-R factors, facets, and testlets from both models and CAPP dimensions were correlated and compared. Two different PCL-R cut-off scores, 25 or more and 30 or more, were used for the analysis. Overall, a strong correlation was found between PCL-R and CAPP scores in the whole sample, but as scores increased and inmates became more psychopathic, the correlations weakened. All these data indicate that psychopathy, understood to mean having high scores on the PCL-R and CAPP, is a multidimensional entity, and inmates can develop the disorder and then receive the diagnosis through different dimensions. The CAPP domains showed better correlations when compared with the PCL-R factors from both models, showing that an instrument for the assessment of psychopathy without a criminal dimension is valuable for clinical assessment and research purposes.

The differential influence of computerized neuropsychological assessment across psychopathology.

Objective: Novel technologies have transformed neuropsychological test administration so that research examining the equivalency of computerized versions of traditional tests is needed. This study examined the relationship between psychological symptom severity and performance on the Wisconsin Card Sorting Test (WCST) using the manual versus computerized administration.Method: Eighty-five participants were randomly assigned to the manual or computerized WCST administration and also completed the Dot Counting Test, Depression Anxiety Stress Scales, and Short UPPS-P Impulsive Behavior Scale. Moderation analyses examined the effects of depressive, anxiety, and impulsivity symptom severity on WCST performance.Results: For Perseverative Responses (PR), the methods of administration (MOAs) were equivalent regardless of psychological symptom severity. For failures to maintain set (FMS), MOA itself influenced performance, with participants making at least twice as many FMS on the computerized WCST. MOA also significantly moderated the relationship between FMS and impulsivity severity, including Lack of Perseverance, Sensation Seeking, and Positive Urgency. Individuals with greater Positive Urgency made more FMS on the manual WCST, and individuals with greater Lack of Perseverance made more FMS on the computerized WCST.Conclusions: Findings suggest that equivalence between the manual and computerized versions of the WCST depends on the WCST subscale and the type of psychological symptom. New normative data need to be developed for the computerized WCST, along with a more consistent method of scoring and interpreting WCST subscales.

Abbreviated assessment of psychopathology in patients with suspected seizure disorders.

PURPOSE: Psychopathology is common in patients undergoing investigation for seizure-related disorders. Psychometric examination using self-report instruments, such as the Symptom Checklist 90 - Revised (SCL-90-R), can assist diagnosis. The SCL-90-R, however, is a lengthy instrument and might not be tolerated by all patients. We assessed several abbreviated forms of the SCL-90-R in patients undergoing video encephalographic monitoring (VEM). METHOD: Six hundred eighty-seven patients completed the SCL-90-R, and scores were computed for the full SCL-90-R and five abbreviated forms. Correlations and mean differences were computed between different forms. Classification accuracy was assessed via receiver operating characteristic (ROC) curves, and measurements models were examined using confirmatory factor analysis (CFA). RESULTS: All abbreviated forms were strongly correlated with the SCL-90-R for general psychopathology (r = 0.93-0.99), depression (r = 0.89-0.95), anxiety (r = 0.97-0.98), psychosis (r = 0.95-0.99), and obsessive-compulsive symptoms (r = 0.97). Classification performance was similar across forms for depression and anxiety, with high negative predictive values (0.90-0.94) and lower positive predictive values (0.34-0.38). Classification performance for psychotic and obsessive-compulsive disorders was poor. Differences were observed between the full SCL-90-R and its abbreviated forms across most domains (d = 0.00-0.65). The published measurement model was most strongly validated for the SCL-27, SCL-14, and the SCL-K-9. CONCLUSIONS: These five SCL-90-R abbreviated forms show high convergent validity with the full version. In patients undergoing investigation for seizure-related disorders, the Brief Symptom Inventory full form (BSI) or short form (BSI-18) is most appropriate where screening for both depression and anxiety is required. The SCL-K-9 is appropriate when only a single measure of global psychological distress is required. None of the instruments were able to detect psychotic or obsessive-compulsive symptoms with great accuracy. Caution should be exercised when making direct comparisons across the different forms.

Crowdsourcing Trauma: Psychopathology in a Trauma-Exposed Sample Recruited via Mechanical Turk.

Although crowdsourcing websites like Amazon's Mechanical Turk (MTurk) allow researchers to conduct research efficiently, it is unclear if MTurk and traditionally recruited samples are comparable when assessing the sequela of traumatic events. We compared the responses to validated self-report measures of posttraumatic stress disorder (PTSD) and related constructs that were given by 822 participants recruited via MTurk and had experienced a DSM-5 Criterion A traumatic event to responses obtained in recent samples of participants recruited via traditional methods. Results suggested that the rate of PTSD in the present sample (19.8%) was statistically higher than that found in a recent systematic review of studies that used only traditional recruitment methods. The severity of PTSD reported in the MTurk sample was significantly greater than that reported in a college sample, d = 0.24, and significantly less than that reported in a veteran sample, d = 0.90. The factor structure of PTSD found in the MTurk sample was consistent with prevailing models of PTSD. Findings indicate that crowdsourcing may improve access to this hard-to-reach population.

Comparing the DSM-5 construct of Disruptive Mood Dysregulation Disorder and ICD-10 Mixed Disorder of Emotion and Conduct in the UK Longitudinal Assessment of Manic Symptoms (UK-LAMS) Study.

It is important to understand new diagnostic entities in classifications of psychopathology such as the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) (code F34.8) construct of Disruptive Mood Dysregulation Disorder (DMDD) and to compare it with possible equivalent disorders in other classificatory systems such as the International Classification of Diseases-10 (ICD-10), which has a category that superficially appears similar, that is, Mixed Disorder of Emotion and Conduct (MDEC) (code F92). In this study, the United Kingdom (UK) arm (UK-LAMS) of the US National Institute of Mental Health (NIMH) supported Longitudinal Assessment of Manic Symptoms (LAMS) multi-site study was used to evaluate and retrospectively construct DMDD and MDEC diagnoses in order to compare them and understand the conditions they co-occur with, in order to improve the clinical understanding. In particular, the phenomenology of UK-LAMS participants (n = 117) was used to determine whether DMDD is a unique entity within the DSM-5. The findings showed that 24 of 68 participants with either DMDD or MDEC (35.3%) fulfilled both diagnostic criteria for DMDD and MDEC, suggesting that these entities do contain overlapping features, particularly symptoms relating to Oppositional Defiant Disorder (ODD)/Conduct Disorder (CD), Attention Deficit Hyperactivity Disorder (ADHD)/Hyperkinetic Disorder (HKD) and/or an anxiety disorder. The data also showed that most of the participants who met DMDD criteria also fulfilled the diagnostic criteria for ODD/CD, ADHD, followed by an anxiety disorder. In this context, this raises the issue whether DMDD is a unique construct or whether the symptomology for DMDD can be better explained as a specifier for ODD/CD and ADHD. Unlike DMDD, MDEC clearly specifies that the label should only be used if emotional and conduct disorders co-exist.

Allowing for Psychosis to be Approachable and Understandable as a Human Experience: A Role for the Humanities in Psychotherapy Supervision.

Psychiatry and related mental health fields, in particular psychotherapy, have a long history of close ties with the humanities. That bond has weakened, however, over the last few decades as medicalized views of mental health and treatment have emerged. In this paper, we explore the potential of the reintroduction of the humanities, specifically novels and related literary genre, into the supervision of student clinicians working with clients who have psychosis. We believe that incorporation of novels and related literary genre into supervision can lead to unique and deepened understanding of the experience of psychosis, and can create an opportunity for a working therapeutic alliance. The potential mechanisms that create these unique opportunities to understand psychopathology are explored, and considerations for the implications for treatment, training, and future research are presented.

Screening for autism spectrum disorders with the brief infant-toddler social and emotional assessment.

OBJECTIVE: Using parent-completed questionnaires in (preventive) child health care can facilitate the early detection of psychosocial problems and psychopathology, including autism spectrum disorders (ASD). A promising questionnaire for this purpose is the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). The screening accuracy with regard to ASD of the BITSEA Problem and Competence scales and a newly calculated Autism score were evaluated. METHOD: Data, that was collected between April 2010 and April 2011, from a community sample of 2-year-olds (N = 3127), was combined with a sample of preschool children diagnosed with ASD (N = 159). For the total population and for subgroups by child's gender, area under the Receiver Operating Characteristic (ROC) curve was examined, and across a range of BITSEA Problem, Competence and Autism scores, sensitivity, specificity, positive and negative likelihood ratio's, diagnostic odds ratio and Youden's index were reported. RESULTS: The area under the ROC curve (95% confidence interval, [95%CI]) of the Problem scale was 0.90(0.87-0.92), of the Competence scale 0.93(0.91-0.95), and of the Autism score 0.95(0.93-0.97). For the total population, the screening accuracy of the Autism score was significantly better, compared to the Problem scale. The screening accuracy of the Competence scale was significantly better for girls (AUC = 0.97; 95%CI = 0.95-0.98) than for boys (AUC = 0.91; 95%CI = 0.88-0.94). CONCLUSION: The results indicate that the BITSEA scales and newly calculated Autism score have good discriminative power to differentiate children with and without ASD. Therefore, the BITSEA may be helpful in the early detection of ASD, which could have beneficial effects on the child's development.

Testing models of psychopathology in preschool-aged children using a structured interview-based assessment.

A number of studies have found that broadband internalizing and externalizing factors provide a parsimonious framework for understanding the structure of psychopathology across childhood, adolescence, and adulthood. However, few of these studies have examined psychopathology in young children, and several recent studies have found support for alternative models, including a bi-factor model with common and specific factors. The present study used parents' (typically mothers') reports on a diagnostic interview in a community sample of 3-year old children (n = 541; 53.9 % male) to compare the internalizing-externalizing latent factor model with a bi-factor model. The bi-factor model provided a better fit to the data. To test the concurrent validity of this solution, we examined associations between this model and paternal reports and laboratory observations of child temperament. The internalizing factor was associated with low levels of surgency and high levels of fear; the externalizing factor was associated with high levels of surgency and disinhibition and low levels of effortful control; and the common factor was associated with high levels of surgency and negative affect and low levels of effortful control. These results suggest that psychopathology in preschool-aged children may be explained by a single, common factor influencing nearly all disorders and unique internalizing and externalizing factors. These findings indicate that shared variance across internalizing and externalizing domains is substantial and are consistent with recent suggestions that emotion regulation difficulties may be a common vulnerability for a wide array of psychopathology.

Measurement and assessment of somatic symptoms.

Somatic symptoms are common presentations in health settings. They can manifest as symptoms of another underlying mental disorder or be termed as medically unexplained. When they are medically unexplained they are invariably subsumed under the diagnostic categories of somatoform disorders. They are associated with interference in functioning, poor quality of life and are burdensome on health resources. The measurement of these symptoms is essential for understanding the individual and planning treatment. There are various instruments that have somatic symptoms measurement in their items. The tools have included somatic symptoms measurement in measuring general psychopathology, somatic symptoms as part of anxiety and depression, somatic symptoms specifically, and as a screening instrument for somatoform disorders. The advantages and disadvantages of common measures have been discussed. It appears that no one measure fulfils the essential criteria of an ideal measure for somatic symptoms. The measures of somatic symptoms should also be culturally sensitive and serve diagnostic, prognostic and heuristic purposes. These aspects are highlighted in the review.

Somatization and somatic symptom presentation in cancer: a neglected area.

Abstract The recognition of somatization process in cancer patients is a challenging and neglected area, for the extreme difficulty in differentiating and assessing the psycho(patho)logical components from those biologically determined and related to cancer and cancer treatment, as well as for the scarce usefulness of rigid categorical DSM criteria. However, several dimensions of somatization (and the interconnected concept of abnormal illness behaviour) have been shown to be diagnosable in cancer patients and to negatively influence coping and quality of life outcomes. An integration of the formal DSM-ICD nosology with a system specifically taking into account the patients' emotional responses to cancer and cancer treatment, such as the Diagnostic Criteria for Psychosomatic Research (DCPR), is suggested. More data on some specific symptom dimensions, including pain, fatigue and sexual disorders, are needed to examine their possible psychological components. More research is also needed regarding the association of somatization with personality traits (e.g. type D distressed personality, alexithymia), developmental dimensions (e.g. attachment), and cultural issues (e.g. culturally mediated attributional styles to somatic symptoms). Also, the impact and effectiveness of specific therapeutic intervention in 'somatizing' cancer patients is necessary.

The Personality Psychopathology-Five (PSY-5): recent constructive replication and assessment literature review.

The Personality Psychopathology-Five (PSY-5; Harkness & McNulty, 1994) is a model of individual differences relevant to adaptive functioning in both clinical and non-clinical populations. In this article, we review the development of the PSY-5 model (Harkness, 1992; Harkness & McNulty, 1994) and discuss the ways in which the PSY-5 model is related to and distinct from other 5-factor models. Using different methods and measures, the dimensions of the PSY-5 model have been constructively replicated (Lykken, 1968) by Tackett, Silberschmidt, Krueger, and Sponheim (2008) and by Watson, Clark, and Chmielewski (2008), and dimensions congruent with the PSY-5 have even been suggested for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; Krueger et al., 2011). PSY-5 Scales can be scored from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher et al., 2001), the MMPI-Adolescent version (MMPI-A; Butcher et al., 1992), and the Restructured Form of the MMPI-2 (MMPI-2-RF; Ben-Porath & Tellegen, 2008). Because the largest body of research exists for the MMPI-2-based scales, we focus our review of the literature on the MMPI-2-based PSY-5 scales (Harkness, McNulty, & Ben-Porath, 1995), but we briefly cover the small, but growing, body of MMPI-A and MMPI-2-RF PSY-5 scales research. We show that the PSY-5 research literature includes a wide variety of psychometric methodologies as well as diverse samples and clinical problems. An integrative summary reprises the theory behind each PSY-5 construct and links it to the reviewed literature. Advantages and limitations of MMPI-2-based PSY-5 scales are discussed.

Examining the construct validity of the elemental psychopathy assessment.

Lynam and colleagues recently developed a new self-report inventory for the assessment of psychopathy, the Elemental Psychopathy Assessment (EPA). Using a sample of undergraduates (N = 227), the authors examined the construct validity of the EPA by examining its correlations with self and stranger ratings on the Five-Factor Model, as well as self-reported ratings of personality disorders, social cognition, and love styles. The EPA psychopathy scores manifested expected correlations with both self and stranger ratings of the Five-Factor Model, particularly with the domains of Agreeableness and Conscientiousness, and were significantly related to various forms of personality pathology such as narcissism and antisocial personality disorders. The EPA also manifested expected relations with aggressive social cognitions. Finally, the EPA psychopathy scores were correlated with romantic love styles indicative of game playing and infidelity. The current results provide further evidence of the construct validity of the EPA as it manifests relations consistent with the nomological network of psychopathy.

The Bern psychopathology scale for the assessment of system-specific psychotic symptoms.

The translation from psychiatric core symptoms to brain functions and vice versa is a largely unresolved issue. In particular, the search for disorders of single brain regions explaining classical symptoms has not yielded the expected results. Based on the assumption that the psychopathology of psychosis is related to a functional imbalance of higher-order brain systems, the authors focused on three specific candidate brain circuitries, namely the language, and limbic and motor systems. These domains are of particular interest for understanding the disastrous communication breakdown during psychotic disorders. Core symptoms of psychosis were mapped on these domains by shaping their definitions in order to match the related brain functions. The resulting psychopathological assessment scale was tested for interrater reliability and internal consistency in a group of 168 psychotic patients. The items of the scale were reliable and a principal component analysis (PCA) was best explained by a solution resembling the three candidate systems. Based on the results, the scale was optimized as an instrument to identify patient subgroups characterized by a prevailing dysfunction of one or more of these systems. In conclusion, the scale is apt to distinguish symptom domains related to the activity of defined brain systems. PCA showed a certain degree of independence of the system-specific symptom clusters within the patient group, indicating relative subgroups of psychosis. The scale is understood as a research instrument to investigate psychoses based on a system-oriented approach. Possible immediate advantages in the clinical application of the understanding of psychoses related to system-specific symptom domains are also discussed.

A new autopsy interview for the assessment of factors potentially related to death in depressed medical patients.

This study tests the reliability and validity of the Bio-Psycho-Social Autopsy (BPSA), a new interview to assess physical, psychopathological, and social factors potentially related to mortality in depressed medical patients. The authors completed special procedures to provide support for the face and content validity of the interview. They built the psychopathological and social sections on the Standardized Polyvalent Psychiatric Interview (SPPI) but gave self-neglect special emphasis. They tested the BPSA on close relatives of 48 deceased patients, both depressed and nondepressed. They calculated interrater reliability coefficients and took preliminary steps to document the construct validity by means of epidemiological and clinical variables. Interrater reliability coefficients were acceptable (M kappa = 0.82). In support of the construct validity, a multivariate analysis showed that BPSA items in the psychopathological section were able to differentiate the expected direction between deceased patients who were depressed and nondepressed. Therefore, the authors considered the BPSA interview to be a reliable assessment of factors potentially associated with death in depressed medical patients, and data presented support the validity of the psychopathological section.

Strength-based assessment in clinical practice.

Strength-based assessment can enhance clinical clarity, improve the range of information, and provide a more complete picture of clients and their circumstances. Deficit-oriented assessment has improved the assessment and treatment of a number of disorders but, at the same time, has created a negative bias, considered strengths as clinical peripheries or by-products, tended to reduce clients to diagnostic categories, and created a power differential, which could be counterproductive to clinical efficacy. Strength-based assessment explores weaknesses as well as strengths to effectively deal with problems. We present a number of strength-based strategies for use in clinical practice. These strategies, we hope, will help clinicians to operationalize how strengths and weaknesses reverberate and contribute to a client's psychological status, which is comprehensive and guards against negative bias.

Bias in psychopathology research.

PURPOSE OF REVIEW: Biases are frequently invoked in psychopathology research, either as core features of particular forms of psychopathology or as errors and distortions that affect psychiatric assessment, diagnosis, treatment, and research methodology. This review provides an overview of recent research on the forms of bias that are commonly examined in the field. RECENT FINDINGS: Recent research has made a number of advances in the analysis of cognitive and affective biases underpinning psychopathology: the effect of rating and other biases on psychiatric assessment and diagnosis; the role of race and gender in psychiatric practice; financial and institutional influences on psychiatric services; and several biases affecting research methodology, study design, and statistical inference. SUMMARY: Bias has several distinct meanings, and encompasses a disparate set of phenomena, so no over-arching conclusion about the place of bias in psychopathology research can be drawn. Recent work, however, makes solid progress toward a better understanding of systematic distortions and how they can be recognized and reduced.

Effect of response distortion on the assessment of divergent facets of psychopathy.

Recent evidence suggests that the Psychopathic Personality Inventory (PPI) is composed of two orthogonal factors, one representing traits such as dominance and low anxiety (PPI-I) and a second that reflects more socially deviant aspects of psychopathy (PPI-II). To assess whether response sets differentially affect these factors, the present research reanalyzed data from two dissimulation studies in which college students completed the PPI both honestly and with instructions either to "fake good" (n = 186) or "fake bad" (n = 143). PPI-II scores decreased significantly in the fake-good condition (d = -.86) and increased significantly when faking bad (d = 2.65). PPI-I scores were unaffected by attempts to feign serious psychopathology (d = .10) and actually increased in the fake-good condition (d = .53). These findings significantly qualify previous conclusions about the effect of response distortion on the PPI.