ABSTRACT
Resumen El modelo dimensional alternativo para los trastornos de personalidad incluye 25 facetas (rasgos patológicos) organizadas en cinco dominios de orden superior (Desapego, Afectividad Negativa, Psicoticismo, Antagonismo y Desinhibición). Para evaluar este modelo, se desarrolló el Personality Inventory for DSM-5 (PID-5), que posee dos versiones: una extensa (220 ítems) que evalúa dominios y facetas, y una breve (25 ítems) que evalúa solo los dominios. En un trabajo anterior, se brindó evidencia favorable para una versión breve (31 ítems) adaptada para ser utilizada en población argentina. En el presente trabajo se estudian las propiedades psicométricas de una versión reducida y modificada del PID-5 que permite evaluar ambos componentes por medio de una cantidad de ítems (108). La validez convergente se evaluó a través de la relación con una medida de rasgos de personalidad normal del Modelo de los Cinco Grandes Factores. Se trabajó con una muestra de tipo no probabilística de n = 525 sujetos de población general, que respondieron la versión adaptada del PID-5 y el Listado de Adjetivos para Evaluar la Personalidad. Los resultados brindaron evidencia de validez y confiabilidad para el instrumento. El Análisis Factorial Exploratorio y Confirmatorio sugirió un buen ajuste de la estructura pentafactorial. La consistencia interna resultó adecuada y los ítems presentaron buenos índices de discriminación. Se observaron diferencias de género y edad, y correlaciones con los factores correspondientes de los cinco grandes. Esta versión puede ser utilizada para evaluar el modelo, con fines tanto clínicos como de investigación, y con ventajas respecto al tiempo de administración respecto a la versión extensa original.
Abstract The official classification of personality disorders in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) remains categorical. However, a dimensional alternative for personality disorders is presented as an emerging model. The model is organized in five higher order domains (Negative Affectivity, Detachment, Antagonism, Disinhibition and Psychoticism), with relationships with the Big Five Model of Personality, strongly established within the Personality Psychology. The proposal also includes 25 facets or second-order traits, included within the main domains. Domains and facets represent psychopathological traits with clinical relevance. To assess this model, the Personality Inventory for DSM-5 (PID-5) was developed. PID-5 has two forms: extensive (220 items) that assesses domains and facets, and brief (25 items) that assesses only the domains. In a previous study, evidence for a short version (31 items) adapted to the Argentine population was provided, that overcomes some of the limitations of the original one. In this work, the psychometric properties of a reduced and modified version of the PID-5 are studied, which allows evaluating five domains and 25 facets, through a reduced number of items (108). We worked with a non-probabilistic sample of n = 525 subjects from the general population, who answered the adapted version of the PID-5 and the Adjectives Checklist to Assess the Big Five Personality Factors (AEP), a Big Five Model measure. The following data analyses were performed: (1) Exploratory and Confirmatory Factor Analysis to evaluate the internal structure of PID-5; (2) reliability analysis to assess the internal consistency of the PID-5 scales; (3) item analysis to assess discriminating power; (4) multivariate analysis of variance (MANOVA) to examine significant differences due to gender and age; and (5) bivariate correlation analysis to analyze PID-5 convergent validity. The results provided evidence of validity and reliability. Exploratory and Confirmatory Factor Analysis suggested a five-factor structure. The facets presented factor loadings in the domain theoretically expected, with some exceptions: Suspiciousness (loaded in Psychoticism), Hostility (loaded in Disinhibition), Depressivity (loaded in Detachment) and Insensitivity (loaded in Detachment). CFA also suggested a good model fit (CFI = .98; RMSEA = .04; SRMR = 0.083). Psychoticism, Detachment, and Disinhibition facets had their higher factor loadings in the expected domain. Negative affectivity showed higher correlations with the rest of the scales. Internal consistency was satisfactory, especially at the domain level, and the items had good discrimination indices. Correlations with the corresponding of the Big Five factors were observed, similar to previous studies. The five PID-5 domains were also found positively correlated. Additionally, gender and age differences were found. In line with previous literature, results suggest that some facets scales are "pure" markers of these domains (e. g., Psychoticism and Antagonism facets), whereas others (e. g., Negative Affectivity facets such as Depressiveness, Suspicion, Hostility), are located "in between" domains since they share features of more than one domain. Psychoticism facets presented higher loadings in their domains and lower in the rest. This is not surprising; although most of psychopathology cannot be understood as categories, schizophyte and Schizotypal Personality Disorder are exceptions, and Psychoticism would be the representation of these categories in the APA model. Findings also provide evidence of convergent validity for the instrument, as well as theorical evidence regarding the relationship between normal and pathological personality traits. This version can be used to evaluate the model, both in research and clinical practice. It has advantages over the original longer version, in terms of administration time and participants' fatigue, while maintaining its psychometric properties. The results are also expected to contribute to the recent literature on the dimensional approach to personality psychopathology. However, complementary studies, particularly with a clinical population, are needed.
ABSTRACT
The diagnosis of personality disorders was formally presented in the first edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-1). DSM-3 proposed a systematic framework for understanding personality disorders, and mentioned the multi-axis diagnosis strategy and category diagnosis criteria. The following editions of DSM still mentioned the strategy and criteria. DSM-5, published in 2013, mentioned the alternative model for personality disorders (AMPD), which indicated a new direction in the diagnosis and assessment of personality disorders. AMPD had a dimensional assessment of the severity of personality pathology (criterion A), and a dimensional assessment of features of personality pathology (criterion B). The criterion A was influenced by the concepts of psychodynamics, like the distinction and integration of self and object in the Kernberg model of personality organization. Level of Personality Functioning Scale (LPFS) and Personality Inventory for DSM-5 were developed to assess personality disorders mentioned in AMPD. The reliability and validity of the tools were demonstrated. Structured Interview of Personality Organization, an assessment tool based on Kernberg model of personality organization, was proved to have significant correlation with LPFS.
ABSTRACT
Objective To investigate the characteristics of strains of AmpC β-lactamase(AmpC enzyme)production in Dathogenic bacteria in blood stream and clinical presentations of the cases, and study the related ampC and ampD genes.Methods One hundred and eighty-one strains of gram negative bacillus in blood stream were collected,Cefoxitin screening test and three-dimensional test were performed for screening of strains of AmpC enzyme,production and those of AmpC enzyme hyperproduction retrospective analysis was condected in the strains with positive results.ampC and ampD gene PCR ampliftcation, sequencing and sequence analysis of positive strains were performed, and gene homology of ampC positive strains was analysed bv Rep-PCR. Results Among 181 strains in blood stream,strains of AmpC enzyme production were detected in 39 isolates by Cefoxitin screening test,with the detection rate of 21.5%(39/181).The detection rate of strains of AmpC enzyme hyperproduction by three-dimensional test was 43.6%(17/39).PCR revealed that the positive rates for ampC and ampD genes were 41%(16/39)and 56.4%(22/39),respectively.The ampC gene sequencing of 16 positive strains indicated that the homology was 98%to 100%by comparison with the GenBank,while the ampD gene sequencing of 2 strains of Enterobacter cloacae demonstrated that the suspected gene mutations existed in the carboxy-terminal of ampD gene. Conclusion The prevalence of drug-resistant pathogenic bacteria in blood stream in this study is due to nosocomial infection.The mutation of ampC gene is rare in the pathogenic bacteria in blood stream with production of AmpC enzyme,while the rate of gene mutation in Enterobacter cloacae is higher, and the deletion and amino acid substitutions in the carboxy-terminal of ampD is highly relevant to the depressed expression of AmpC enzyme.
ABSTRACT
Objective To investigate the influence of plasmid spread and ampD mutation to Enterobacter cloacae that leads to the AmpC β-lactamase change from inducible type to constitutive type. Methods The Enterobacter cloacae were isolated from the patients with nosocomial infection. The inducible type isolations and their constitutive type changers were put into the same group. The plasmid ampC gene and chromatin ampD gene in pairs in each group were amplified, sequenced and compared. Results Of 195 patients infected by Enterobacter cloacae of inducible type, 25 (12.82%) were changed to the ones of constitutive high type. In these 25 changed groups, 10 were caused by plasmid spread, 10 by ampD mutation, 1 by both, and 4 by neither. Twelve changed constitutive type strains had ampD significant mutations, in which 7 were frame-shift mutations and 5 were spot mutations. Conclusions The change ratio of Enterobacter cloacae from inducible type to constitutive type is rather high. Both plasmid spread and ampD mutation are possibly the mechanism of such change. Plasmid mediated AmpC β-lactamase spreads among different species and interregionally. The mutation rate of chromatin ampD gene is also higher than the natural mutation rate. These two mechanisms should be considered in clinical treatment.