[A dimensional diagnostic approach using the "Assessment of DSM-IV Personality Disorders (ADP-IV)" Questionnaire]. / Dimensionale Diagnostik mit dem Fragebogen zur Erfassung von DSM-IV-Persönlichkeitsstörungen (ADP-IV).

OBJECTIVES: The ADP-IV is a self-assessment instrument of personality disorders providing categorical as well as dimensional diagnoses. The German translation of the Dutch original has already shown sufficient reliability as well as a rather weak convergent validity of categorical diagnoses. This study investigates the validity of the dimensional assessment of personality disorders. METHODS: Four hundred patients and a community sample of 385 subjects completed the ADP-IV. A SCID-II interview and an expert consensus rating were also performed in 210 patients. Norms for patients and the community sample were calculated by using z-transformation. Receiver operator curves (ROC) were employed for the determination of cut-offs for categorical diagnoses on the basis of the dimensional scores. RESULTS: The ROC analyses resulted in negative predictive values of 99 % for the five most frequent personality disorders in the sample; in contrast, positive predictive values were low. CONCLUSIONS: The instrument is well suited for screening purposes, allowing for a reliable exclusion of personality disorders. For diagnosing personality disorders, however, clinical interviewing remains necessary. Norms and a dimensional personality disorder profile provide hints concerning the presence of pathological personality traits with respect to the reference group. The ADP-IV represents the only German-language questionnaire for the assessment of DSM-IV personality disorders which has been sufficiently validated. It is freely available on the internet at http://zmkweb.uni-muenster.de/einrichtungen/proth/dienstleistungen/psycho/diag/index.html.

[Validation of the "Assessment of DSM-IV Personality Disorders (ADP-IV)" Questionnaire]. / Validierung der deutschen Version des Fragebogens zur Erfassung von DSM-IV Persönlichkeitsstorungen (ADP-IV).

OBJECTIVES: The "Assessment of DSM-IV Personality Disorders (ADP-IV)" represents a 94-item questionnaire that allows for a categorical and dimensional assessment of the DSM-IV personality disorders. METHODS: Psychometric properties of the German ADP-IV were investigated in 400 psychotherapy outpatients and a community sample of 385 persons. The SCID-II interview and a standardised expert consensus rating were employed for the assessment of concurrent validity. RESULTS: The ADP-IV showed satisfactory reliability; the median Cronbach's alpha for the subscales was .76 (range .65-.87), the median retest reliability .79 (range .37-.88). Factor analysis revealed an 11-factor solution that explained 49.4% of the variance. The median correlation of the dimensional ADP-IV subscale scores with the SCID-II and the expert consensus ratings were .51 (range: .34-.72) and .44 (range: .27-.62), respectively. The kappas for the chance corrected agreement of categorical ADP-IV diagnoses with the SCID-II diagnoses and the expert ratings were .35 and .29 for any personality disorder and a median of .37 and .30 for the specific personality disorders. CONCLUSIONS: The ADP-IV shows satisfactory reliability and a validity that is comparable and partly superior to other self-rating instruments. The advantages of the instrument are its brevity, the inclusion of distress ratings, and the dimensional scoring that allows for the construction of detailed profiles of personality pathology. Moreover it is freely available in the internet: (http://zmkweb.uni-muenster.de/einrichtungen/proth/dienstleistungen/psycho/diag/index.html).

[Predictors of successful psychotherapy referral in a psychotherapy outpatient clinic and subsequent psychotherapeutic outcome]. / Prädiktoren des Uberweisungserfolgs einer psychotherapeutischen Klinikambulanz und des späteren Therapieverlaufs.

OBJECTIVES: Many patients are referred to psychotherapy by outpatient units of psychiatric hospital departments. This study investigates predictors of success and outcome of subsequent psychotherapy in this group of patients. METHODS: Two years after referral, 140 out of an initial sample of 215 patients of a psychotherapy outpatient unit were followed up by means of a telephone interview and questionnaires (GHQ, IIP). In addition, their therapists were interviewed. RESULTS: 57.1% of the patients actually began psychotherapy; of these, 67.5% completed or were continuing the treatment. Predictors of referral success were younger age, female gender, higher levels of depression, a less competitive, subassertive, nurturant, and expressive personality style, and a preexisting high motivation for psychotherapy. In the total sample of 140 patients there was a significant improvement of psychopathology (0.54 < d < 0.99), interpersonal problems (0.25 < d < 0.33), and subjective experience of symptoms (d = 0.26). Patients who began psychotherapy did not show a significantly better outcome after two years compared to those who were non-compliant. CONCLUSIONS: Randomized-controlled studies are not comparable to regular outpatient treatment. Patients who did not begin psychotherapy despite referral might have been stabilized by the initial brief intervention they received at the psychotherapy outpatient unit, and consequently did not feel the need for any additional psychotherapy. This group of patients should be identified before being referred and offered a short-term psychotherapy at the outpatient unit.