Obsessive-compulsive disorder and the five-factor model of personality: distinction and overlap with major depressive disorder.

Research on individual differences in obsessive-compulsive disorder (OCD) has focused largely on analogue models with participants experiencing sub-clinical obsessions and/or compulsions. Few studies have examined the association between normal, dimensional personality traits and obsessive-compulsive symptomatology in a clinical sample. The purpose of this study was to examine personality differences in patients with a primary diagnosis of OCD (n = 98) or major depression (n = 98) using the domains and facets of the five-factor model of personality (FFM). Patients completed the self-report version of the Revised NEO Personality Inventory (NEO PI-R). When contrasted with community controls (Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual, Psychological Assessment Resources, Odessa, FL, 1992), participants with OCD were found to differ across the domains (and facets) of neuroticism, extraversion, and conscientiousness and the facets of openness and agreeableness. Further, when compared to depressed participants, those with OCD were found to be more extraverted, agreeable, conscientious and less neurotic. With the exception of the conscientiousness domain (and facets), these significant differences were maintained even after controlling for depression severity. These results highlight the unique associations between trait domains and facets of the FFM and OCD.

Cognitive behavioral therapy for schizophrenia: an empirical review.

Early case studies and noncontrolled trial studies focusing on the treatment of delusions and hallucinations have laid the foundation for more recent developments in comprehensive cognitive behavioral therapy (CBT) interventions for schizophrenia. Seven randomized, controlled trial studies testing the efficacy of CBT for schizophrenia were identified by electronic search (MEDLINE and PsychInfo) and by personal correspondence. After a review of these studies, effect size (ES) estimates were computed to determine the statistical magnitude of clinical change in CBT and control treatment conditions. CBT has been shown to produce large clinical effects on measures of positive and negative symptoms of schizophrenia. Patients receiving routine care and adjunctive CBT have experienced additional benefits above and beyond the gains achieved with routine care and adjunctive supportive therapy. These results reveal promise for the role of CBT in the treatment of schizophrenia although additional research is required to test its efficacy, long-term durability, and impact on relapse rates and quality of life. Clinical refinements are needed also to help those who show only minimal benefit with the intervention.

The content and structure of schizotypy: a study using confirmatory factor analysis.

This study examined the content of subscales within a multidimensional scale of self-reported schizotypy and their subsequent interrelationship by means of confirmatory factor analysis (CFA). Neither single-factor nor four-factor models provided good fits to the data; two-factor and three-factor models showed very good fits. On closer look, the three-factor solution was, overall, marginally the best fit and gave credence to a model with positive schizotypy, negative schizotypy, and social impairment as the factors. This model was in contrast to those that have disorganization as the third factor. In the present study, the subscale of disorganization loaded on the factor of positive schizotypy. The three-factor solution proposed here may be seen as giving support to the structures advocated by Meehl (1962), Strauss et al. (1974), and Lenzenweger et al. (1991).

Cognitive therapy of schizophrenia: a new therapy for the new millennium.

Over the past decade, major advances have been made in extending the principles and therapeutic strategies of cognitive therapy to the treatment of schizophrenia. In a number of large-scale outcome studies with cognitive therapy for schizophrenia, cognitive therapy has been shown to offer significant gains for those patients who have not been wholly helped with medications. It may even serve to prevent the consolidation of the illness if delivered with those in the early stage of the illness. We first outline the "state-of-the-art" conceptualization and strategies employed by cognitive therapists to treat positive and negative symptoms and then review the clinical trials.

Is self-criticism unique for depression? A comparison with social phobia.

BACKGROUND: This study further examined the diagnostic specificity of the self-critical personality dimension, as measured by the Depressive Experiences Questionnaire (DEQ; Blatt et al., 1976. The Depressive Experiences Questionnaire. Yale University Press, New Haven). METHODS: Patients with major depression (n=26) were compared to social phobia patients (n=32). RESULTS: Depressed patients scored significantly higher on the DEQ Self-Criticism dimension. However, when current level of depressed mood was controlled for, self-criticism was not a significant predictor of diagnostic status. Further, the level of DEQ self-criticism reported by patients with social phobia was almost three times greater than the level reported in an earlier diagnostic specificity study with panic disorder patients [Bagby et al., 1992. Diagnostic specificity of the dependent and self-critical personality dimensions in major depression. J. Affect. Disord. 26, 59-64]. LIMITATIONS: Only one measure of self-criticism was used in this study, and the research design was cross-sectional rather than prospective. CONCLUSIONS: Self-criticism is not unique to major depression, and this personality dimension may be implicated in other forms of psychopathology [Blatt, 1991. A cognitive morphology of psychopathology. J. Nerv. Ment. Dis. 179, 449-458]. Some cognitive features believed to play an important role in depression may also be salient in persons with social phobia.

Rumination and distraction in major depression: assessing response to pharmacological treatment.

BACKGROUND: Response style theory of depression (RST) predicts that individuals who ruminate in response to their depressed mood will suffer an amplification and prolongation of that mood, whereas individuals who engage in distraction responses will alleviate and attenuate their depressed mood. RST has been shown to predict prolonged depression in samples of non-clinical, untreated individuals with mild to moderate depression but has not been tested in samples of depressed patients undergoing treatment. OBJECTIVE: In this preliminary investigation we examined: (1) whether RST predicts non-response to pharmacotherapy with outpatients suffering from major depression, and (2) whether distractive and ruminative responses are associated with clinical variables hypothesized to be associated with them. METHODS: Eighty-nine depressed outpatients being treated with standard antidepressant pharmacotherapy were administered the Response Style Questionnaire, a scale designed to measure rumination and distraction, prior to treatment. RESULTS: Distraction, but not rumination, predicted change in depression severity over the course of treatment and overall treatment outcome. Neither rumination nor distraction was associated with previous number of depressive episodes or duration of current depressive episode. DISCUSSION: These results provide only partial support for RST as a predictor of treatment response. Future investigations are needed to determine if rumination and distraction are predictive of recurrent depressive episodes in recovered depressed patients. LIMITATIONS: As the data in this study was retrieved from a clinical database, the conclusions of this report must be viewed tentatively. Replication with other clinical samples is needed.

Negative attributional style in seasonal and nonseasonal depression.

OBJECTIVE: There is a substantial relationship between dysfunctional cognitions and the clinical course of major depression. This study examined whether this association extends to patients with seasonal affective disorder. METHOD: A revised version of the Attributional Style Questionnaire was used to assess negative attributional style and predict response to treatment in a group of depressed outpatients, 26 with seasonal depression and 30 with nonseasonal, unipolar major depression. RESULTS: Pretreatment scores on negative attributional style did not differ between the patients with seasonal affective disorder and those with nonseasonal depression. Negative attributional style predicted poor response to pharmacotherapy in the nonseasonal depression group but did not predict response to light therapy in the group with seasonal affective disorder. CONCLUSIONS: Dysfunctional cognitions may play a lesser role in seasonal affective disorder than in nonseasonal depression.

Self-report ratings and informants' ratings of personalities of depressed outpatients.

OBJECTIVE: This study sought to determine whether personality traits of depressed patients could be assessed similarly by informants and self-reports of the patients themselves. METHOD: Forty-six depressed outpatients completed the self-report (first-person) version of the Revised NEO Personality Inventory and nominated informants who knew them well to complete the third-person version of that instrument. RESULTS: Agreement between the self-ratings and informants' ratings on the five factors of the inventory--neuroticism, extraversion, openness-to-experience, agreeableness, and conscientiousness--was high. The only significant difference between the self-ratings and informants' ratings was on the extraversion scale, where the patients rated themselves as significantly more introverted than did the informants. CONCLUSIONS: Informants' ratings of personality are similar to self-report ratings of depressed patients. Depressed mood may not influence the self-report of personality traits.

Detecting feigned depression and schizophrenia on the MMPI-2.

Increasingly, investigations evaluating the effectiveness of the MMPI-2 in the assessment of malingering employ methodologies whereby research participants are asked to feigned specific disorders rather than just to "fake bad." Yet there is little research addressing the issue of whether different validity scales and indicators work differently in the detection of different feigned disorders. In this study the comparative effectiveness of a number of validity scales and indicators on the MMPI-2 to assess feigned depression and feigned schizophrenia were evaluated. Overall, the validity scales and indicators were better at detecting feigned schizophrenia than they were in detecting feigned depression, attributable, most likely, to closer familiarity with depressive experiences. The validity scales F, Fb, and F(p) best distinguish patients with schizophrenia from participants feigning schizophrenia, and F and Fb best distinguish patients with depression from participants feigning depression.

Relationship between the five-factor model of personality and unipolar, bipolar and schizophrenic patients.

The purpose of this study was to examine personality differences among three different Axis I disorders-recovered patients with unipolar depression (n = 62), euthymic patients with bipolar disorder (n = 34), and patients with schizophrenia in the residual phase of their illness (n = 41) using the five-factor model of personality (FFM). The dimensions of the FFM-Neuroticism (N), Extraversion (E), Openness (O), Agreeableness (A), and Conscientiousness (C)-were measured with composite scores derived from the NEO Personality Inventory (NEO PI) and the Revised NEO Personality Inventory (NEO PI-R). While no group differences emerged on N or C, the bipolar patients scored significantly higher on the Positive Emotion facet (subscale) of E than the unipolar patients. The schizophrenic patients scored lower on the Feelings, Values and Actions facets of O than did the unipolar and bipolar patients. The unipolar patients scored higher on A than the schizophrenic patients.

The assessment of competence to make a treatment decision: an empirical approach.

OBJECTIVE: To compare physicians' judgements of competency in routine clinical practice with the findings obtained from a structured clinical interview. METHODS: Ninety-six patients referred for electroconvulsive therapy were administered the Competency Interview Schedule (CIS) prior to their first treatment. Cluster analysis was employed to categorize patients to 1 of 5 cluster centres represented by case studies previously judged competent or incompetent by lawyers and health professionals. RESULTS: A match-mismatch table revealed 88% (N = 66) of the 75 patients found competent by the attending physician and 90.5% (N = 19) of the 21 patients found incompetent by the attending physician were classified in agreement with the CIS. The 9 misclassified patients found competent by the attending physician but classified incompetent by the CIS had consented to treatment. The 2 misclassified patients found incompetent by the attending physician but classified competent by the CIS had refused treatment. Examination of individual item scores from the CIS indicated that, in some cases, a different standard of competency was applied in routine clinical practice depending upon the patient's treatment decision. CONCLUSIONS: The CIS is presented as a useful guide for clinicians with an interest in competency evaluations but caution is advised in using the instrument to make formal evaluations of competency owing to the imprecise definition of competency in various jurisdictions.

The psychometric properties of the Competency Interview Schedule.

One of the most contentious issues in medical and legal practice is how to reliably assess the mental competence of individuals who consent or refuse psychiatric treatment. Current legislation does not provide clear definitions of what constitutes competence or incompetence to make a treatment decision. As a preliminary attempt to operationalize the concept of competency, we have developed a 15 item questionnaire. The present study reports on the psychometric properties of the instrument. Test-retest and interrater reliability results were good. The instrument was internally consistent and discriminated between individuals found competent and incompetent by the treating physician.

Biological and psychosocial predictors of job performance following a first episode of psychosis.

OBJECTIVE: The purposes of this study were 1) to evaluate occupational functioning 18 months after a first episode of psychosis and 2) to determine predictors of differential outcome. METHOD: Using a variety of sociodemographic, clinical, and psychophysiological measures, the project team assessed adults experiencing a first episode of schizophrenia (N = 33) or affective psychosis (N = 31). Identical measures were obtained from a comparison group (N = 46) who had no history of psychiatric disorder. Work performance was rated at entry into the study and 18 months later. RESULTS: At entry into the study, the schizophrenic subjects displayed the worst job performance, the asymptomatic individuals the best. The subjects with affective psychosis fell in between. Each of the two diagnostic groups evidenced postmorbid occupational decline. Three factors predicted good outcome in the schizophrenic group--good premorbid job performance, female gender, and scores on putative markers of biological vulnerability for the illness. For the affective disorder group, positive labeling by a significant other proved the only predictor of good outcome. CONCLUSIONS: These findings suggest that post-morbid occupational decline is common to both schizophrenia and affective psychosis. Past accomplishment and biological vulnerability predicted short-term course for these schizophrenic patients; psychosocial factors played a more prominent role in affective psychosis.

Numbers and quality of oocytes after induction of multiple folliculogenesis in women and in mice with different lots of human menopausal gonadotropins.

OBJECTIVE: To develop a murine in vivo bioassay that is sensitive to inherent variability of hMG. DESIGN: Female F1 hybrid mice were mated after injection with fixed dosages of each of four lots of hMG. Oocytes/embryos were collected and monitored during 5 days of culture. Outcome measures were compared with retrospective outcomes of ovarian stimulation of women with the same hMG lots. The bioassay was then used to compare biopotencies of six different lots of hMG. SETTING: Center for assisted reproductive technology. INTERVENTIONS: None. PATIENTS: Outcomes of controlled ovarian stimulation and IVF were retrospectively analyzed from 43 patients. MAIN OUTCOME MEASURES: Numbers of oocytes/embryos recovered, numbers fertilized, and numbers progressing beyond fertilization. RESULTS: Differences in biopotencies of hMG lots in the murine in vivo bioassay were consistent with differences in outcomes of patients treated with the same hMG lots during controlled ovarian stimulation. Bioassay outcomes also differed between different lots of hMG. CONCLUSION: The bioassay described in this study is sensitive to between-lot differences in hMG that affect follicle recruitment and oocyte quality in women (and in mice). In this respect, the bioassay could be of value in screening hMG lots, before its exploitation in a patient population. One such application is explored.

Current cannabis use and tardive dyskinesia.

The aim of this study was to examine the relationship between substance abuse and tardive dyskinesia (TD) in 51 chronic, neuroleptic-treated, community outpatients with a DSM-III-R diagnosis of schizophrenia. In the presence of a clinical researcher, subjects completed a questionnaire on past and current alcohol and drug use, and provided information pertaining to variables which have, in the past, been implicated in the development of TD: smoking habits, caffeine consumption, and current neuroleptic dose. Subjects were also administered the Abnormal Involuntary Movement Scale (AIMS) in an interview format with either two or three trained raters present in the room. Consistent with previous reports, our results indicated a trend for females and older patients with a longer duration of illness to show elevated scores on the AIMS. In a hierarchical multiple regression analysis, however, cannabis use was found to correlate best with the presence of TD, out-ranking other putative factors.

Auditory hallucinations in women and men.

The total population of a community schizophrenia registry sample yielded information about the relative lifetime frequency of hallucinations in women and men. Whereas hallucinations in non-auditory modalities were equally distributed between the two sexes, auditory hallucinations were significantly more common in women. These results will be considered in relation to the existing literature on hallucinations and gender.