Major depression and personality disorder.

The authors examined an interview and paper-and-pencil assessment of the DSM-III personality disorders (PDs) in depressed inpatients, and depressed relatives of psychiatric patients and never-ill controls who had a lifetime history of major depression. The rates of PDs according to the Structured Interview for DSM-III Personality Disorders (SIDP) were similar in the two groups, except for borderline PD which was more frequent in the inpatients. Of the individuals with a PD, the patients were more likely than the relatives to have two or more PDs, and the borderline and histrionic patients were more prototypic of these disorders than were the borderline and histrionic relatives. In contrast to the SIDP results, the rates of PDs according to the Personality Disorders Questionnaire (PDQ) were higher in the patient sample. These results thus extend the previously described high rates of PDs in depressed patients to a sample of individuals with a lifetime history of treated or untreated depression, and they suggest that interview assessments of personality may be less sensitive to the state effects of depression than are questionnaires.

Diagnosing personality disorder in depressed patients. A comparison of patient and informant interviews.

Personality disorder (PD) diagnosis were made in 66 depressed patients based on independent interviews of the patient and a close informant. The patients and informants markedly differed in their descriptions of the patients' normal personality. The kappa coefficient of agreement for the diagnosis of any PD was .13, and all kappa values for the individual PD diagnoses were below .35. Informants reported more pathologic conditions than the patients, such that PDs were diagnosed in 57.6% (38/66) of the patients, based on the informant interview, and in 36.4% (24/66), based on the patient interview. We also examined dimensional scores. In general, we found only modest correlations between the patient and informant dimensional scores and that the ratings based on the informant interviews were higher. These results varied by specific PD diagnoses. Consensus ratings, which were based on both sources of information, were sometimes more strongly associated with patient information and sometimes with informant information, and this, too, varied among the different PDs.

The relationship between age and post-dexamethasone cortisol: a test of three hypotheses.

Previous studies report that DST nonsuppressors are older than normal suppressors. Data are presented on 188 primary unipolar major depressive inpatients and 35 healthy controls. In males, age appeared to correlate positively with post-dexamethasone cortisols in depressed patients and normal controls, although mean levels were higher in depressives. Female controls showed no consistent relationship between age and post-dexamethasone cortisol. A positive relationship did exist for depressed women. However, the association disappeared when age-of-onset was entered into the model, suggesting that in females early onset may identify a subtype of depression with normal DST suppression.

A self-report scale to diagnose major depressive disorder.

The Inventory to Diagnose Depression (IDD) is a self-report scale designed to diagnose DSM-III major depressive disorder (MDD). In our analysis, its test-retest reliability and internal consistency were high. The IDD was significantly associated with other self-report and interviewer rated depression scales and was sensitive to clinical change. Diagnostic agreement between the IDD and clinician's diagnosis of MDD was as high as that found in studies examining the interrater reliability of the diagnosis of MDD. Moreover, our results suggested that the IDD may aid clinicians in detecting secondary depression and distinguishing psychotic depression from nonaffective psychoses. The IDD may be particularly useful in light of the recent evidence that American psychiatrists continue to underdiagnose depression and overdiagnose schizophrenia.

ECT response in depressed patients with and without a DSM-III personality disorder.

Twenty-five inpatients with DSM-III major depressive disorder received ECT and were interviewed with the Structured Interview for DSM-III Personality Disorders. Patients with and patients without a personality disorder had similar short-term responses to ECT. The results of a 6-month prospective follow-up showed that depressed patients with a personality disorder were significantly more symptomatic and eight times more likely to be rehospitalized.

Assessment of DSM-III personality disorders: the importance of interviewing an informant.

The Structured Interview for DSM-III Personality Disorders was used to interview 82 patients. In addition, a close relative or friend of the patient was interviewed regarding each patient's normal personality. After the informant interview, the diagnosis of the presence or absence of any personality disorder was changed in almost 20% of the sample. In general, the information given by the informants revealed additional pathology in the patients and was less frequently used to retract a diagnosis. Despite conflicting information from the patients and informants, the reliability of personality disorder assessment remained high.

Evaluation of symptoms of major depressive disorder. Self-report vs. clinician ratings.

The authors examine the relationship between self-reported and interviewer ratings of individual symptoms of major depressive disorder. The overall rate of agreement between the self-reported and clinician ratings was about 80% for 14 of the 18 symptoms, and the median Kappa for determining the presence or absence of the symptoms was .62. Disagreement was greatest for psychomotor disturbance, decreased concentration, and indecisiveness. The authors discuss how the unreliability of interviewer assessments limits the amount of agreement between self-reported and clinician ratings.

A structured interview for the DSM-III personality disorders. A preliminary report.

With few exceptions, published studies fail to indicate that the DSM-III personality disorders can be distinguished from each other with respect to etiology, prognosis, treatment response, or family history. The Structured Interview for the DSM-III Personality Disorders (SIDP) was developed to improve axis II diagnostic reliability, and hence allow validity testing of axis II. Sixty-three subjects were independently rated by two interviewers using the SIDP. The kappa coefficients for interrater agreement reached .70 or higher for histrionic, borderline, and dependent personalities. While it is impossible to separate the validity testing of the SIDP from validity testing of the DSM-III personality criteria themselves, preliminary results from 102 inpatient SIDP interviews suggest some criterion-based validity with respect to standard personality rating scales and some construct validity with respect to the dexamethasone suppression test.

Symptom contamination of life event scales.

One hundred and seventy postpartum women completed the Social Readjustment Rating Scale (SRRS) and the Beck Depression Inventory (BDI). The point-biserial correlation between each item on the SRRS and the BDI was calculated. The four items identified by Lehman (1978) as being symptoms rather than life events per se were more highly correlated with the BDI than the remaining items. However, the correlation between the life event scale and the BDI was not significantly lowered after these items were removed. It is concluded that while life event scales should not include such symptom-like items, the contention made by some critics of the life event literature that all research using the Holmes and Rahe instrument is undermined soley because of the inclusion of these items, may be inappropriate.