Engagement in posttraumatic stress disorder treatment for veterans who experienced military sexual trauma and are diagnosed with serious mental illness.

It is important to ensure that veterans who have experienced military sexual trauma (MST) and have posttraumatic stress disorder (PTSD) have access to trauma-focused treatment. For veterans with serious mental illness (SMI), prior work documents decreased likelihood to receive trauma-focused care. This study focused on evaluating the engagement of Veterans Health Administration (VHA) patients diagnosed with PTSD and who have experienced MST in PTSD specialty care, as well as how this differs for veterans with SMI. Using VHA administrative data, all VHA patients who screened positive for MST prior to fiscal year 2019 (FY2019) were identified (N = 84,503). Based on information from FY2019, measures of psychiatric diagnosis status and VHA treatment participation were generated for all cohort members. Logistic regressions assessed whether there were differences in the likelihood to initiate PTSD care (1+ VHA PTSD specialty clinic encounter) or receive guideline-concordant levels of PTSD specialty care (8+ VHA PTSD specialty clinic encounter) during FY2019. Several other patient characteristics associated with decreased likelihood to receive VHA PTSD specialty servies were identified, including White race and older age. Patient SMI status was not significantly associated with likelihood to initiate or receive guideline-concordant levels of PTSD specialty care. Overall, PTSD treatment initiation was low (11% of veterans with SMI initiated PTSD specialty treatment, as opposed to 10% of veterans without SMI). Additional work is merited to identify ways that VHA is able to overcome barriers to trauma care participation experienced by persons who have experienced MST and been diagnosed with PTSD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Mortality and suicidality in veterans health administration patients with newly-identified early episode psychosis.

Within the Veterans Affairs (VA), management of self-harm is a major clinical priority. However, there is limited information on risks for self-harm among VA patients with emerging psychotic disorders relative to VA patients with other emerging mental health conditions. Using information from fiscal years 2010 through 2018, a national cohort of VA patients 30 or younger was classified based on mental health diagnoses into three groups: 1) early episode psychosis (EEP), 2) non-early episode psychosis mental health (non-EEP MH), or 3) no mental health (no MH). Analyses focused on cohort members' risk for all-cause mortality, suicide mortality, and non-fatal suicide attempts (NFSA) during the year following initial diagnosis of mental health conditions (or first year of VA care, for the no MH group). In unadjusted analyses, the EEP group had elevated rates of all-cause mortality, suicide mortality, and NFSA relative to the non-EEP MH and no MH groups and the non-EEP MH had elevated rates of all-cause mortality, suicide mortality, and NFSA relative to the no MH group. After adjusting for demographics and care receipt, EEP status was unrelated to all-cause mortality but associated with increased suicide mortality risk and NFSA. Non-EEP MH status was associated with reduced risk of all-cause mortality but increased risk for NFSA. In the year following first diagnosis, VA patients with EEP are at increased risk for suicide mortality and self-harm even after accounting for other risk factors. Clinical services targeting this crucial time can help promote safety for this vulnerable group.

Borderline personality disorder traits and rates of NSSI during the COVID-19 pandemic: An initial investigation.

Objective: The current study evaluated frequency of nonsuicidal self-injury (NSSI) and associated maladaptive traits between three time periods: pre-pandemic, early pandemic, and later pandemic. Participants: Two college student samples (n = 362; n = 337) were collected via two online studies. Method: Participants completed measures assessing maladaptive borderline personality traits, engagement in NSSI over the past month, and reasons for and types of NSSI engaged in across the lifetime. Results: Results demonstrated a stable and potentially a slight increase in general rates of NSSI over the course of the pandemic. Further, specific maladaptive traits that underly borderline personality disorder (i.e., despondence, fragility, self-disturbance, and anxious-uncertainty) were related to engagement in NSSI 1-month post COVID. Conclusion: The study highlights the need for added interventions that might reach at risk populations during these heightened periods of stress.

Attitudes, Clinical Practices, and Perceived Advocacy Needs of Professionals With Interests in Personality Disorders.

Experts in personality disorders (PDs) generally prefer dimensional diagnostic systems to categorical ones, but less is known about experts' attitudes toward personality pathology diagnoses in adolescents, and little is known about public health shortfalls and advocacy needs and how these might differ geographically. To fill these gaps, the International Society for the Study of Personality Disorders surveyed 248 professionals with interests in PDs about their attitudes toward different diagnostic systems for adults and adolescents, their PD-related clinical practices, and perceived advocacy needs in their area. Results suggested that dimensional diagnostic systems are preferable to categorical and that skepticism about personality pathology in adolescents may not be warranted. The most pressing advocacy need was the increased availability of PD-related services, but many other needs were identified. Results provide a blueprint for advocacy and suggest ways that professional societies can collaborate with public health bodies to expand the reach of PD expertise and services.

Piloting an Interprofessional Narrative-Based Interactive Workshop for End-of-Life Conversations: Implications for Learning and Practice.

BACKGROUND: Based on the principles of Narrative Medicine, this study explored a narrative-based workshop for multi-level interdisciplinary clinicians who have EOL conversations. METHODS: Fifty-two clinicians participated in narrative-based interactive workshops. Participants engaged narrative in three forms: viewing narratives, writing/sharing narratives, and co-constructing narratives. Post workshop interviews were conducted and thematically analyzed. RESULTS: Five themes characterized how the workshop shaped learning and subsequent care experiences: (1) learning to enter/respond to the patient stories, (2) communicating across professions and disciplines, (3) practicing self-care. Additional themes emphasized (4) barriers to narrative learning and (5) obstacles to applying narrative to practice. DISCUSSION: Results highlight the function/utility of narrative forms such as the value of processing emotions via reflective writing, feeling vulnerable while sharing narratives, and appreciating colleagues' obstacles while observing patient-clinician simulations. Challenges associated with narrative such as writing anxiety and barriers to implementation such as time constraints are detailed to inform future initiatives.

Veterans affairs serious mental illness patients: Differences in high-intensity service use by personality disorder status.

Individuals with serious mental illnesses (SMI) or personality disorders (PD) have complex treatment needs and are at risk of adverse outcomes. Yet, little is known about the impact of comorbid SMI and PD on risk factors. This study used the Veterans Health Administration (VHA)'s corporate data warehouse (CDW) to assess the differences between those with and without a comorbid PD, as well as the prevalence and impact of PD diagnoses on high-intensity/emergency service utilization in VHA patients with a SMI diagnosis (schizophrenia spectrum disorders and bipolar spectrum disorders). In fiscal year 2018, 163,904 VHA patients had encounters that listed SMI diagnoses, including 9,216 patients who had encounters that listed PD diagnoses. Bivariate analyses and logistic regression were used to compare group characteristics and determine whether a PD diagnosis was associated with utilization of high-intensity care services. The SMI with no PD and SMI with comorbid PD (SMI-PD) groups differed in terms of demographic, medication, clinical, and service utilization characteristics, including that the SMI-PD group was 5.25 times more likely to have documented suicide risk and 4.73 times more likely to have documented behavioral risk. After controlling for multiple patient characteristics, patients in the SMI-PD group were 1.35 times more likely to have some emergency department (ED) utilization and 1.94 times more likely to have some inpatient mental health use. Having a diagnosed comorbid PD was associated with increased prevalence of medical and psychiatric problems. Findings suggest that patients with comorbid PDs have particularly high-treatment needs and may benefit from assessment of, and adapted treatments for, PDs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Predictors of High-Intensity Psychiatric Service Utilization by Veterans Health Administration Patients With Early Psychosis.

OBJECTIVE: People with early episode psychosis (EEP) have more negative care outcomes than do people with later episode psychosis (LEP), including higher levels of high-intensity psychiatric service use. It is unclear whether these differences are best explained by clinical differences between these two groups or whether people with EEP have specific treatment needs. An assessment of the treatment needs of patients with EEP can help inform the implementation of national treatment programming designed to provide better care to this group. METHODS: Administrative data were used to compare characteristics of Veterans Health Administration patients who had EEP (i.e., a psychotic diagnosis, diagnosis history of ≤4 years, and age ≤30 years; N=4,595) with those with LEP (i.e., a psychotic diagnosis, longer diagnosis history, and older age; N=108,713) who received care during a 1-year evaluation period. The authors generated logistic regressions to assess the potential impact of EEP status on the likelihood of receipt of emergency department (ED) and inpatient psychiatric admissions while controlling for other patient characteristics. RESULTS: Patients with EEP had elevated psychiatric comorbidity and mental health severity yet received equivalent outpatient mental health services. Patients with EEP were more likely to have had an ED visit for the treatment of a mental health condition and inpatient psychiatric admissions; this pattern persisted in analyses that controlled for group differences. CONCLUSIONS: Patients with EEP have unique mental health treatment needs. The development and implementation of EEP-specific treatments could help address these needs and reduce the number of patients using higher levels of psychiatric services within large health care systems.

Access to timely mental health care treatment initiation among Veterans Health Administration patients with and without serious mental illness.

Timely care initiation is a priority within the Veterans Health Administration (VHA). Patients with serious mental illnesses (SMI) are a group that benefits from timely care initiation due to elevated risks of negative outcomes with delayed care. However, no evaluation has assessed whether VHA SMI patients disproportionately experience delays in mental health care initiation. VHA administrative care data were used to compare delays in mental health care initiation for VHA patients with and without SMI who had newly identified mental health needs. Analyses assessed rates of delayed initial mental health appointments within five settings (General Mental Health [GMH], Primary Care Mental Health Integration [PC-MHI], Post-Traumatic Stress Disorder [PTSD], Substance Use Disorder [SUD], and Psychosocial Rehabilitation clinics [PSR]). SMI patients were more likely to receive delayed initial appointments in three of five clinical settings (PTSD, SUD, PSR) and had significantly longer average wait times for an initial appointment when referred to the PTSD clinic for an initial appointment. Overall, SMI patients were equally as likely to receive delayed initial appointments. While VHA SMI patients were not more likely to experience delayed mental health care initiation overall, they were more likely to experience delays within three of the five treatment settings. Findings suggest that the majority of VHA SMI patients experience equivalent timeliness, though those with more complex needs, and particularly those with trauma-related care needs, may be more likely to experience treatment initiation delays. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Personality disorder and suicide risk among patients in the veterans affairs health system.

Among veterans in Veterans Health Administration (VHA) care, patients with mental health and substance use conditions experience elevated suicide rates. However, despite previously demonstrated high rates of suicidal behavior, little is known regarding suicide rates among veteran VHA users with personality disorders (PDs) as a whole, or by PD clusters (A: Eccentric; B: Dramatic; C: Fearful; and PD-not otherwise specified). PD prevalence and suicide rates were assessed through 2017; overall and by clusters for 5,517,024 veterans alive as of 12/31/2013 and with more than 2 VHA encounters in 2012-2013. In all, 46,050 (.83%) had a PD diagnosis in 2012-2013. Suicide risk was examined using proportional hazards regressions adjusted for age, sex, veteran status, clustering within a geographic region, and other mental health diagnoses. Patients with PDs had greater suicide risk than those without (156.5 vs. 46.7 per 100,000 person-years). Individuals in Cluster B, which includes borderline and antisocial PDs, were at the highest risk (178.5 per 100,000 person-years), followed by PD-not otherwise specified and Cluster C (152.6 and 121.4 per 100,000 person-years, respectively). Rates of PDs in the VHA system were lower than those usually found in community samples. Veterans with a PD diagnosis had an increased risk of suicide, which was especially elevated for those with Cluster B diagnoses. Study findings document the importance of enhancing diagnosis and treatment for veterans with PDs and targeted suicide prevention services. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examining the Interpersonal Profiles and Nomological Network Associated with Narcissistic Grandiosity and Narcissistic Vulnerability.

Theory and research have consistently shown that pathological narcissism can best be described by 2 phenotypic expressions, narcissistic grandiosity and narcissistic vulnerability. The current study sought to examine the specific types of interpersonal problems reported by those high in narcissistic grandiosity and high in narcissistic vulnerability as well as examine the nomological network associated with these 2 manifestations of narcissism. In a sample of university students who completed self-report measures of pathological narcissism, interpersonal problems, depression, self-esteem, malignant self-regard, self-defeating personality disorder symptoms, and anger, we found that narcissistic grandiosity (n = 108) was associated with one distinct interpersonal profile, for example, being overly intrusive in relationships with others, while narcissistic vulnerability (n = 88) was associated with a wider range of interpersonal problems on the interpersonal circumplex. Using cluster analysis, we found 3 interpersonal subtypes associated with narcissistic vulnerability, an intrusive subtype, a cold subtype, and a socially avoidant subtype. Further examination of group differences showed that the 3 interpersonal subtypes associated with narcissistic vulnerability could also be distinguished based on their experience and expression of anger. This suggests the importance of assessing profiles of interpersonal functioning and anger in narcissistic vulnerability. The clinical implications of our results are discussed.

10 Years Later : The Impact of the Affordable Care Act on Prevention and Public Health in North Carolina.

The passage of the Affordable Care Act had a great impact on the landscape of public health programming and clinical preventive care in North Carolina. Large funding measures have supported community-based prevention efforts and led to policy, systems, and environmental changes to support a healthier population.

Validation and extension of personality disorder spectra scales from MMPI-2-RF items.

OBJECTIVES: Recent efforts have been made to develop 10 personality disorder spectra scales using items from the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). These scales, developed by Sellbom et al. (2018, J. Pers. Assess., 1-15), demonstrated good validity and warranted cross-validation. METHOD: In all, 97 veterans undergoing neuropsychological evaluation in a VA outpatient clinic completed the MMPI-2-RF and the MCMI-III. We examined the psychometric properties of the scales and proposed additional scales based on personality constructs found in other established tests and prior versions of the Diagnostic and Statistical Manual for Mental Disorders (DSM; APA, 2013). RESULTS: The 10 original and three additional scales demonstrated acceptable psychometric properties. Most of the 13 scales correlated strongly with the corresponding MCMI-III scale, however, DSM criteria coverage was variable between scales. CONCLUSION: These data provide additional support for 10 personality disorder spectra scales based on MMPI-2-RF items and establish preliminary evidence for three additional scales. Further validation is needed in larger and diverse samples.

Development of a Short Form for the DSM-5 Levels of Personality Functioning Questionnaire.

The Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013) introduced the Alternative DSM-5 Model for Personality Disorders (AMPD). Criterion A of the AMPD conceptualizes level of personality functioning (LOPF) in terms of self- and interpersonal functioning. This article describes the development of a short form for the DSM-5 Level of Personality Functioning Questionnaire (DLOPFQ). A sample of 1,279 participants was drawn from community, clinical, and college settings. All participants completed the DLOPFQ full form. The sample was split into a derivation sample (n = 640) and a validation sample (n = 639). Exploratory factor analysis of the derivation sample data was used to select short-form items. Using the validation sample, confirmatory factor analyses (CFAs) were used to assess fit for proposed item-to-subscale assignments. Short-form subscales had good internal consistency estimates, correlated strongly with full-form subscales, correlated with one another, and were associated with relevant constructs. CFA supported a second-order factor model (i.e., four factors loading onto a higher order LOPF factor). Overall, the DLOPFQ Short Form provides a brief assessment of the constructs measured by the full form. Limitations of the study are reviewed, speculations for improving the measure are discussed, and suggestions for future directions are provided.

Comparing DSM-5-Hybrid, SWAP, and PDM prototype models of personality disorders: Convergent and divergent findings.

Although dimensional models of personality disorders are of great interest, there exist three methods by which personality disorders may be diagnosed for their fit to a predetermined prototype. In this study, we evaluate a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), hybrid model prototype match (modified from the original prototype DSM-5 proposal; Skodol, Bender, Morey, et al., 2011; Skodol, Bender, Oldham, et al., 2011), the Shedler-Westen Assessment Procedure-2 (Shedler, 2015), and the Psychodynamic Diagnostic Manual prototype match (PDM Task Force, 2006). Three hundred twenty-nine clinical psychology graduate students and interns rated patients they currently were treating with each of the aforementioned diagnostic models, as well as completing a checklist of their DSM-IV personality disorder symptoms. Matching a prototype was defined as being a very good match (exemplifying the disorder, a prototypical case) or a good match (has the diagnosis, disorder applies). Frequencies of the prototype assignments are reported. For the SWAP-2 and PDM, depressive and borderline personality disorders were most frequently assigned, whereas avoidant and borderline personality disorder were the most assigned prototypes for the DSM-5 hybrid categories. However, the degree of convergence across methods on similar diagnostic constructs was low. Implications of these findings for personality disorder diagnosis are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Implementation and Evaluation of a Life Narrative Interview Program for Medical Inpatients.

Objectives: Two studies in the early 1990s demonstrated that life narrative interviews conducted by age-peer volunteers strengthened the coping of older patients undergoing invasive medical procedures. The present article reports on the implementation of a similar life narrative interview program for medical inpatients and subsequent evaluation of the mood and coping effects of the intervention. Methods: Three volunteers (mean age = 69 years) were trained to administer 45- to 60-minute life narrative interviews. Fifty-three inpatients (mean age = 70 years) on various units of a Mid-Atlantic non-profit hospital agreed to participate. The Positive and Negative Affect Schedule and Coping Self-Efficacy Inventory (CSEI) were administered before and after the interviews. Results: T-tests indicated a significant increase in positive affect and decrease in negative affect following the interview but no changes in the CSEI. Patient satisfaction questions administered after the interview indicated that patients had a high level of satisfaction with the interview experience. Conclusions: The life narrative interview program appeared to improve the overall mood of participants while providing a satisfying activity to engage in while in the hospital. Clinical Implications: The project demonstrated a cost-effective method for employing volunteers to enhance the experience of patients at healthcare facilities.

Expanding the validity of the malignant self-regard construct in an Italian general population sample.

Malignant self-regard (MSR) was proposed as a particular type of self-structure that may account for similarities among a set of clinically relevant Personality Disorders (PDs) such as masochistic/self-defeating and depressive PDs that yet have failed to be adequately represented in the diagnostic manuals. The investigation on the MSR may provide a better framework upon which to understand the nature of these personality types and their discrimination from related constructs. The present study examines the psychometric properties of the Italian adaptation of the Malignant Self-Regard Questionnaire (MSRQ). Reliability and validity indicators are determined in a large sample of adults from general population (n = 2574). The measure was found to be reliable and valid, given its correlations with measures of depressive personality, negative affectivity, self-defeating, and vulnerably narcissistic personalities. MSR also can be meaningfully differentiated from a nomological network of related constructs, including sadness rumination, depression, neuroticism, extraversion, and grandiose narcissism. These findings suggest that MSR may be a personality component which includes a negativistic self-representation, vulnerability and hypersensitivity to judgment, sometimes compensated by perfectionistic tendencies. As a whole, results seem to support the reliability and the validity of the Italian adaptation of the MSRQ as a measure of the MSR.

"Operating in the dark": Nurses' attempts to help patients and families manage the transition from oncology to comfort care.

AIMS AND OBJECTIVES: To investigate challenges nurses face when providing care for oncology patients transitioning from curative to palliative care and to identify educational and support opportunities for nurses. BACKGROUND: Communicating with oncology patients/families transitioning from curative treatments to care focused on comfort can be problematic for a variety of reasons. Research suggests discrepancies exist between physicians' and patients' perceptions of probable length of life. These disconnects can deepen suffering. Oncology and palliative care nurses are well positioned to facilitate this transition. However, they receive little formal instruction regarding these complex scenarios beyond what occurs through on-the-job training. METHODS: Twenty-eight nurses working in oncology (n = 14) and palliative care (n = 14) settings participated. The constant comparative method was used to analyse the data. RESULTS: Four themes emerged that characterise oncology and palliative care nurses' experiences: (a) coping with interprofessional communication errors during the transition, (b) responding to patient/family reactions to miscommunication about the goals of care, (c) navigating emotional connection to patients, and (d) adapting to sociocultural factors that influence information exchange. CONCLUSIONS: This study supports previous research regarding challenges related to patient reactions, family relationships and emotional burden during end-of-life care. However, it adds to the literature by a providing a more in-depth explication of interprofessional and patient-physician communication barriers that negatively impact care. RELEVANCE TO CLINICAL PRACTICE: Misunderstandings between patients, physicians and nurses have the potential to distress complicate nurses' efforts to support patients and families. Nurses reported a problematic power dynamic that impedes their ability to facilitate communication between patient and physician or to offer insights that could enhance patient care. Medical education and continuing education initiatives are needed to build understanding across professional roles and specialties and to improve comfort discussing worsening prognosis and end-of-life issues.

Are malignant self-regard and vulnerable narcissism different constructs?

In the clinical and empirical literature, vulnerable narcissism and malignant self-regard (MSR) have been found to be highly interrelated and associated with theoretically related personality constructs, suggesting that the two constructs may be much more similar than different. The present study set out to test this hypothesis by examining the relationship of vulnerable narcissism and MSR to experiences and expressions of anger, the factor structure of grandiose and vulnerable narcissism with MSR, the associations of MSR and vulnerable narcissism to the five factor model of personality, and to global self-esteem in self-report measures within 1168 undergraduate students. A separate study of 158 undergraduates also assessed how MSR and vulnerable narcissism predicted state and trait anxiety and anger after receiving positive or negative feedback, and the extent to which negative feedback interacted with MSR and vulnerable narcissism. Overall, compared with grandiose narcissism, both MSR and vulnerable narcissism were more associated with experiencing anger internally, self-reports of state and trait anger, high levels of neuroticism and openness, and lower levels of extraversion and global self-esteem. Both vulnerable narcissism and MSR uniquely predicted trait levels of anger and anxiety and state levels of anger after receiving negative feedback. It is concluded that MSR and vulnerable narcissism are likely identical constructs.

Convergent and Discriminant Validity and Utility of the DSM-5 Levels of Personality Functioning Questionnaire (DLOPFQ): Associations with Medical Health Care Provider Ratings and Measures of Physical Health.

The ability to evaluate patients' level of personality functioning in assessing personality disorders has become increasingly important since the DSM-5 Section III hybrid system of personality disorder assessment was released. One measure developed to assess this criterion is the DSM-5 Levels of Personality Functioning Questionnaire (DLOPFQ; Huprich et al., 2017 ), which assesses individuals' self and other representations in four domains-self-direction, identity, empathy, and intimacy-across two contexts-work or school and relationships. A sample of 140 psychiatric and internal medicine outpatients were administered several questionnaires, including the DLOPFQ. Provider ratings also were obtained for level of functioning and DSM-5 pathological personality traits. Several of the DLOPFQ scales were significantly correlated with self-reported and provider-reported measures of DSM-5 trait domains and levels of functioning, along with self-reported measures of effortful control, overall physical and mental health, and well-being. Certain DLOPFQ scales and subscales were associated with provider ratings of likeability and patient contact with the providers. However, relatively modest validity coefficients, as well as poor discriminant validity of domain scales, indicate further research and measure refinement might be needed. It is concluded that, although further research is necessary, the DLOPFQ could be useful for understanding patients' personality pathology in clinical settings.

Introduction of the DSM-5 levels of Personality Functioning Questionnaire.

With the introduction in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) of a hybrid system of personality disorder assessment, the ability to assess patients' traits, as well as their level of personality functioning, has become increasingly important. To assess this criterion, the DSM-5 Levels of Personality Functioning Questionnaire (DLOPFQ) was developed. The DLOPFQ assesses individuals' self-impairments and other impairments in several domains (self-direction, identity, empathy, and intimacy) and across 2 contexts (work/school and relationships). A sample of 140 psychiatric and medical outpatients was administered the DLOPFQ and several other measures to assess its reliability and construct, incremental, and discriminant validity. The internal consistency and convergence with validation measures yielded generally meaningful and expected results. Several DLOPFQ scales and subscales were significantly correlated with measures of DSM-5 trait domains and levels of personality functioning. DLOPFQ scales also correlated with self-reported ratings of overdependence, detachment, healthy dependency, and overall mental health and well-being. The DLOPFQ also predicted interpersonal and general functioning beyond DSM-5 trait domains. These results support the reliability and validity of the DLOPFQ, which appears to be suitable for clinical use and warrants ongoing study. (PsycINFO Database Record (c) 2018 APA, all rights reserved).