MCMI-III as a treatment outcome measure for psychiatric inpatients.

The Million Clinical Multiaxial Inventory-III (MCMI-III) recently was introduced to replace and update the MCMI-II. A sample of 97 psychiatric inpatients were administered the MCMI-III shortly following admission, and again 7-10 days later. Changes in the personality and symptom scales generally paralleled those found in previous work with the MCMI-II, although the mean retest interval was considerably shorter than in the earlier study. However, some differences between the two instruments were observed, confirming the need for ongoing cross-validation work on the MCMI-III as an instrument that is distinct from the MCMI-II.

The relationship of length of stay to MCMI-II and MCMI-III change scores.

Differences between short versus longer lengths of stay on inpatient change scores were evaluated. Test-retest scores of 98 adult psychiatric inpatients tested with the MCMI-II in 1989 were compared with test-retest scores of 97 adult inpatients tested with the MCMI-III in 1995. The two samples of patients were comparable on demographic and diagnostic variables. Findings suggest a smaller degree of change associated with shorter lengths of stay, as measured by effect sizes and the proportions of patients moving from the clinically significant to the clinically nonsignificant range on scales for anxiety and depression.

Comparison of psychiatric day hospital patient and inpatient scores on the MCMI-III.

This study contrasts self-reported symptomatology on the MCMI-III of a sample of 97 psychiatric patients admitted directly to inpatient care with a sample of 75 patients admitted directly to day hospital treatment. The predominant Axis I diagnosis of patients in both samples was an affective disorder. Effect sizes of the degree of change from admission to retesting one week later were calculated and fell generally within the medium effect size range. There were no MCMI-III subscale differences between groups at either test time. A test item dealing with suicidal ideation did differentiate between the groups, with inpatients expressing more suicidal ideation at admission.

The GAF and psychiatric outcome: a descriptive report.

Since the Global Assessment of Functioning Scale (GAF) was introduced in DSM-III-R in 1987, it has been widely used, but minimally researched. This report provides information concerning the use of the GAF in routine clinical practice. Clinicians rated adult inpatients, adult day hospital patients, and adolescent inpatients at admission and discharge from psychiatric treatment. All samples were rated as significantly less dysfunctional at discharge. There were also significant differences in mean levels of dysfunction between the adult and adolescent samples at admission and discharge. These discrepancies were hypothesized to be associated with the GAFs unclear instructional format. Although this study concerned the GAF as described in the DSM-III-R, our findings are likely to be generalizable to DSM-IV, because no substantive changes have been made to the GAF.

Utility of the Inventory of Suicide Orientation-30 (ISO-30) for adolescent psychiatric inpatients: linking clinical decision making with outcome evaluation.

This report describes a study that integrates program evaluation with clinical practice. The subjects were 139 adolescent psychiatric inpatients who were tested with the Inventory of Suicide Orientation-30 (ISO-30) at admission and retested six days after admission. Aggregate analyses showed statistically significant changes in the direction of decreased suicidality on all ISO-30 indices. Further analyses compared the data with normative data from the ISO-30 manual, and also evaluated the relationships between ISO-30 scores and length of stay. Implications of the results and also methods of integrating outcome with clinical practice are discussed.

Agreement between patient self-report and clinician rating: concurrence between the BSI and the GAF among psychiatric inpatients.

Two rating scales were compared for 200 adult psychiatric inpatients at admission to, and discharge from, the hospital. Patients rated their own psychological symptoms on the Brief Symptom Inventory (BSI), and clinicians rated patients' psychological, social, and occupational functioning on the Global Assessment of Functioning (GAF) Scale. Analyses indicated no significant relationships between symptom distress reported by patients and global functioning rated by clinicians. These findings support previous research that has shown minimal congruence among criterion measures that differ in rating source.

Persistent MAPI scale 6 elevations after inpatient treatment.

Of 81 adolescent inpatients with elevated (> 74) admission scores on scale 6 (forceful/antisocial) of the Millon Adolescent Personality Inventory (MAPI; Millon, Green, & Meagher, 1982), 44 (54.32%) continued to have elevated scale 6 scores on the discharge administration of the test. These 44 subjects (labeled High 6) did not differ significantly from the other 37 subjects (labeled Low 6) on several variables that have been associated with conduct disturbance. The two groups did differ significantly, however, on family size, parental (especially paternal) psychopathology, and prognosis. The High 6 group tended to come from larger families, had a higher frequency of parental pathology, and more often received negative prognoses than did the Low 6 group. A discriminant function analysis conducted on the MAPI expressed concerns scales on the admission administration of the test resulted in a 76.54% correct classification of subjects into the High 6 and Low 6 groups. In general, the High 6 subjects appeared less troubled and more trouble than those subjects in the Low 6 group. The findings of this study demonstrate the potential of the MAPI as a component in the assessment of the treatment amenability of adolescents with disruptive behavior disorders.

Unidimensionality of the Brief Symptom Inventory (BSI) in adult and adolescent inpatients.

This study investigated the factor structure of the Brief Symptom Inventory (BSI; Derogatis, 1992) for adult and adolescent psychiatric inpatients. The BSI was administered to 217 adults and 188 adolescents at admission and discharge from a private psychiatric hospital. Principal components factor analyses revealed that most variance among dimension scores was accounted for by one unrotated factor. Factorial invariance was evident across adult and adolescent samples for admission and discharge scores. Our findings are consistent with previous research on the BSI and Symptom Checklist-90-R (Derogatis, 1977), suggesting that both instruments measure primarily a unidimensional construct of general psychological distress.

The Brief Symptom Inventory (BSI) as an outcome measure for adult psychiatric inpatients.

In this study the Brief Symptom Inventory (BSI; Derogatis & Spencer, 1982) was administered to 89 males and 128 females at admission and discharge from a private psychiatric hospital. For mean scores, statistically significant decreases were observed on all BSI scales and global indices. Effect sizes ranged from high medium to large. Also, when clinical significance indices were calculated with regard to changes made by individual patients, we found that approximately 50% of all inpatients evidenced a decrease on the Global Severity Index (GSI), which meets the dual criteria of significant change and posttreatment functioning in the normal range. Compared with inpatient norms (Derogatis & Spencer, 1982), our sample generally scored higher at admission and lower at discharge.

The MAPI as a treatment outcome measure for adolescent inpatients.

The Millon Adolescent Personality Inventory (MAPI; Millon, Green, & Meagher, 1982) was administered at admission and discharge to 215 hospitalized adolescents. Significant mean score differences were found for both internalizing (affective disorder) and externalizing (disruptive behavior disorder) adolescents. Consistent with theory, internalizing adolescents reported significantly greater distress at both admission and discharge than externalizing adolescents. Finally, test-retest reliability coefficients were somewhat lower than those reported previously (Millon et al., 1982) for hospitalized adolescents.

The MCMI-II depression scales: do they assist in the differential prediction of depressive disorders?

This study examined the diagnostic efficiency of the Millon Clinical Multiaxial Inventory-II (MCMI-II) Major Depression (CC) and Dysthymia (D) scales for the differential prediction of unipolar depressive disorders. The MCMI-II was administered to 109 inpatients at a large private psychiatric hospital in the Midwest. All patients had a primary Axis I diagnosis of a depressive disorder, given at discharge by the attending psychiatrists. When CC scores were compared to clinician diagnoses, results indicated that the sensitivity of the CC scale was improved over what had previously been reported for studies involving the MCMI-I CC scale. However, overall, the D scale functioned slightly better as a predictor of major depression than did the CC scale. One likely factor in explaining this finding is that the CC scale contains very few items assessing vegetative/somatic symptomatology, which are the critical factors in distinguishing major depression from other unipolar depressive disorders.

Individual variability in self-reported improvement for depressed psychiatric inpatients on the MCMI-II.

This study evaluated self-reported symptom improvement on the MCM-II Dysthymia (D) scale for 109 depressed psychiatric inpatients. Rather than presenting the findings in traditional "group mean" format, data were analyzed to highlight the variability of clinical improvement for individual patients. Two criteria for judging clinically significant improvement (Jacobson, Follette, & Revenstorf, 1984) were employed, namely, that the client move from the dysfunctional to functional range during treatment and that the change between pretest and posttest be statistically reliable. Results indicated that 39 (35.8%) of the 109 patients met these criteria.

Interrupting the reenactment cycle: psychotherapy of a sexually traumatized boy.

This case study describes the course in psychotherapy of an eight-year-old boy who had been sexually traumatized at an early age by his biological father. He was seen for 35 individual sessions during a three-month hospitalization. Many of the problems evidenced at admission were conceptualized as ineffective attempts to reenact and master the original trauma. Hospitalization provided an environment in which acting-out behaviors could be controlled in a manner sufficient to allow anxiety to be utilized in psychodynamically oriented therapy. A key element in psychotherapeutic work was the recognition that the boy struggled with positive as well as negative feelings toward his abusing father. Individual therapy provided a context in which these ambivalent feelings could be expressed, which ultimately allowed for developmental progression.

The stability of the MCMI-II for psychiatric inpatients.

The MCMI-II (Millon, 1987) has been introduced recently as a successor to the MCMI-I (Millon, 1983). Because numerous revisions have been made in the MCMI-II, it will need to be cross-validated as an instrument distinct from the MCMI-I. The purposes of this study were to: (1) cross-validate the test-retest stabilities for MCMI-II personality and symptom scales; and (2) compare and contrast the MCMI-II and MCMI-I in regard to scale stability. The MCMI-II was administered to 98 psychiatric inpatients at admission and discharge. Results were generally consistent with the data reported by Millon (1987), in that the basic personality scales evidenced the greatest stability, the pathological personality scales somewhat lower stability, and the symptom scales the least stability. Compared to the MCMI-I, test-retest coefficients were generally higher for the MCMI-II.

The MCMI-II as a treatment outcome measure for psychiatric inpatients.

Recently, the MCMI-II (Millon, 1987) has been introduced as a successor to the MCMI-I (Millon, 1983). This study evaluated the MCMI-II as a treatment outcome measure for psychiatric inpatients. Ninety-eight patients were tested at admission and discharge with the MCMI-II. Changes in mean MCMI-II scores on the basic and pathological personality scales, as well as the moderate and severe symptom scales, were generally congruent with findings from a previous outcome study with the MCMI-I (Piersma, 1986a). However, several differences between the MCMI-II and MCMI-I were noted, which suggests that the MCMI-II will need to be cross-validated as an instrument distinct from the MCMI-I.

A hospital-based crisis service for adolescents: a program description.

In the past three decades there has been rapid growth in crisis intervention services. This article describes the development of a hospital-based crisis service for adolescents. This Crisis/Assessment Unit (CAU) has met a community need for a responsive program for adolescents in acute psychiatric crises. The development of the CAU is described and critiqued. In addition, a typical case admitted for crisis services is presented.

The MCMI as a measure of DSM-III Axis II diagnoses: an empirical comparison.

This study compared MCMI and clinician Axis II diagnoses for DSM-III diagnostic categories. Subjects were 151 consecutively admitted inpatients at a private psychiatric hospital. The MCMI was administered to all subjects shortly after admission and shortly before discharge. MCMI diagnostic impressions for both admission and discharge then were compared to clinician diagnoses. Results indicated that the MCMI diagnosed Axis II disorders much more frequently than did clinicians. Agreement rates between the MCMI and clinicians were uniformly low across all categories except dependent personality. In addition, there was a relatively low degree of correspondence between MCMI admission diagnoses and MCMI discharge diagnoses. Implications of these results are discussed.

The Millon Clinical Multiaxial Inventory (MCMI) as a treatment outcome measure for psychiatric inpatients.

The Millon Clinical Multiaxial Inventory (MCMI) is a 175-item inventory designed to assess both clinical symptomatology and underlying, more enduring personality traits and syndromes. The purpose of this study was to determine whether the MCMI personality scales evidenced greater stability over time than did the MCMI symptom scales. The MCMI was administered to 151 consecutively admitted inpatients at an acute care, private psychiatric hospital. Patients were administered the MCMI shortly after admission and shortly before discharge. Results indicated that the personality scales evidenced greater stability than the symptomatology scales, although statistically significant changes between admission and discharge scores also occurred for the personality scales. Implications are discussed.

Wechsler Memory Scale performance in geropsychiatric patients.

Patients (N = 36) on a geropsychiatric acute care unit were administered the Wechsler Memory Scale (WMS) at admission and discharge. The results indicated that there were significant increases in WMS scores from admission to discharge. Mean scores on the WMS were generally below those previously reported for normal geriatric groups, but above those reported for chronically ill or demented groups. As in previous studies, a significant positive relationship was found between education and WMS score, although no such relationship was found between age and WMS score. Overall, the results highlight the need for comprehensive norms for the elderly, which would increase greatly the practical utility of the WMS in clinical settings.

Patient comments concerning psychiatric hospitalization.

During the past decade increasing attention has been paid to consumer assessment of mental health services. This study summarizes and interprets the comments made by 1457 adults and 474 adolescents concerning their inpatient care at a large private psychiatric hospital. Although adult and adolescent comments evidenced many similarities, adolescents tended to give a greater number of responses and to be more critical of hospitalization than were adults. Comparisons with previous research also supported findings that individual therapy is the most highly valued treatment modality, while food, finances, and living conditions are the most commonly criticized aspects of psychiatric hospitalization.