Biomedical subjects
Publications and source records attributed to S W Hurt.
Among 180 patients with DSM-III borderline personality disorder, patients with concurrent affective and substance use disorders had a higher rate of serious suicide attempts than other patients. Clinicians should be alert to axis I disorders in assessing suicide potential in borderline patients.
Seventy-six women completed a three-month prospective evaluation for premenstrual syndrome (PMS). As a part of the evaluation, they completed Rotter's Locus of Control (LOC) form in the follicular phase and premenstrually. It was found that the LOC scores of women meeting criteria for PMS rose significantly (became more "external") premenstrually, while scores of women without PMS did not show significant change. In addition, the premenstrual LOC scores of women meeting criteria for PMS were significantly higher than were scores of the non-PMS women. The results are consistent with the idea that cycle related changes in self-perception occur in women demonstrating PMS symptomatology.
The 1983 National Institute of Mental Health (NIMH) guidelines for a premenstrual syndrome (PMS) diagnosis were applied to Daily Rating Form (DRF) data in a prospective research study. The use of two sets of criteria, each consistent with the NIMH guidelines, resulted in prevalence rates of 44% and 17%. The authors discuss other problems in defining a "syndrome": symptom patterns and the relationship between PMS and the presence of a psychiatric disorder.
The DSM-III employs a categorical model for the classification of personality disorders. A dimensional model provides certain advantages, but there has not yet been an empiric attempt to identify an optimal set of dimensions. We systematically assessed the presence of each of the symptoms for the personality disorders in 84 patients. The number of symptoms of each of the personality disorders possessed by each patient was correlated across patients, and the correlations were subjected to a multidimensional scaling program. A three-dimensional solution was compared with the placements of the personality disorders predicted by dimensions published previously.
The effect of therapeutic alliance on treatment outcome in a stratified sample of 96 hospital inpatients was assessed by means of a 6-point alliance scale as well as by demographic, treatment history, and psychopathological data. Alliance was correlated with improvement at discharge but not with demographic or prior treatment characteristics. Symptom patterns and personality dysfunction were shown to be differentially related to the quality of the alliance. Patients with axis I substance abuse, adjustment, and somatoform disorders had the poorest alliance and the poorest outcomes. The authors generated a model to predict outcome of hospital treatment, using patient alliance ratings, axis I and II diagnoses and their combinations, and admission Global Assessment Scale scores.
The authors have the largest follow-up sample of long-term treatment ever done. They have studied almost 500 patients, 20 years after discharge from the long-term treatment unit at Psychiatric Institute. This article reviews some of their findings and identifies the patient population that requires and can benefit from long-term treatment.
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This study compares 17 hospitalized borderline personality disorder (BPD) patients with 20 normal control subjects. Four criteria sets--DSM III, Grinker, Gunderson, and Kernberg--were combined and used with the semistructured DIAGNOSTIC INTERVIEW BORDERLINES (DIB) Scale. Findings indicate that among BPD patients the following were most prominent: 1) impulsive episodes 2) unstable relationships 3) chronic feelings of depressive emptiness/loneliness 4) acting out behavior and, somewhat less prevalent, 5) identity disturbance. BPD patients can be discriminated by different patterns of disturbance while sharing other features in common with them. While DSM III requires five of eight items for BPD diagnosis, from the above group significantly less than five adequately made a positive diagnosis in this study. BPD seems to identify a heterogeneous group of patients with behavioral disturbances without particular personality specificity which share certain core characteristics among which additional features may further subtype component members.
This study explores the discriminant validity of the MMPI in relationship to the DSM-III and the Diagnostic Interview for Borderlines (DIB) constructs of Borderline Personality Disorder (BPD). A two-way analysis of variance model assessed differences between inpatients (n = 42) and outpatients (n = 42) and between BPD and nonBPD patients. We compare the best discriminant model for the current samples with previous BPD discriminant functions. The present study assesses a wider range of psychopathology in which the MMPI appears to be relatively insensitive to the BPD construct while retaining the high specificity reported in previous studies. Implications for the use of the MMPI as a diagnostic instrument are discussed.
This study critiques and extends the DSM-III use of fixed and explicit criteria by applying principles and statistics common within actuarial decision theory (eg, conditional probabilities). The value and limitations of sensitivity and specificity rates are discussed and compared with an interesting but rarely used statistic, positive predictive power. The statistics and analyses provided herein also provide an empirical method for developing diagnostic criteria and determining when and how the DSM-III cutoff points might be adjusted, recognize the importance of base rates and utilities to efficient diagnosis, and provide an explicit, quantitative means by which to make optimal differential diagnoses and to make use of the overlap among psychiatric diagnoses. The issues are illustrated in the differential diagnosis of the Borderline Personality Disorder, but they have a relevance to the development and application of the other DSM-III diagnoses.
The authors compared three methods of assessing borderline personality disorders. Test-retest reliability for the self-report Personality Diagnostic Questionnaire was adequate and compared favorably with the interrater reliability of the DSM-III-oriented clinical interview and the semistructured research interview. The overall prevalence of personality disorders scored on the questionnaire was similar to that generated by the clinical interview. The specificity and sensitivity of the questionnaire for the diagnosis of borderline personality disorder were slightly higher than 60%, which suggests that it may be a useful and economical instrument for identifying patients with borderline personality disorder.
The authors compared the reliability of two methods of distinguishing borderline personality disorder--DSM-III and the Diagnostic Interview for Borderline Patients. The reference group, outpatients with other personality disorders and without major axis I pathology, was more difficult to distinguish from the patients with borderline personality disorder than such groups used in previous samples. The sensitivity and specificity of the Diagnostic Interview for Borderline Patients were calculated, with DSM-III used as a criterion. The findings confirm considerable overlap between borderline and schizotypal personality disorders, more impairment in functioning in borderline patients than in those with other personality disorders, and the high reliability with which borderline personality disorder can be diagnosed.
Psychiatric diagnoses and severity of suicide attempts were compared between adolescents (14-19 years) and young adults (20-35 years) with depressed mood hospitalized following a suicide attempt. The depressive disorders manifested by the two age groups, determined by semi-structured interview, were basically the same. The degree of lethality and frequency of suicide attempts were approximately equal in the two groups. Adolescents in this investigation who manifested the same behaviors as older patients were diagnosable by the same criteria.
We examined the usefulness of the Thought Disorder Index (TDI), an instrument for assessing 21 categories of thought disorder ranging from subtle to flagrant, in a group of schizophrenic patients treated with an antipsychotic drug. The TDI charted the changes in thought disorder and showed a high degree of congruence with other scales of thought disorder. Because it does not depend on the clinical interview for its data and because it yields sensitive information about thought slippage independently of symptom assessments, the TDI may be profitably employed in a variety of research contexts.
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The concepts of primary and secondary affective disorders have become widely accepted by researchers of adult psychiatric disorders. They are based on the chronological development of certain specified major affective disorders in relation to diagnosable, nonaffective psychiatric disorders. Despite potential etiological implications, little data are currently available on the primary-secondary classification applied to cases with early onset adolescent and young adulthood affective disorders. This study reports on the application and clinical implications of the primary-secondary classification in a sample of 65 adolescent and young adult inpatients who meet Research Diagnostic Criteria (RDC) for an index episode of Major Depressive Disorder.
The DSM-III definition of borderline personality disorder emphasizes affective symptoms. The authors hypothesized that depressed patients with borderline personality disorder would be more likely to be suicidal than those without this diagnosis. Of 53 inpatients treated for depression, 46 manifested personality disorders; borderline personality disorder was the most prevalent axis II diagnosis. That borderline patients had more complicated courses than the other depressed patients was evidenced by their histories of suicidal behavior. Most patients diagnosed as having borderline personality disorder continued to fulfill criteria for this diagnosis even when suicide attempts were excluded as a diagnostic criterion.