The ability of individuals with psychoactive substance use disorders to escape detection by the Personality Assessment Inventory.

The ability of individuals with psychoactive substance use disorders to dissimulate successfully on the Personality Assessment Inventory (PAI; L. C. Morey, 1991) was evaluated. Patients receiving treatment for drug abuse who were instructed to respond honestly (n?=?59) had significantly higher scores on the PAI scales measuring problems with alcohol and other drug use than (a) patients instructed to respond defensively (n?=?59), (b) respondents suspected of abusing psychoactive substances who were referred for an evaluation by the criminal justice system and who had reasons to conceal their drug use (n?=?59), and (c) respondents from a nonclinical control group (n?=?9). However, a PAI validity scale designed to measure positive dissimulation was prone to making false positive and false negative errors, depending on the cutoff employed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Personality Assessment Inventory profiles of deployed combat troops: An empirical investigation of normative performance.

The present study examined the normative scores and psychometric properties of the Personality Assessment Inventory (PAI; Morey, 1991) within a non-treatment-seeking sample of soldiers deployed to combat zones in Iraq, compared with a sample of community adults matched with respect to age and gender. Results indicate the scores and properties of the PAI scales were generally quite similar in the Iraq and community samples, with modest differences emerging on only 3 subscales addressing antisocial behavior, issues with close relationships, and interpersonal vigilance. These results suggest that standard normative interpretation of PAI scales is appropriate even when the instrument is administered in a combat zone. In comparison with prior research, the results may suggest that documented mental health issues among combat veterans, when present, may be particularly likely to emerge postdeployment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Physical and mental comorbidity of substance use disorders in psychiatric consultations. European Consultation-Liaison Workgroup

Comorbidity of substance use disorders with physical and mental disorders was investigated among 1249 consecutive psychiatric consultation patients admitted to six general hospitals in Finland. Of the patients 354 (28%) were diagnosed with substance use disorders (ICD-10), of which 22% were due to use of at least two different types of psychoactive substances. Alcohol dependence (117/226) in male patients and acute drug intoxication (49/128) at a similar rate as alcohol dependence (44/128) in female patients were the most common clinical conditions. With few exceptions, all substance use disorders were comorbid and in 63% of affected patients comprised a "triple diagnosis" (i.e., physical, mental, and substance use diagnoses concurrently). Poisonings and personality disorders in both sexes, digestive system diseases in men, and injuries in women were related to substance use disorders. Conclusions for service provision were: (1) the high level of co-occurrence of physical and mental disorders with substance use disorders calls for comprehensive, multi-disciplinary assessment of any substance use problems ascertained in psychiatric consultations; (2) poisoning with substance use involvement and mental comorbidity was the most common combined clinical condition justifying provision of addiction psychiatric emergency consultations in general hospitals; (3) polydrug use indicating severe problems and complex treatment needs should be identified; and (4) psychiatric referrals of patients with physical alcohol-related disorders should be ensured in general hospitals.     

Clinical implications of the co-occurrence of substance use and other psychiatric disorders.

The co-occurrence of substance use and psychiatric disorders is the rule rather than the exception in mental health and substance use treatment settings across the United States. Such co-occurrence may call for special assessment and evaluation procedures, modified treatment plans, and specialized follow-up. Treatment of co-occurrence of substance abuse and psychiatric disorders requires more cross-disciplinary collaboration; greater integration of substance use, mental health, and social services treatment approaches; and modifications in the training of care providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Stability and Impact of Environmental Factors on Substance Use and Problems After Adolescent Outpatient Treatment for Cannabis Abuse or Dependence.

Because alcohol or other drug use following adolescent substance abuse treatment is common, understanding mediators of posttreatment outcome could help improve treatment interventions. The authors conducted path analyses based on data from 552 adolescents (aged 12-18; 82% male) with cannabis abuse or dependence who participated in outpatient treatment. The analysis used the Family Conflict and Cohesion subscales, from the Family Environment Scale, and several scales and indices from the Global Appraisal of Individual Needs. Family conflict, family cohesion, and social support indirectly predicted substance use and substance-related problems as mediated by recovery environment and social risk. This model replicated across 4 follow-up waves (3, 6, 9, and 12 months postintake). These results support the idea of targeting environmental factors during continuing care as a way to improve treatment outcomes for adolescents with cannabis disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of cocaine and other substance dependence to well-being of high-risk psychiatric patients

OBJECTIVE: The co-occurrence of substance dependence disorders was determined in a sample of 160 frequently hospitalized adults with severe mental illness, and the relationship between substance dependence and psychosocial functioning and well-being was examined. METHODS: A structured interview was used to assess subjects for co-occurring current DSM-III-R substance dependence disorders during an acute psychiatric hospitalization. They were administered a structed interview that included the subscales of the Addiction Severity Index, the Center for Epidemiological Studies-Depression Scale, Lehman's Quality of Life Interview, Rosenberg's Self-Esteem Scale, the Mastery Scale, and questions about service needs. RESULTS: Seventy-eight of the subjects (48.8 percent) were diagnosed as having at least one current substance dependence disorder. Most subjects with comorbid substance dependence were polysubstance dependent (55.1 percent), and almost half (44.9 percent) met criteria for cocaine dependence. Subjects who were substance dependent were significantly overrepresented among those diagnosed with bipolar disorder, psychotic disorder not otherwise specified, and major depression. When the analysis controlled for demographic characteristics and primary diagnosis, comorbidity was related to depressive symptoms, adverse life conditions, and diminished life satisfaction in several domains. Substance-dependent subjects were significantly more likely to have been arrested and jailed than nondependent subjects. Cocaine-dependent subjects were significantly less satisfied than all other subjects with their living situation and personal safety and more likely to request assistance for their drug and alcohol use problems. CONCLUSIONS: The findings corroborate high rates of co-occurring substance dependence disorders among frequently hospitalized patients with severe mental illness. They also reveal a high prevalence of cocaine dependence and a dramatic pattern of negative correlates of cocaine dependence. The findings suggest that successful interventions for substance dependence may improve these patients' life circumstances and that psychiatric patients may be particularly receptive to such interventions during hospitalization.     

Clinical utility of the Cross-Cultural (Chinese) Personality Assessment Inventory (CPAI-2) in the assessment of substance use disorders among Chinese men.

This study examined the clinical utility of the Cross-Cultural (Chinese) Personality Inventory (CPAI-2) in differentiating the personality characteristics of Chinese men with substance use disorders from other psychiatric patients and normal control participants. The CPAI-2 profile of 121 Chinese men with substance use disorders was contrasted with that of a matched psychiatric comparison group (n = 172) and a normal comparison group (n = 187). Multivariate analyses of variance and logistic regression results supported the utility of the CPAI-2 clinical scales, especially Pathological Dependence, Antisocial Behavior, and Depression, for assessing substance use disorders. The Pathological Dependence scale (cutoff T score of 64) achieved good sensitivity and specificity. Apart from the universal personality traits related to neuroticism, conscientiousness, and agreeableness found in Western studies, the indigenously derived CPAI-2 personality scales, including Family Orientation and Harmony, highlighted deficits in social adjustment and interpersonal relationship as important cultural features in the personality characteristics of these participants. The study provided a cross-cultural extension to research on the relationship between personality and substance use disorders and could assist clinicians in considering culturally relevant treatment approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for principal versus comorbid conditions in psychiatric outpatients with the Psychiatric Diagnostic Screening Questionnaire.

In examining the performance of screening scales, a distinction should be made between principal and additional diagnoses. The Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a brief, psychometrically strong self-report scale designed to screen for the most common Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Axis I disorders encountered in outpatient mental health settings. In the present report, the authors compared the performance of the PDSQ in identifying principal and comorbid disorders. Seven hundred ninety-nine psychiatric outpatients completed the PDSQ and were interviewed with the Structured Clinical Interview for DSM-IV. The sensitivity and negative predictive values of the PDSQ subscales were similar for principal and additional diagnoses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Older and younger patients with substance use disorders: Outpatient mental health service use and functioning over a 12-month interval.

This observational study compared a nationwide sample of older patients with substance use disorders (n = 3,598; age > 55) with a demographically and diagnostically matched sample of younger patients on initial functioning, subsequent outpatient mental health service use, and 12-month follow-up outcomes. Older patients were initially functioning as well as or better than younger patients according to substance use, psychiatric, family, and legal criteria. The groups received comparable amounts of outpatient mental health care. At a 12-month follow-up, older patients generally had better substance use and functioning outcomes than did younger patients. The findings suggest that older patients with substance use disorders are keeping pace with demographically and diagnostically comparable younger patients in obtaining specialized outpatient mental health services and that they have positive treatment prognoses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Detecting back irrelevant responding on the Personality Assessment Inventory in a psychiatric inpatient setting.

The present studies focus on strategies for detecting back irrelevant responding (BIR) on the Personality Assessment Inventory (PAI; L. C. Morey, 1991). Moderate BIR levels can greatly affect the clinical scales of the PAI. Further, the PAI's Inconsistency and Infrequency validity scales are less than optimal for detecting BIR. L. C. Morey and C. J. Hopwood (2004) developed an alternative strategy for detecting BIR that involves comparison of 2 scales from the PAI short-form with the same 2 scales from the PAI full-instrument. The present study examines how different BIR levels affect the clinical, treatment, and interpersonal scales of the PAI in 2 psychiatric inpatient samples. The effectiveness of various strategies for detecting BIR in an inpatient setting is also discussed. Consistent with previous research, moderate rates of BIR impacted several PAI scales in a meaningful way. The Inconsistency and Infrequency validity scales of the PAI were relatively ineffective for detecting low-to-moderate BIR levels. Conversely, the short-form full-instrument comparison strategy was much more sensitive to BIR. Finally, a new BIR detection indicator is presented that improves sensitivity rates for detecting all BIR levels in an acute setting. The implications of these results for detecting BIR in inpatient settings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between clinician assessment and self-assessment of personality disorders using the SWAP-200 and PAI.

The relation between self- and peer-informant reports of personality using psychometric instruments has been the focus of considerable research. The quantified judgments of clinically experienced observers such as treating clinicians have also been studied. The focus of the present article is on the measurement of 3 personality disorders (borderline, antisocial, and obsessive-compulsive) using the Shedler-Westen Assessment Procedure (SWAP-200), an instrument designed to quantify personality ratings made by clinically experienced informants, and the self-report Personality Assessment Inventory (PAI). SWAP-200 personality disorder scales showed small to medium correlations with borderline and antisocial personality disorder scales from the PAI. As predicted, SWAP-200 obsessive-compulsive personality disorder correlated negatively with these scales, suggesting discriminant validity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal study of drug and alcohol use by psychosis-prone and impulsive-nonconforming individuals.

The rates of substance use and abuse are higher among psychotic patients and antisocial individuals than in the general population. In a 10-year longitudinal study, psychosis-prone individuals identified by the Perceptual Aberration (L. J. Chapman, J. P. Chapman, M. L. Raulin, 1976) and Magical Ideation (Per-Mag) scales (M. Eckblad & L. J. Chapman, 1983), and individuals with antisocial traits, identified by the Impulsive Nonconformity (Noncon) scale (L. J. Chapman et al., 1984), exceeded a control group on rates of substance use disorders. As hypothesized, the Per-Mag group demonstrated preferential patterns of substance use similar to those reported for schizophrenic patients. Participants who scored deviantly on both the Per-Mag and Noncon scales were at especially heightened risk for substance use disorders. Psychosis proneness at the initial screening predicted substance abuse at the follow-up evaluation, but substance abuse at the initial interview did not predict later clinical psychosis or psychoticlike experiences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relapse in Alcohol- and Drug-Disordered Adolescents With Comorbid Psychopathology: Changes in Psychiatric Symptoms.

This study examined reciprocal relationships between posttreatment substance use and psychiatric symptoms in adolescents with both a substance use disorder and an Axis I mental health disorder. Participants (13-18 years old) were recruited from inpatient treatment centers and interviewed during treatment and monthly for 6 months. Participants who relapsed (N = 103; 48% female) reported the incidence and severity of psychiatric symptoms experienced before and after their 1st posttreatment substance use. The number of symptoms and depression symptoms experienced were related to use of stimulants and other drugs during relapse. There was evidence for both self-medication (symptom reduction) and rebound (symptom exacerbation) effects of substance use on symptom severity. These results demonstrate that, for adolescents with both substance use and mental health disorders, psychiatric symptoms are 1 factor influencing posttreatment substance use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discriminant validity of the Psychopathy Checklist in a forensic psychiatric population.

The association between psychopathy and other mental disorders was investigated in 80 male forensic patients. Psychopathy was assessed with the Psychopathy Checklist (PCL; R. D. Hare [see PA, Vol 67:2477]). Diagnoses of other mental disorders were based on Axis I and Axis II criteria listed in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and on two standardized psychiatric rating scales. PCL diagnoses were significantly related only to antisocial and histrionic personality disorder (PD) and to nonalcohol substance abuse disorders. PCL ratings were also positively correlated with prototypicality ratings of antisocial, histrionic, and narcissistic PD and negatively correlated with ratings of avoidant PD. The results provide evidence for the convergent and discriminant validity of the PCL and are consistent with the view that psychopathy is a distinct clinical syndrome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital distress and mental health care service utilization.

Objective: This study was designed to evaluate the association between marital distress and mental health service utilization in a population-based sample of men and women (N = 1,601). Method: The association between marital distress and mental health care service utilization was evaluated for overall mental health service utilization and for specific sectors of treatment providers, including psychiatrist, other mental health provider, other medical provider, and religious services provider. Interviews were used to assess past-year service utilization and presence of anxiety, mood, and substance use disorders. Results: Approximately 12% of married individuals sought help for problems with their emotions, nerves, or substance use during the 12 months preceding the interview. Marital distress was significantly associated with (a) overall mental health service utilization and service utilization provided by each of the sectors of providers when controlling for demographic variables and (b) overall mental health service utilization and receiving treatment from a psychiatrist when additionally controlling for past-year anxiety, mood, or substance use disorders. There was little evidence that the associations between marital distress and service utilization were moderated by gender or presence of psychiatric disorders. Conclusion: The finding that marital distress is associated with greater mental health care service utilization suggests that clinicians should assess both individual and relationship factors among individuals presenting for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Should I stay or should I go? Personality Assessment Inventory and Rorschach indices of early withdrawal from psychotherapy.

The Personality Assessment Inventory (PAI) and the Rorschach were used to investigate differences between patients who withdrew early from university-based outpatient psychodynamic psychotherapy and those who continued in treatment. The study employs two sets of analyses, one utilizing the complete sample (N = 101) and a second comprised of comparison pairs matched on the specific therapist delivering treatment (n = 36 for Rorschach; n = 38 for PAI). It was hypothesized that early withdrawers would score higher on the PAI Treatment Rejection Scale (RXR) and the PAI Treatment Process Index (TPI) than treatment continuers. It was also hypothesized that early treatment withdrawers will have better overall interpersonal relationships, less need for closeness and intimacy, less available psychological resources and more current stimulus demands, and lower levels of psychological/cognitive disturbance as measured by the Rorschach. In addition, differences between the two groups on PAI treatment and clinical scales and subscales were examined. Results indicated that PAI RXR differentiated between the two groups (p     

The utility of motivational interviewing as an adjunct to exposure therapy in the treatment of anxiety disorders.

Motivational interviewing (MI; W. R. Miller & S. Rollnick, 2002) was designed as a prelude to standard substance use treatment. Because of its purported capacity to resolve ambivalence about change, MI has been applied to many other behavioral and mental health problems. Ambivalence about engaging in exposure-based therapies is common among those with anxiety disorders, and systematic efforts (e.g., MI) to ameliorate such ambivalence may yield superior clinical outcomes. The use of MI as an adjunct intervention to standard exposure therapy in anxiety disorders is explored with a focus on treatment retention and adherence. Shared and disparate treatment difficulties among substance use and anxiety disorder populations suggest that MI may be especially effective with anxiety disorders. Empirical evidence supporting the use of MI with substance abuse and anxiety disorder populations is presented. Practical aspects of MI's clinical application as an adjunct intervention to standard exposure therapies for anxiety disorders are discussed. Last, a future research agenda is delineated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reliability and validity of the Addiction Severity Index among outpatients with severe mental illness.

This study provides psychometric data for the Addiction Severity Index (ASI) when administered to persons with severe and persistent mental disorders. Participants were 97 outpatients (26 women) at a public psychiatric facility. The internal consistency of the composite scores was lower in this psychiatric sample than in previous nonpsychiatric samples. Interrater reliability was acceptable for most composite scores but low for many severity ratings. Several scores showed low temporal stability. Validity evidence was weak for the employment and family-social subscales, acceptable for drug and alcohol subscales, and mixed for psychiatric, medical, and legal subscales. Due to mixed reliability and validity evidence, caution should be exercised when using the ASI with patients having severe mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The convergence and predictive validity of the Multidimensional Pain Inventory and the Personality Assessment Inventory among individuals with chronic pain.

Objective: To explore the convergence, redundancy, and validity of the Multidimensional Pain Inventory (MPI) and the Personality Assessment Inventory (PAI) in a chronic pain treatment setting. Participants: Data from intake (N=235) and follow-up (N=187) for individuals with an average of 9 years of chronic pain who participated in a 20-day integrative treatment program were analyzed. Outcome Measures: Oswestry Disability Index, Beck Depression and Anxiety inventories, Rand Short-Form Health Survey, and clinician-rated ability to stand and carry. Results: Conjoint factor analyses suggested that the MPI and PAI combine to tap five orthogonal factors: Negative Affect, Support, Externalizing, Physical Dysfunction, and Impulsivity. MPI and PAI scales significantly related to various aspects of client functioning, although these scales were more limited in predicting clinician-rated markers and change during treatment. Conclusion: Results support the combined use of the MPI and PAI to understand patient heterogeneity and predict treatment outcome in chronic pain samples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of substance abuse in psychotherapy clients: The effectiveness of the MMPI-2 substance abuse scales.

The Minnesota Multiphasic Personality Inventory—2 (MMPI—2) contains 3 scales, the MacAndrew Alcoholism Scale—Revised (MAC—R), the Addiction Potential Scale (APS), and the Addiction Acknowledgement Scale (AAS), that were developed to identify alcohol and drug abusing individuals. The current study was designed to measure the effectiveness of these scales at detecting substance abuse problems in a community-based mental health sample. MAC—R, APS, and AAS scores were obtained from 64 therapists who identified 68 substance abusing and 392 nonabusing psychotherapy clients. The results indicated that mean scores on all 3 scales were higher for the substance abusers than for nonabusers. Furthermore, discriminant analysis found all 3 scales to be effective screening tools. The AAS was the best single predictor, and a combination of the AAS and MAC—R provided the best overall discrimination. The implications of early substance abuse detection on treatment effectiveness are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)