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)     

Sensation seeking, substance abuse, and psychopathology in treatment-seeking and community cocaine abusers.

Sensation seeking, substance abuse severity, and psychiatric disorders were systematically assessed in a clinical and a community sample of 335 cocaine abusers. In contrast to low-sensation-seeking cocaine abusers, high-sensation seekers exhibited more severe symptoms of substance abuse, exhibited more severe psychosocial impairment, were more likely to be polysubstance abusers, and had an earlier age of onset for substance use and abuse. High-sensation seekers were more likely to report both a lifetime history and family history of antisocial personality, attention deficit disorders and conduct disorder. Sensation seeking was related to several dimensions that are important for defining subtypes of substance abusers and was consistent with other features of a Type II classification. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Millon Clinical Multiaxial Inventory Alcohol Abuse and Drug Abuse scales and the identification of substance-abuse patients.

This study investigated the effectiveness of the Millon Clinical Multiaxial Inventory Alcohol- and Drug-Abuse scales in identifying known alcohol and drug abusers in a sample of 561 adult psychiatric inpatients (408 women and 153 men). Only 43% of the alcoholics and 49% of the drug abusers were identified with the recommended base rate cutoff score of 75. False-positive rates were greater than 50% for each scale, and the scales had a significant positive intercorrelation. Although this study may have some limitations regarding how substance-abuse diagnoses were determined, these findings raise questions about the validity and clinical utility of these scales. Further studies of the item composition and effectiveness of these scales, as well as comparisons with other approaches to substance abuse assessment, are indicated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cross-validation of a psychological test battery to detect faked insanity.

Attempts were made in these 2 studies of simulated insanity to enhance ecological validity: Experimental fakers were given potent monetary incentives to conceal their deception; psychiatric inpatients and convicted felons were used in criterion groups; and Ss took a battery of psychological tests that varied in task demands. In Exp 1, 8 predictor variables drawn from the Minnesota Multiphasic Personality Inventory (MMPI), Bender Gestalt, and a newly developed Malingering Scale were used to derive a single discriminant function that best differentiated 20 prison inmates faking insanity from 40 nonfaking criterion and control group Ss. The optimal function consisted of 3 variables, yielded a canonical correlation of .823, and correctly classified 93.3% of Ss. Exp 2 served to cross-validate the derived equation on 22 substance abusers instructed to fake insanity and 20 inpatients from a schizophrenia treatment unit who received standard instructions. On cross-validation, 97.6% of Ss were correctly classified. Reasons for the unexpected lack of predictive "shrinkage" are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validation of the Adult Suicidal Ideation Questionnaire and the Reasons for Living Inventory in an adult psychiatric inpatient sample.

This study investigated the factor structure of the Adult Suicidal Ideation Questionnaire (ASIQ) and the Linehan Reasons for Living Inventory (LRFI) in a sample of 205 adult psychiatric inpatients. Confirmatory factor analyses provided moderate support for the construct validity of each instrument. Coefficient alphas for the ASIQ (.98) and LRFL (.93) were high. In addition, a range of different clinical cutoff points was derived for each instrument. Both instruments were also better than chance in differentiating between the suicide attempter and psychiatric control groups. High ASIQ and low LRFL scores were significantly associated with scores on selected Minnesota Multiphasic Personality Inventory-2 Content scales. The analyses also indicated that only the ASIQ added to the symptoms of hopelessness and negative affect in differentiating between the suicide attempter and psychiatric control groups. Results suggest that both instruments may be useful screening tests for suicidal behavior in psychiatric long-term care inpatient samples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

If you want to know, consider asking: How likely is it that patients will hurt themselves in the future?

Although self-harming behavior is a common and costly problem for psychiatric inpatients released from the hospital, standardized tools that assess patients' risk for self-harm are rarely used in clinical settings. In this study of dually diagnosed psychiatric inpatients (N = 147), we assessed the utility of patients' self-perceptions of risk in predicting self-harm in the community. Patients' self-perceptions of risk predicted self-harm 8 weeks after discharge from the hospital (Lag 1; area under the curve [AUC] = 0.75). Self-perceptions of risk at the 8-week interview also predicted self-harm 2 months later (Lag 2; AUC = 0.72). Self-perceived risk added predictive utility above and beyond scores on a measure of depression and seemed to capture changes in risk state over time. The results suggest that inpatients can accurately perceive their own risk and therefore may be important collaborators in the risk management process. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An examination of the applicability of the Substance Abuse Proclivity Scale to young adult males.

The substance abuse proclivity (SAP) scale, which was derived from the Minnesota Multiphasic Personality Inventory (MMPI) for use with young (16–21 yr old) males, was applied to samples of 69 young adult male substance abusers, 51 college students, 26 psychiatric outpatients, and 1,298 medical outpatients (all Ss aged 20–29 yrs). Analyses demonstrated that the validity shrinkage was very modest when the scale was applied to Ss of this older age range. The correlation between age and SAP scale score was both significant and negative for 363 independently identified substance abusers (aged 13–26 yrs), which suggests that the scale taps something more basic than the accumulated consequences of the chronic use of substances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

MMPI differences of black and white male polydrug abusers seeking treatment

The hypothesis that among clinical samples of substance abusers Blacks score lower than Whites on the MMPI was supported when comparing 494 White and 159 Black male veterans (mean age 28 yrs) seeking treatment for polydrug abuse. Blacks scored lower on the Depression, Hysteria, Psychopathic Deviate, and Psychasthenia scales when age, education, socioeconomic status, and intelligence were controlled. The findings do not support the notion of ethnic bias in the MMPI. Rather, the results underscore the need for identifying moderator variables that differentially interact to produce lower Black profiles among substance abusers in comparison to Whites, but higher Black profiles among psychiatric patients. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subtypes of cocaine abusers: Support for a Type A–Type B distinction.

The dysfunction and generalizability of a multidimensional alcoholism typological system was systematically assessed in 399 inpatient, outpatient, and non-treatment-seeking cocaine abusers. Two different cluster-analytic procedures supported the construct, concurrent, and predictive validity of the Type A–Type B distinction in cocaine abusers. Participants classified as Type B (33%) cocaine abusers exhibited higher rates of premorbid risk factors (family history, childhood behavior problems, personality, age of onset), more severe drug and alcohol abuse, more addiction-related psychosocial impairment, more antisocial behavior, and more comorbid psychiatric problems than Type A participants (67%). Multidimensional typological systems have had a major impact on the alcoholism field and may be equally important for the assessment, prevention, treatment, and theoretical understanding of other substance use disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A cross-cultural comparison of American Indian, Black, and White inpatients on the MMPI and presenting symptoms.

Studied personality differences among 97 Black, 454 White, and 36 American-Indian psychiatric inpatients, aged 16–70 yrs. Comparisons were made both on the total samples and on matched samples of Black–White and American-Indian–White patients according to SES. Data included presenting complaints, diagnoses, demographic information, and the MMPI. Results show that Black inpatients, in both representative and matched comparisons, had significantly higher scores than both other groups on the Validity, Paranoia, Schizophrenia, and Hypomania subscales of the MMPI. Results may reflect actual symptomatic differences between the groups rather than supporting the conclusion that the MMPI "overpathologizes" for Black patients. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substitution of immediate-release valproic acid for divalproex sodium for adult psychiatric inpatients

In a prospective open-label study, the substitution of immediate-release valproic acid for divalproex sodium was evaluated in the treatment of 47 adult psychiatric inpatients who had been stabilized on divalproex for at least one month. After two weeks, no significant change in Clinical Global Impressions scale (CGI) scores or in seizure frequency occurred, and serum valproate concentrations decreased by 14.4 percent (p=.001). One patient was restarted on divalproex because of gastrointestinal complaints. Among the 19 patients remaining hospitalized at six months, mean CGI scores did not significantly change. Costs were reduced 83 percent; annual savings per patient was approximately $905. These preliminary results suggest that many chronic psychiatric inpatients stabilized on divalproex may be safely switched to valproic acid.     

Verbal rate, eyeblink, and content in structured psychiatric interviews.

The purpose of the present experiment was to investigate the relationship between verbal rate, content, and eyeblink rate in experimental interviews, and to provide further evidence for an earlier hypothesis that momentary anxiety increases verbal rate. Thirty-six female psychiatric inpatients were given personality tests and were then seen for an experimental interview. Verbal rate and eyeblink rate were measured for 30-second intervals. Correlations between personality test scores, psychiatric ratings, and eyeblink and verbal rate revealed two clusters of moderate correlations. The results supported the hypothesized relationship between verbal content and verbal rate. The eyeblink findings were considered as further evidence of the relationships between momentary tension, verbal rate and verbal content. The relationships of the dependent variables to the test scores and psychiatric ratings were discussed as suggestive of the importance of personality dynamics as determinants in the complex process of interpersonal communications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A study of bedside screening procedures for cognitive deficits in chronic psychiatric inpatients

The Mini-Mental State Examination (MMSE) and the Trail Making Test, part B (TMT-B) were compared for screening cognitive deficits in a sample of 104 psychiatric inpatients at a long-term hospital. The TMT-B classified 84% of the patients as impaired. The classic MMSE cutoff score (< or = 23) using serial sevens and spelling classified 42% and 24% of the patients respectively, as impaired. The new MMSE cutoff classified 71% as impaired. Education, gender, and medication may influence impairment when using the MMSE classic cutoff scores. In TMT-B only, impairment was influenced by chronicity. The TMT-B was able to distinguish patients impaired in the MMSE. The TMT-B, therefore, may be more useful than the MMSE to screen for cognitive deficits in chronic psychiatric inpatients.     

Internal and external validity of seven Wechsler Intelligence Scale for Children—Third Edition short forms in a sample of psychiatric inpatients.

This study examined the validity of 7 short forms of the Wechsler Intelligence Scale for Children—Third Edition (WISC—III; Wechsler, 1991) in a heterogeneous sample of 212 child and adolescent psychiatric inpatients. Short-form scores were transformed into deviation IQs (DIQ) through linear scaling techniques and then compared to (a) WISC—III Full Scale IQ (FSIQ) scores through paired-sample t tests and Pearson correlations to examine internal validity and (b) standardized academic achievement scores through Pearson correlations to examine external validity. A 2 (race)?×?2 (gender)?×?2 (age) multivariate analysis of variance, with FSIQ minus DIQ scores as dependent variables, revealed that several short forms yield different FSIQ estimates between race, gender, and age groups. Two short forms are recommended for use with child and adolescent psychiatric inpatients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial variations on the MacAndrew Alcoholism Scale of the MMPI.

The present investigation examined the effect of race on the MacAndrew Alcoholism Scale (MAC) performance of alcoholic and nonalcoholic inpatients in an active-duty military sample. Black and white alcoholics performed similarly on the MAC in terms of mean score and accuracy of identification by cutting scores. Black nonalcoholics scored significantly higher than white nonalcoholics on the MAC. The MAC was found to discriminate successfully between white alcoholics and nonalcoholics (66.3%) but not between black alcoholics and nonalcoholics (55.5%). The inability of the MAC to discriminate between black alcoholics and nonalcoholics in an active-duty military sample suggests caution in its use with black patients in this setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Simple, but effective: Odd- and even-item short forms for the WAIS—R.

Two easy-to-administer Wechsler Adult Intelligence Scale—Revised (WAIS—R) short forms for test–retest situations were developed. One sample of 90 22–67 yr old male psychiatric inpatients and a cross-validation sample of 30 22–79 yr old psychiatric inpatients completed the full WAIS—R. Test results were scored in the standard fashion and for 2 short forms developed by an odd–even split on 9 of the 11 subtests. Verbal, Performance, and Full Scale IQs derived from both short form scales closely approximated standard-form WAIS—R IQs. Short-form subtest-scaled scores, however, were more discrepant from the standard-form subtest-scaled scores. The short forms' practical advantages are discussed. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relations between the Pleasant Events Schedule, depression, and other aspects of psychopathology.

Studied the relations between the Mood Related subscale of the Pleasant Events Schedule (PES), depression, and other psychopathology. 100 psychiatric inpatients and outpatients (mean age 35.7 yrs) had diagnoses of either major, nonmajor, or no depression. All Ss completed the PES, the Beck Depression Inventory, the State-Trait Anxiety Inventory, and a Dutch personality questionnaire. Results show that the PES correlated negatively with depression as well as with anxiety and (social) neuroticism. Principal components analysis revealed 2 factors, negative and positive affect. The latter was dominated by PES scores. Using factor scores, the 3 diagnostic groups could be meaningfully discriminated. It is concluded that depression may be better described using 2 affect dimensions rather than 1. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pre- and postsynaptic neurotoxic effects of dopamine demonstrated by intrastriatal injection

The coexistence of psychiatric and substance abuse problems within the same patient occurs with significant frequency. These patients present serious challenges to a health care system which has traditionally treated mental health and substance abuse in separate venues, with differing and sometimes contradictory treatment modalities. Few studies exist on the treatment of the "dual diagnosis" patient utilizing an integrated approach, where both problems are addressed by the same staff on a single inpatient ward. We describe such a program in which dual diagnosis patients on one ward are separated into two different treatment tracks based upon the severity of their psychiatric illness. Follow-up measures at 3 months after discharge are compared for patients from each treatment track, with no significant difference found for the five outcome variables studied. This suggests that chronically mentally ill inpatients may benefit from integration of attention to their substance abuse problems with psychiatric treatment.     

Construct validity of the dependence syndrome as measured by DSM-IV for different psychoactive substances

The Diagnosis of Drug Dependence in the Official Psychiatric Nomenclatures (DSM-III-R, DSM-IV, and ICD 10) are based on the Drug Dependence Syndrome construct. Although the validity and utility of the dependence syndrome has been widely documented for alcohol, the generalizability of the dependence syndrome to other psychoactive substances is still not clear. Thus, this article examines the construct validity of the drug dependence syndrome, as measured by diagnostic criteria for DSM-IV, using both internal consistency analyses and confirmatory factor analyses. Data were obtained from non-mutually exclusive groups of abusers for five drugs (alcohol, cocaine, marijuana, opioids, sedatives, stimulants) drawn from a pool of 521 subjects obtained from drug treatment, general psychiatric and community samples. As predicted by the theory, drug dependence items were found to be unidimensional and factorially distinct from measures of the consequences of substance abuse (e.g. legal problems) for all drug groups. Moreover, the drug dependence items yielded internally consistent scales that produced a distribution of scores reflecting a continuum from low to high severity of abuse for all drugs.