Public Health Commons^™

Crisis Intervention Services In Juvenile Detention Centers, Charles A. Sanislow, John Chapman, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

The prevalence of mental disorders among juvenile detainees is estimated to be as high as 60 percent, and reports suggest that adolescents who are detained have a three- to fourfold risk of suicide. The transfer of juveniles who commit serious offenses to the adult legal system and the problems of overwhelmed child care agencies appear to have precipitated a shift in the composition of populations in juvenile detention centers. Adolescents are often detained for minor legal charges that occur in the context of severe behavioral problems and family stress. We report on a collaborative venture between a state juvenile justice …

Plausibility And Possible Determinants Of Sudden 'Remissions' In Borderline Patients, John G. Gunderson, Donna S. Bender, Charles A. Sanislow, Shirley Yen, Jennifer Bame Rettew, Regina Dolan-Sewell, Ingrid R. Dyck, Leslie C. Morey, Thomas H. Mcglashan, M. Tracie Shea, Andrew E. Skodol

Charles A. Sanislow, Ph.D.

THIS STUDY documents dramatic improvements in patients with borderline personality disorder (BPD) and explores their possible determinants. From a sample of the 160 carefully diagnosed borderline patients on whom prospective follow-along data was collected, a subsample of 18 was identified whose DSM-IV criteria count fell to two or fewer during the course of the first 6 months of the study and retained that improvement for the next 6 months. Follow-along data including month-by-month ratings of BPD criteria; week-by-week ratings of Axis I disorders, medication changes, and life events were then used to establish concensus ratings on four hypothesized causes: Axis …

Co-Occurrence Of Dsm-Iv Personality Disorders With Borderline Personality Disorder, Carlos M. Grilo, Charles A. Sanislow, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

No abstract provided.

Functional Impairment In Patients With Schizotypal, Borderline, Avoidant, And Obsessive-Compulsive Personality Disorder, Andrew E. Skodol, John G. Gunderson, Thomas H. Mcglashan, Ingrid R. Dyck, Robert L. Stout, Donna S. Bender, Carlos M. Grilo, M. Tracie Shea, Mary C. Zanarini, Leslie C. Morey, Charles A. Sanislow, John M. Oldham

Charles A. Sanislow, Ph.D.

Objective: The purpose of this study was to compare psychosocial functioning in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder and patients with major depressive disorder and no personality disorder.

Method: Patients (N=668) were recruited by the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. The carefully diagnosed study groups were compared on an array of domains of psychosocial functioning, as measured by the Longitudinal Interval Follow-Up Evaluation—Baseline Version and the Social Adjustment Scale.

Results: Patients with schizotypal personality disorder and borderline personality disorder were found to have significantly more impairment at work, in social relationships, and …

Confirmatory Factor Analysis Of The Dsm-Iv Criteria For Borderline Personality Disorder: Findings From The Collaborative Longitudinal Personality Disorders Study, Charles A. Sanislow, Carlos M. Grilo, Leslie C. Morey, Donna S. Bender, Andrew E. Skodol, John G. Gunderson, M. Tracie Shea, Robert L. Stout, Mary C. Zanarini, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: This study tested the factor structure of the DSM-IV criteria for borderline personality disorder by using confirmatory methods for the analysis of covariance structures in a large group from a multisite study.

Method: A total of 668 primarily treatment-seeking subjects were reliably assessed for personality disorders by using the Diagnostic Interview for DSM-IV Personality Disorders. Associations among criteria for borderline personality disorder were examined. A confirmatory factor analysis was performed to test diagnosis as a unitary construct and to test an earlier-reported three-factor model comprising disturbed relatedness, behavioral dysregulation, and affective dysregulation. The three-factor model was subsequently tested by …

Confirmatory Factor Analysis Of Dsm-Iv Schizotypal, Borderline, Avoidant, And Obsessive-Compulsive Personality Disorders: Findings From The Collaborative Longitudinal Study Of Personality Disorders, Charles A. Sanislow, Leslie C. Morey, Carlos M. Grilo, John G. Gunderson, M. Tracie Shea, Andrew E. Skodol, Robert L. Stout, Mary C. Zanarini, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: To test the diagnostic constructs implied by DSM-IV Axis-II personality disorders by examining relationships between different combinations of DSM-IV criteria.

Method: Confirmatory factor analysis was used to test the borderline, schizotypal, avoidant and obsessive-compulsive personality disorder constructs in a large treatment-seeking sample (N=668) from a multisite study. A model based on the three DSM-IV Axis II clusters was also tested. Both models were tested against a unitary ‘generic’ model constructed from four criteria sets combined.

Results: Goodness-of-fit for both the three-cluster and four disorder models was significantly better than the unidimensional model, and the four-disorder model was significantly better …

Internal Consistency And Intercriterion Overlap Within And Between Dsm-Iv Axis Ii Personality Disorders: Findings From The Collaborative Longitudinal Study Of Personality Disorders, Carlos M. Grilo, Thomas H. Mcglashan, Leslie C. Morey, John G. Gunderson, Andrew E. Skodol, M. Tracie Shea, Charles A. Sanislow, Mary C. Zanarini, Donna S. Bender, John M. Oldham, Ingrid Dyck, Robert L. Stout

Charles A. Sanislow, Ph.D.

Objective: To evaluate performance characteristics of DSM-IV Personality Disorders (PDs) criteria.

Method: Six hundred and sixty-eight adults recruited for the Collaborative Longitudinal Personality Disorders Study (CLPS) were assessed with diagnostic interviews.

Results: Within-category inter-relatedness was evaluated by Cronbach’s alpha and median intercriterion correlations (MIC). Cronbach’s alpha ranged from 0.47 to 0.87 (median=0.71); seven of the 10 PDs had alphas greater than 0.70. Between-category criterion overlap was evaluated by ‘inter-category’ intercriterion correlations between all PD pairs (ICMIC). ICMIC values (median=0.08) were lower than MIC values (median=0.23). Diagnostic efficiency statistics (sensitivity, specificity, positive predictive power and negative predictive power were calculated for …

Treatment Utilization By Patients With Personality Disorders, Donna S. Bender, Regina T. Dolan, Andrew E. Skodol, Charles A. Sanislow, Ingrid R. Dyck, Thomas H. Mcglashan, M. Tracie Shea, Mary C. Zanarini, John M. Oldham, John G. Gunderson

Charles A. Sanislow, Ph.D.

Objective: Utilization of mental health treatment was compared in patients with personality disorders and patients with major depressive disorder without personality disorder.

Method: Semistructured interviews were used to assess diagnosis and treatment history of 664 patients in four representative personality disorder groups—schizotypal, borderline, avoidant, and obsessive-compulsive—and in a comparison group of patients with major depressive disorder.

Results: Patients with personality disorders had more extensive histories of psychiatric outpatient, inpatient, and psychopharmacologic treatment than patients with major depressive disorder. Compared to the depression group, patients with borderline personality disorder were significantly more likely to have received every type of psychosocial treatment …

Suicidal Ideation And Help-Negation: Not Just Hopelessness Or Prior Help., Coralie Wilson

Coralie J Wilson

Few distressed young people seek professional psychological help and little is known about what sources of help young people seek for different problems. In suicidal youth, poor help-seeking may be exacerbated by the process of help-negation. The current study is the first of a larger program of PhD research developed and led by the second author. In the current study, three hundred and two undergraduate university students completed a questionnaire measuring suicidal ideation, hopelessness, prior help-seeking experience, and help-seeking intentions. Participants indicated they would seek help from different sources of help for different types of problems, but friends were consistently …

Adolescent Opinions About Reducing Help-Seeking Barriers And Increasing Engagement., Coralie Wilson

Coralie J Wilson

Effective mental illness prevention programs are important for the safety of youth and adolescents. Research suggests that programs should facilitate appropriate help-seeking by lowering help-seeking barriers. This study used focus groups to obtain high school student opinions about actual help-seeking behaviors, reducing adolescent help-seeking barriers, raising sensitive issues with adolescents, and increasing appropriate help-source engagement. Transcript analysis revealed several themes. Relationship and trust were key approach factors for current help-seeking. Memories of successful prior helping episodes were also important. Education about appropriate help-seeking, presented in ways consistent with those currently used by adolescents (e.g., through peer networks), might reduce help-seeking …

Suicidal Ideation And Help-Negation: Not Just Hopelessness Or Prior Help., Coralie J. Wilson

Frank Deane

Few distressed young people seek professional psychological help and little is known about what sources of help young people seek for different problems. In suicidal youth, poor help-seeking may be exacerbated by the process of help-negation. The current study is the first of a larger program of PhD research developed and led by the second author. In the current study, three hundred and two undergraduate university students completed a questionnaire measuring suicidal ideation, hopelessness, prior help-seeking experience, and help-seeking intentions. Participants indicated they would seek help from different sources of help for different types of problems, but friends were consistently …

Adolescent Opinions About Reducing Help-Seeking Barriers And Increasing Engagement., Coralie J. Wilson

Frank Deane

Effective mental illness prevention programs are important for the safety of youth and adolescents. Research suggests that programs should facilitate appropriate help-seeking by lowering help-seeking barriers. This study used focus groups to obtain high school student opinions about actual help-seeking behaviors, reducing adolescent help-seeking barriers, raising sensitive issues with adolescents, and increasing appropriate help-source engagement. Transcript analysis revealed several themes. Relationship and trust were key approach factors for current help-seeking. Memories of successful prior helping episodes were also important. Education about appropriate help-seeking, presented in ways consistent with those currently used by adolescents (e.g., through peer networks), might reduce help-seeking …

Schizotypal Personality Questionnaire-Brief: Factor Structure And Convergent Validity In Inpatient Adolescents, Seth R. Axelrod, Carlos M. Grilo, Charles A. Sanislow, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

We examined the internal consistency, factor structure, and validity of the Schizotypal Personality Questionnaire-Brief (SPQ-B). Two hundred thirty-seven psychiatrically hospitalized adolescents were administered the SPQ-B and a battery of well-established self-report instruments. The SPQ-B demonstrated adequate internal consistency. Exploratory factor analysis provided mixed support for the SPQ-B 3-factor structure of interpersonal deficits, cognitive-perceptual deficits, and disorganization. The Interpersonal and Cognitive-Perceptual subscales demonstrated convergent and discriminant relationships with other measures of interpersonal impairment and cognitive abnormalities. We concluded that the SPQ-B is a promising measure for evaluating schizotypal personality disorder features, specifically interpersonal and cognitiveperceptual deficits, with adolescent psychiatric inpatients.

Schizophrenia: A Critical Examination, Charles A. Sanislow, Robert C. Carson

Charles A. Sanislow, Ph.D.

No abstract provided.

Factor Analysis Of The Dsm-Iii-R Borderline Personality Disorder Criteria In Psychiatric Inpatients, Charles A. Sanislow, Carlos M. Grilo, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: The goal of this study was to examine the factor structure of the DSM-III-R criteria for borderline personality disorder in young adult psychiatric inpatients.

Method: The authors assessed 141 acutely ill inpatients with the Personality Disorder Examination, a semistructured diagnostic interview for DSM-III-R personality disorders. They used correlational analyses to examine the associations among the different criteria for borderline personality disorder and performed an exploratory factor analysis.

Results: Cronbach’s coefficient alpha for the borderline personality disorder criteria was 0.69. A principal components factor analysis with a varimax rotation accounted for 57.2% of the variance and revealed three homogeneous factors. …

The Collaborative Longitudinal Personality Disorders Study: Reliability Of Axis I And Ii Diagnoses., Mary C. Zanarini, Andrew E. Skodol, Donna S. Bender, Regina T. Dolan, Charles A. Sanislow, Elizabeth Schaefer, Leslie C. Morey, Carlos M. Grilo, M. Tracie Shea, Thomas H. Mcglashan, John G. Gunderson

Charles A. Sanislow, Ph.D.

Both the interrater and test-retest reliability of axis I and axis II disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). Fair-good median interrater K (.40-.75) were found for all axis II disorders diagnosed five times or more, except antisocial personality disorder (1.0). All of the test-retest K for axis II disorders, except for narcissistic personality disorder (1.0) and paranoid personality disorder (.39), were also found to be fair-good. Interrater and test-retest dimensional reliability figures for axis II were generally higher than those for their categorical …

Psychological And Behavioral Functioning In Adolescent Psychiatric Inpatients Who Report Histories Of Childhood Abuse, Carlos M. Grilo, Charles A. Sanislow, Dwain C. Fehon, Steve Martino, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: The purpose of this study was to examine psychological and behavioral functioning in psychiatrically hospitalized adolescents who report histories of childhood abuse. Method: Three hundred twenty-two subjects completed an assessment battery of psychometrically well-established instruments. Childhood abuse was assessed by using the childhood abuse scale of the Millon Adolescent Clinical Inventory. Childhood abuse scores of 30 or less and 70 or greater were used to create two study groups—no abuse (N=93) and high abuse (N=70), respectively. The two study groups were compared demographically and on the battery of instruments. Results: The two groups differed substantially on most measures of …

Treatment Outcome Of Personality Disorders, Charles A. Sanislow, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: To review the treatment outcome of personality disorders.

Method: A literature search of studies pertaining to personality disorder and outcome was conducted, and studies that focused primarily on Axis II were retained. Of these, naturalistic outcome studies were distinguished from those that addressed treatment outcome specifically. The treatment outcome studies were examined in terms of type of treatment intervention, dependent variables, and outcome.

Results: Contrary to contemporary assumptions about Axis II, a substantial number of treatment outcome studies were identified. Trends in the assumptions underlying psychosocial and pharmacologic approaches were identified on the basis of dependent variables.

Conclusion: There …

The Schizophrenias, Robert Carson, Charles Sanislow

Charles A. Sanislow

No abstract provided.

Norm-Of-Reaction: Definition And Misinterpretation Of Animal Research, Steve A. Platt, Charles A. Sanislow

Charles A. Sanislow, Ph.D.

The development of a phenotype is due to an interaction of the genotype with the environment. Two terms have been used to describe the outcome of this interaction, the norm-of-reaction and the reaction range. The first represents the theoretically limitless distribution of the phenotypes that may be expressed by a given genotype. The reaction range implies an upper and lower limit for phenotype expression possible from a given genotype. A critical distinction between the reaction range and the norm-of-reaction is that the norm-of-reaction is a statement of the conceivable interactions found but does not imply any predictability other than that …