Greg Haggerty

Attachment and interpersonal distress: examining the relationship between attachment styles and interpersonal problems in a clinical population

The present study examined the relationship between self-perceived attachment styles and interpersonal problems. Specifically, we utilized a clinical sample from an outpatient university-based community clinic who completed the Experiences in Close Relationships Scale-Revised, the Relationship Questionnaire and Inventory of Interpersonal Problems Circumplex Scales (IIP-64) as part of a psychological assessment process. The results showed a significant positive correlation between the IIP-64 total score and both attachment anxiety and attachment avoidance. Findings revealed significant negative relationships between a secure attachment and the dominant, vindictive, cold, socially inhibited and non-assertive subscales of the IIP-64. Findings also revealed a significant positive relationship between a fearful attachment and the dominant, vindictive, cold, socially inhibited and non-assertive subscales of the IIP-64. Finally, results showed a significant relationship between a dismissive attachment and the dominant subscale of the IIP-64.

The physician-patient working alliance and patient psychological attachment, adherence, outcome expectations, and satisfaction in a sample of rheumatology patients.

Over the past twenty years, the physician–patient relationship (eg, the physician–patient working alliance) has emerged as an integral component to the treatment of patients for a myriad of health conditions. Psychological, emotional, and behavioral dimensions of patients’ working alliance with their physicians, along with patients’ attachment styles, were examined in relation to rheumatology patients’ adherence to treatment plans, outcome expectations, and satisfaction. Study participants were 101 adult outpatients from a rheumatology clinic. Path analyses demonstrated that the physician–patient working alliance predicted outcome expectations (Standardized Beta [SB] = 0.27), and patient satisfaction (SB = 0.62), and that patient satisfaction in turn predicted patient adherence (SB = 0.48). Physicians’ ratings of patient adherence were significantly and positively correlated with patients’ ratings of the physician–patient working alliance. No significant paths were evident with respect to patient attachment. The physician–patient working alliance directly predicts patient satisfaction, and outcome expectations, and indirectly predicts adherence through patient satisfaction.

Convergent and divergent validity of the relationship profile test: investigating the relationship with attachment, interpersonal distress and psychological health†

The present study looked to illustrate the convergent and divergent validity of the Relationship Profile Test (RPT), which is a 30-item self-report measuring destructive overdependence, dysfunctional detachment, and healthy dependence. The RPT items are written to draw upon Bornsteins (19921993) 4-component model as well as other essential components of the dimension in question (Bornstein et al., 2003). The results reveal that the subscales of the RPT are related in predictable ways to scores on measures of adult attachment, interpersonal distress, and psychological health and well-being. The clinical implications of the results and the assessment of dependency in the clinical setting are discussed.

Alzheimer's Disease - Not an Exaggeration of Healthy Aging

The world population is becoming older now. The boom of the elderly population comes from public health efforts to improve living conditions and prevent disease, and from improved medical interventions. People more than 65-year-old who are representing 12.9% of the population now is expected to grow to be 19% of the population by 2030. Very few numbers of diseases will have such socioeconomic burden on society in the newer world. Although Alzheimers disease (AD) has been studied very well recently, still its exact etiopathogenesis is unknown. Currently there are no available tests for the definitive diagnosis of AD. So the clinical diagnosis of AD remains a diagnosis of exclusion. This limits the potential for early intervention. The difference between normal degenerative processes of brain and preclinical changes of AD is a gray zone and there is no particular way to distinguish between the two. Now several modalities like functional magnetic resonance imaging (fMRI), positron emission tomography (PET) scan, electrophysiological tests and cerebrospinal fluid (CSF) biomarkers for tauopathy and Aβ have shown to be promising in the development of early diagnostic tools for neurodegenerative changes and help us to differentiate between healthy aging and pathological aging. In this article we tried to discuss about the differences between pathological and physiological aging process from radiological, pathological, biochemical, and electrophysiological point of view. However, differentiating between physiological and pathological dementia still remains a challenge.

Development and preliminary validation of the Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI) in a psychiatric sample.

Research over the last decade has been promising in terms of the incremental utility of psychometric tools in predicting important clinical outcomes, such as mental health service utilization and inpatient psychiatric hospitalization. The purpose of this study was to develop and validate a new Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI). Logistic regression was initially used in a development sample (n = 253) of psychiatric patients to identify unique PAI indicators associated with inpatient (n = 75) as opposed to outpatient (n = 178) status. Five PAI variables were ultimately retained (Suicidal Ideation, Antisocial Personality-Stimulus Seeking, Paranoia-Persecution, Negative Impression Management, and Depression-Affective) and were then aggregated into a single LOCI and independently evaluated in a second validation sample (n = 252). Results indicated the LOCI effectively differentiated inpatients from outpatients after controlling for demographic variables and was significantly associated with both internalizing and externalizing risk factors for psychiatric admission (range of ds = 0.46 for history of arrests to 0.88 for history of suicidal ideation). The LOCI was additionally found to be meaningfully associated with measures of normal personality, performance-based tests of psychological functioning, and measures of neurocognitive (executive) functioning. The clinical implications of these findings and potential utility of the LOCI are discussed.

Estimating the Effects of Thematic Apperception Test Card Content on SCORS–G Ratings: Replication With a Nonclinical Sample

ABSTRACT The content of Thematic Apperception Test (TAT) cards can, in some cases, influence how respondents form narratives. This study examines how imagery from select TAT cards affects the narratives of respondents from a nonclinical setting. The Social Cognition and Object Relations Scale–Global Rating Method (SCORS–G; Stein, Hilsenroth, Slavin-Mulford, & Pinsker, 2011; Westen, Lohr, Silk, Kerber, & Goodrich, 1989) was used to rate narratives. Forty-nine college students provided narratives to 6 TAT cards. Narratives were rated by two expert raters using the SCORS–G. Consistent with prior research, Card 2 exhibited the most pull for adaptive ratings on SCORS–G scales, and 3 BM exhibited the most pull for maladaptive ratings. Findings for other cards were mixed. Although raters were highly reliable, internal consistency estimates were lower than desirable for 6 of the 8 SCORS–G scales. Variance component estimates indicated that card by person interactions accounted for the largest amount of variance in person-level scores. Results and limitations are discussed in light of prior research. We also make suggestions for further lines of research in this area.

Clinical Validity of a Dimensional Assessment of Self- and Interpersonal Functioning in Adolescent Inpatients

The Social Cognition and Object Relations Scale–Global Version (SCORS–G) is a clinical rating system assessing 8 domains of self- and interpersonal relational experience that can be applied to narrative response data (e.g., Thematic Apperception Test [TAT; Murray, 1943], early memories narratives) or oral data (e.g., psychotherapy narratives, relationship anecdotal paradigms). In this study, 72 psychiatrically hospitalized adolescents consented and were rated by their individual and group therapist using the SCORS–G. Clinicians also rated therapy engagement, personality functioning, quality of peer relationships, school functioning, global assessment of functioning (GAF), history of eating-disordered behavior, and history of nonsuicidal self-injury. SCORS–G composite ratings achieved an acceptable level of interrater reliability and were associated with theoretically predicted variables (e.g., engagement in therapy, history of nonsuicidal self-injury). SCORS–G ratings also incrementally improved the prediction of therapy engagement and global functioning beyond what was accounted for by GAF scores. This study further demonstrates the clinical utility of the SCORS–G with adolescents.

A brief inpatient measure of global psychiatric symptom severity: initial validation of the Brief Symptom Measure-25 for an adolescent inpatient sample.

Abstract Adolescent psychiatry is experiencing a growing need for brief yet psychometrically robust outcome measures for inpatient settings. Outcome measures currently available present limitations to clinicians and patients alike in terms of their excessive length, time of completion, difficulty to score, and focus on specific clusters of symptoms. The present study sought to validate the Brief Symptom Measure-25 (BSM-25) as a brief and easily administered measure of global psychiatric symptom severity in adolescent inpatient samples. This study evaluated the results from 154 adolescent inpatients who completed several self-report measures at admission. The findings demonstrate that the instrument has good construct validity when compared with validated measures of psychological health and well-being, behavioral problems, and interpersonal distress. We also showed the sensitivity to change of the BSM-25 from admission to discharge, and we showed that this healthy change was paralleled in several measures (self-reports and clinician ratings), using data from 75 adolescent psychiatric inpatients who were assessed at admission and also at discharge. Although this is only the first step in the validation of this measure for an adolescent inpatient setting, the BSM-25 shows promise as a brief outcome measure of global psychiatric symptom severity while maintaining validity and instrument sensitivity.

Extending the Validity of the Personality Assessment Inventory's (PAI) Level of Care Index (LOCI) in Multiple Psychiatric Settings

The purpose of this study was to extend the validity and clinical application of the Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI) in 2 independent psychiatric samples. In Study 1 (N = 201), the LOCI effectively differentiated level of care (inpatients from outpatients), and was also meaningfully associated with risk factors for psychiatric admission (e.g., suicidal ideation, self-harming behavior, previous psychiatric admission, etc.), even after controlling for other demographic variables (range of Cohens ds = 0.57–1.00). Likewise, the LOCI also incremented other risk indicators (suicide and violence history) and relevant PAI indexes (i.e., Mean Clinical Elevation, and Suicide and Violence Potential) in predicting level of care, and explained an additional 6% to 12% of variance in the target variable. Diagnostic efficiency analyses indicated LOCI scores in the range of 15 to 18 optimize positive and negative predictive power, and classification rate. In Study 2 (N = 96), the LOCI was found to be significantly higher in those with a recent psychiatric admission within the past 6 months (d = 0.64), as compared to those without an admission. Similarly, those who were admitted for suicide risk had significantly higher mean LOCI scores as compared to those who did not (d = 0.70). The clinical implications of these findings and potential application of the LOCI are discussed.

A Brief Measure of Psychological Health and Well-Being Initial Validation of the Schwartz Outcome Scale for an Adolescent Inpatient Sample

Abstract The present study evaluated whether the Schwartz Outcome Scale-10 (SOS-10), a well-validated self-report measure of psychological health and well-being in the adult population, would tap this construct similarly in an adolescent inpatient sample. This study looked to compared scores on the SOS-10 with the Youth Self-Report (YSR) and the Inventory of Interpersonal Problems (IIP), two well-validated self-report measures of behavioral problems and interpersonal distress. A total of 154 adolescent psychiatric inpatients completed the SOS-10, YSR self-report, and the IIP-32 at or within a day of admission to the inpatient unit. The results showed that the SOS-10 was negatively related to the subscales of the YSR and the scales of the IIP-32. Although just the first step in the validation of this measure for the adolescent inpatient population, the SOS-10 shows promise as a measure of psychological health and well-being and, possibly, as a brief outcome measure.