Interview Ratings Research Articles

Sexual dysfunction in patients with psoriasis

Psoriasis can have a significant impact upon sexual function. The aim of this study was to investigate sexual function in females and males with psoriasis and to evaluate whether coexistent depression has an additional negative effect on sexual function in these patients. A total of 66 female subjects (39 with psoriasis and 27 healthy volunteers as a control group) and 70 male subjects (39 with psoriasis and 31 healthy volunteers as a control group) were enrolled in the study. A Psoriasis Area and Severity Index (PASI) was used to determine the severity of psoriasis for the patient groups. The Female Sexual Function Index (FSFI) was used to assess female sexual function and the International Index of Erectile Function (IIEF) was used to evaluate male sexual function. Quality of life was assessed with the Dermatology Life Quality Index (DLQI). The diagnosis of depression was made according to the Structured Clinical Interview for DSM-IV (SCID-I) interview and Hamilton Depression Rate Scale (HDRS) was used for grading depression. FSFI total score was found to be significantly decreased in female psoriatic patients without depression and psoriatic patients plus depression compared with healthy controls (24.09 +/- 5.33 vs. 24.25 +/- 4.52 vs. 28.12 +/- 3.48, respectively, p = 0.004). However, FSFI score was not significantly different between patients with psoriasis without depression and those with psoriasis plus depression (p > 0.05). IIEF total score was also found to be significantly decreased in male psoriasis without depression and psoriasis plus depression patients compared with healthy controls (54.21 +/- 13.07 vs. 52.0 +/- 14.73 vs. 61.69 +/- 9.49, respectively, p = 0.023). The difference in IIEF scores between patients with psoriasis without depression and in those with psoriasis plus depression were not statistically significant (p > 0.05). The results of the study demonstrated that patients with psoriasis, especially females have distinct sexual dysfunction compared with healthy controls, and coexistent depression has no additional negative effect on sexual dysfunction in our patients. Patients with psoriasis should be evaluated in terms of sexual function in order to provide a better quality of life.

Insight as a Predictor of Treatment Outcome in Behavioral Group Treatment for Obsessive–Compulsive Disorder

The presence of poor insight into the senselessness of symptoms of obsessive–compulsive disorder (OCD) has been theoretically linked to poor treatment response, yet few studies have examined this question. This study examined the role of poor insight in 69 OCD patients, who completed 7 weeks of cognitive behavioral group therapy. Participants completed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and other measures of psychopathology. Insight was measured using interviewer ratings on an item of the Y-BOCS and participants were grouped as having “poor” or “adequate” insight. The analyses revealed that, after pre-treatment levels of OCD severity, depression, and medication status, were controlled, patients with adequate insight experienced better post-treatment outcomes than those with poor insight. These results suggest that patients with poorer insight can still benefit from treatment, but may experience a less favorable outcome than patients with better insight. Implications for the treatment of OCD are discussed.

The Latent Structure of Attention-Deficit/Hyperactivity Disorder: A Taxometric Analysis

To test whether the latent structure of attention deficit/hyperactivity disorder (ADHD) is best understood as categorical or dimensional in samples of 1774 children (aged 6-12 years) and 1222 adolescents (aged 13-17 years) drawn from an Australian epidemiological study. Two taxometric procedures (MAXEIG and MAMBAC) examined ADHD symptom measures assessed by diagnostic interview and parental ratings. Consistent with behavioural genetic research, findings fail to support the view that a latent category underpins ADHD. ADHD is best modelled as a continuum among both children and adolescents, and no discrete dysfunction can therefore be assumed to cause it. The placement of the diagnostic threshold should therefore be decided on pragmatic grounds (e.g. impairment or need for treatment).

Comorbid Psychiatric Disorders in Children with Autism: Interview Development and Rates of Disorders

The Kiddie Schedule for Affective Disorders and Schizophrenia was modified for use in children and adolescents with autism by developing additional screening questions and coding options that reflect the presentation of psychiatric disorders in autism spectrum disorders. The modified instrument, the Autism Comorbidity Interview-Present and Lifetime Version (ACI-PL), was piloted and frequently diagnosed disorders, depression, ADHD, and OCD, were tested for reliability and validity. The ACI-PL provides reliable DSM diagnoses that are valid based on clinical psychiatric diagnosis and treatment history. The sample demonstrated a high prevalence of specific phobia, obsessive compulsive disorder, and ADHD. The rates of psychiatric disorder in autism are high and are associated with functional impairment.

Child ADHD and personality/temperament traits of reactive and effortful control, resiliency, and emotionality

Models of attention-deficit/hyperactivity disorder (ADHD) suggest developmental influences may feed into components of the disorder separately from associated disruptive behavior problems. We investigated this in terms of key personality/temperament traits of Reactive and Effortful Control, Resiliency, and Emotionality. A sample of 179 children (age 6-12, 63% boys), of whom 92 had ADHD, 52 were Controls, and 35 were borderline or not otherwise specified cases of ADHD, were examined. Dispositional trait scores were derived from parent-completed California Q-sort and the Early Adolescent Temperament Questionnaire. Child ADHD symptoms were evaluated using maternal structured diagnostic interview and teacher-completed symptom ratings. Traits were differentially associated with symptoms. Reactive Control was related to hyperactivity-impulsivity as rated by both parents and teachers. Negative Emotionality was related to oppositional-defiance. Resiliency was primarily related to inattention-disorganization as rated by both parents and teachers; Effortful Control was related uniquely to inattention in parent but not teacher data. A moderation effect emerged; the relationship between parent-rated Negative Emotionality and teacher-rated ADHD symptoms was stronger for children with high levels of both Reactive and Effortful Control. Results are interpreted in relation to a two-pathway model of ADHD; regulation problems contribute to the emergence of symptoms of inattention-disorganization, reactive or motivational control problems to the emergence of hyperactivity-impulsivity, and these are distinct from negative affectivity. Children with regulation deficits and a reactive motivational style are especially at risk for the development of ADHD.

Family psychiatric history evidence on the nosological relations of DSM‐IV ADHD combined and inattentive subtypes: new data and meta‐analysis

A key issue in the nosology of attention deficit hyperactivity disorder (ADHD) has concerned whether the DSM-IV combined (ADHD-C) and primarily inattentive (ADHD-PI) subtypes are in fact distinct disorders, or instead are fairly closely related, perhaps differing only in severity. Pertinent to this question, but in short supply, are data on family psychiatric history. We present new data followed by a meta-analysis. For the new data 210 children were well-characterized via structured interview and multi-informant ratings as ADHD-C or ADHD-PI. Three hundred and thirty-five parents completed structured diagnostic interviews to determine whether they had ADHD-C or ADHD-PI. Comorbid disorders were also assessed. For the meta-analysis, 6 existing family-history data sets using DSM-IV subtypes were pooled and analyzed (total N = 4120). The new family study found support for subtype-specific transmission, but the effect was small. Girls with ADHD-C had more severe family psychiatric histories (non-ADHD disorders in parents) than girls with ADHD-I, but this subtype effect did not occur for boys. The meta-analysis of 6 data sets implemented a model-fitting methodology. Despite inconsistent results across individual studies, the pooled data consistently suggested that (1) some degree of subtype specific transmission is occurring, (2) the effect is small, (3) non-specific (gradient) transmission also occurs, specifically in families of children with ADHD-C. The much-debated relation between these two most prevalent ADHD subtypes is best modeled via two processes transmitting in families. One process is distinct for the two syndromes, and the other is shared. We briefly suggest neuropsychological models that would account for this state of affairs and suggest future research to refine the nosology with these findings in mind.

Voice and Upper Airway Symptoms in People With Chronic Cough and Paradoxical Vocal Fold Movement

Chronic cough (CC) and paradoxical vocal fold movement (PVFM) share several common features; however, there has been no systematic comparison of these two conditions. The aims of this study were to contrast and compare the symptom profiles of CC and PVFM, to clarify the relationship between the two conditions, and to explore how symptom characteristics could be used to design an individualized treatment program. Participants included 55 people with a combination of PVFM and CC that was refractory to medical treatment, 8 people with PVFM alone, 56 people with CC alone, 25 people with voice disorders, and 27 normal controls. Symptoms and descriptive features of CC, PVFM, and voice disorders were assessed via structured case history interview, symptom frequency, and severity ratings, ratings of activity limitation, and anxiety/depression ratings. Results indicated consistent overlap in the symptom profile between people with CC and those presenting with a combination of CC and PVFM. Participants with PVFM without cough and those with voice disorders overlapped with the participants with CC on some dimensions; however, there were still some significant differences between them. These data suggest that CC and PVFM are related and manifestations of a common underlying condition but that voice disorders are a discrete entity. Most participants had normal ratings on screening for anxiety and depression. Results indicated that there were no consistent psychiatric symptoms in any of the groups studied, and they do not support the label of psychogenic cough for CC that is refractory to medical treatment. Characteristics of CC such as nature and timing of the cough provide important information for developing behavioral treatment programs for individual patients who have exhausted medical options. A template has been provided that is a practical method of designing an integrated behavioral treatment program based on those individual patient characteristics.

A taxometric investigation of the latent structure of social anxiety disorder in outpatients with anxiety and mood disorders

The latent structure of social phobia was examined in a sample of 2,035 outpatients with anxiety and mood disorders to determine whether the disorder operates in a categorical or dimensional fashion. We performed three mathematically distinct taxometric procedures-MAMBAC, MAXEIG, and L-Mode-using five indicators constructed from clinical interview ratings and questionnaire measures of social anxiety symptoms. Results from screening analyses and simulated comparison data consistently indicated that the data were suitable for taxometric analysis. The collective results across procedures, consistency tests, and analysis of simulated comparison data produced converging evidence in support of the conclusion that the latent structure of social phobia is dimensional.

APPLIED RESEARCH: Examining the Influence of Using Same Versus Different Questions on the Reliability of the Medical School Preadmission Interview

Background: Researchers generally recommend a structured format for the medical school preadmission interview (MSPI). However, the relative benefits of various elements of structure remain unexamined.Purpose: In this study, we compared the performance of a highly structured interview format with a semistructured format. Specifically, we examined how the reliability of interview ratings is likely to change when using the same versus different questions for each applicant being interviewed.Method: Variance components from a generalizability (G) study of a structured interview are used in decision studies to compare the relative efficiency of using the same versus different questions for each applicant.Results: Using different questions for each interviewee is practically as reliable as using the same questions for all applicants (G =. 55 vs.. 57, respectively).Conclusions: Because there are a number of drawbacks to using the same questions for all applicants (i.e., security and validity) and little advantage in terms of increased reliability, the semistructured question format should be considered when conducting the MSPI. A suggested method of implementing a semistructured interview is by presenting each applicant a set of questions randomly drawn from a pool of interview questions.

Disability disclosure effects on employment interview ratings of applicants with nonvisible disabilities.

ObjectiveTo investigate the effects of timing of verbal disclosure of a disability on employment interview ratings of applicants with nonvisible disabilities.Study DesignParticipants (56 college students) viewed 2 videotaped employment interviews: 1 involving an applicant who disclosed a nonvisible

Personality Saturation in Structured Interviews

Applied psychologists have long been interested in the relationship between applicant personality and employment interview ratings. Analysis of data from two studies, one using a situational interview and one using a behavioral interview, suggests that the correlations of structured interview ratings with self-report measures of personality factors are generally rather low. Further, a small meta-analysis integrates these two studies and the limited previous literature to arrive at a similar conclusion – there is relatively little relationship between structured interviews and self-reported personality factors.

Development of a questionnaire for assessment of the psychosocial impact of dental aesthetics in young adults

The aim of this study was to develop a psychometric instrument for assessment of orthodontic-specific aspects of quality of life. The study subjects, 194 young adults aged 18-30 years, were interviewed using a pool of 23 items dealing with the psychosocial impact of dental aesthetics. Self- and interviewer-rating of the dental aesthetic appearance of each subject were carried out using the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Additionally, the Perception of Occlusion Scale and a modification of the Dental Aesthetic Index (DAI) were applied. Factorial analyses identified four measures within the item pool, namely Dental Self-Confidence, Social Impact, Psychological Impact, and Aesthetic Concern. The factor structure was confirmed in an independent sample of 83 subjects aged 18-33 years. The reliabilities of the factor analysis-derived scales were between alpha (alpha) 0.85 and 0.91. They differed between respondents with varying severity of malocclusion, as assessed by subject and interviewer ratings. The results suggest that the proposed instrument, termed the 'Psychosocial Impact of Dental Aesthetics Questionnaire' (PIDAQ), meets the criteria of factorial stability across samples and criterion-related validity and reliability, and might be a promising tool for further research and clinical application in orthodontics.

Depressive symptoms and the regulation of proinflammatory cytokine expression in patients with coronary heart disease

Objective: Depressive symptoms increase the risk of morbidity and mortality in patients with coronary heart disease (CHD). Mounting evidence indicates that inflammatory processes may underlie this association. This study examined whether depressive symptoms are associated with the dysregulation of inflammatory cytokine production in response to an in vitro infectious challenge. Methods: Forty-one patients with CHD were enrolled 3 months or more after an acute myocardial infarction or revascularization procedure. Depressive symptoms were assessed through self-report and interviewer ratings. Cytokine production was measured after white blood cells were cultured in vitro with endotoxin in the presence of varying concentrations of dexamethasone. Results: Depressive symptoms were not associated with the quantity of in vitro inflammatory cytokine production. However, to the extent that they reported symptoms of depression, patients showed greater sensitivity to the anti-inflammatory properties of glucocorticoids. This was manifested by increased suppression of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) production by dexamethasone. Conclusions: Increased sensitivity to glucocorticoid inhibition could render depressed patients vulnerable to latent infections and inflammatory processes that accelerate the progression of cardiac disease.

Anxiety and Schizophrenia: The Interaction of Subtypes of Anxiety and Psychotic Symptoms

To examine the interaction of specific anxiety subtypes and psychosis. Accumulating evidence suggests that anxiety and its disorders play a significant role in patients with schizophrenia, but few studies have examined multiple types of anxiety and how they interact with different symptoms of schizophrenia. Thirty-two patients diagnosed with schizophrenia or schizoaffective disorder were assessed through self-report measures and interviewer rating scales to examine symptoms of psychosis and anxiety. A majority of patients (62%) were diagnosed with at least one comorbid anxiety disorder. Obsessive-compulsive symptoms and social anxiety symptoms were related to positive symptoms, bizarre behavior, and quality of life (QOL). Furthermore, panic and social anxiety were related to suspiciousness/paranoia. No consistent relationship was found with negative symptoms. Finally, severity of anxiety disorders was negatively correlated with the severity of formal thought disorder. This is one of the first studies to simultaneously examine the interrelationships of different types of anxiety symptoms and psychotic symptoms. The present findings are consistent with the studies that have suggested relationships between panic and paranoia and comorbid anxiety disorders and impaired QOL. These data suggest that further research into anxiety in schizophrenia, including the cognitive and neurobiological correlates, may help elucidate the mechanisms involved in the manifestation of these psychopathologies. Anxiety disorders are common in patients with schizophrenia. The presence of such symptoms may influence the presence of core psychotic symptoms and QOL. More information is needed in terms of the relationship between treatment of these symptoms and changes in psychotic symptoms and/or relapse prevention.

The stability of maternal ratings of medical student interviews

Little information is available on the intrarater reliability of parent ratings of medical student interview skills. The aim of this study was to compare maternal ratings of a videotaped medical student interview, with ratings by the same mother of the same interview seen a month later. Thirty mothers rated 1 of 2 'medical student' interview videotapes (random allocation). An actor played the role of the student and demonstrated different student skill levels in each interview. Mothers rated the same interview again a month later (mean +/- SD 34 +/- 13 days). Maternal satisfaction was measured using the Medical Interview Satisfaction Scale (MISS, maximum score 203) and the Interpersonal Skills Rating Scale (IPS, maximum score 91) with higher scores indicating higher satisfaction. No significant differences in mean maternal ratings were observed following the first and second viewings of each interview. The average percentage difference in first and second viewing scores was MISS 4%, IPS 8% with correlation coefficients MISS 0.96, IPS 0.87 (P < 0.05). The high levels of stability in maternal evaluations of simulated medical student interviews supports the use of maternal evaluations for longitudinal monitoring of medical student performance.

When smokers are resistant to change: experimental analysis of the effect of patient resistance on practitioner behaviour

In the field of motivational interviewing, practitioner confrontational behaviour has been associated with lower levels of patient behaviour change. We set out to explore whether resistance to change among smokers affects practitioner confrontational and other behaviours. Experimental manipulation of levels of patient resistance in a role play. The study was conducted at the start of a 2-day health behaviour change workshop. Thirty-two practitioners who had registered for the workshop. The practitioners were assigned randomly to interview a standardized patient (actor) who portrayed a smoker who had been briefed to display either high or low levels of resistance to change. Interviews were audiotaped and transcribed. Practitioners and standardized patients completed interview ratings at the end of each interview. After listening to each taped interview practitioners were assigned a global score for confrontation, empathy and expert instructional style. Interviews were then submitted to a qualitative analysis. Higher levels of practitioner confrontational behaviour were observed in the high resistance group. This was evident both from the global scores (median 2 versus 0, P = 0.001) and the qualitative analysis. Global scores for empathy and expert instruction were not significantly different. Qualitative analysis also suggests a pervasive negative impact on other practitioner behaviours. Higher patient resistance probably leads to an increase in confrontational and other negative behaviours in health professionals attempting to promote behaviour change. This challenges important assumptions about the influence of practitioner behaviour on patient behaviour and subsequent health-related outcomes.

Behavioral signs of schizoidia and schizotypy in social anhedonics

Social anhedonia appears to be a promising indicator of Meehl's construct of schizotypy. While findings from diagnostic, cognitive, and psychophysiological studies have supported the validity of social anhedonia as an indicator of schizotypy, the behavioral characteristics of these putative schizotypes are not yet fully understood. This study utilized a rating system for behavioral signs of schizoidia and schizotypy to determine whether atypical interpersonal behaviors were observable in social anhedonics and to examine if these behavioral signs provide unique information, beyond traditional symptom ratings, in the identification of putative schizotypes. A community sample of 170 18–19-year-olds (85 social anhedonics, 85 controls) received diagnostic evaluations which were videotaped and subsequently rated for behavioral signs of schizoidia and schizotypy. Compared to controls, the social anhedonia group displayed significantly more behavioral signs characteristic of schizoid and schizotypal personality disorders. Behavioral signs of schizoidia accounted for a significant amount of group variance even after controlling for clinical symptom ratings. These results indicate that social anhedonics display interpersonal behaviors consistent with risk for schizophrenia-spectrum disorders and that these behavioral signs convey information about group status that is not accounted for by traditional clinical interview ratings of symptomatology.

Assessing Personality With a Structured Employment Interview: Construct-Related Validity and Susceptibility to Response Inflation.

The authors evaluated the extent to which a personality-based structured interview was susceptible to response inflation. Interview questions were developed to measure facets of agreeableness, conscientiousness, and emotional stability. Interviewers administered mock interviews to participants instructed to respond honestly or like a job applicant. Interviewees completed scales of the same 3 facets from the NEO Personality Inventory, under the same honest and applicant-like instructions. Interviewers also evaluated interviewee personality with the NEO. Multitrait-multimethod analysis and confirmatory factor analysis provided some evidence for the construct-related validity of the personality interviews. As for response inflation, analyses revealed that the scores from the applicant-like condition were significantly more elevated (relative to honest condition scores) for self-report personality ratings than for interviewer personality ratings. In addition, instructions to respond like an applicant appeared to have a detrimental effect on the structure of the self-report and interview ratings, but not interviewer NEO ratings.

Improving Guideline Adherence for the Diagnosis of ADHD in an Ambulatory Pediatric Setting

The American Academy of Pediatrics (AAP) has published clinical practice guidelines for the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). However, implementation of guidelines has been notoriously difficult to achieve in the wider context of changing individual physicians' clinical practice. Implement a formalized diagnostic protocol for ADHD and study whether this protocol improved adherence of pediatric residents and faculty to published guidelines for the diagnosis of ADHD. Quasi-experimental retrospective record review of 63 pediatric patients evaluated for ADHD by pediatric residents and faculty in an outpatient pediatric clinic before (n = 25) and after (n = 38) implementation of a formal diagnostic process for ADHD. The key elements of the new diagnostic process include completion of a semistructured interview and mandatory rating scales for home and school. The published AAP guidelines include 1) documentation of Diagnostic and Statistical Manual for Mental Disorders (DSM) IV criteria; 2) evidence of core symptoms obtained directly from home and 3) from school; and 4) assessment for coexisting conditions. Adherence was assessed to each criterion individually (yes/no) and was summarized in a single score. Only 4% of clinicians and nurse practitioners diagnosing children in the before group adhered to all 4 AAP guidelines, compared to 82% in the after group (P < .001). Significant improvement was observed across each of the 4 criteria in the AAP guidelines. Moreover, the improvement in adherence to all 4 guidelines was noted for residents and faculty. A significant improvement in adherence to AAP guidelines was obtained for all providers through implementation of a structured diagnostic approach to ADHD.

Levels of Depressive Symptoms in Spouses of People With Lung Cancer: Effects of Personality, Social Support, and Caregiving Burden

The authors sought to identify the personality correlates of depressive symptoms in 120 spouses of people with lung cancer. Spouses completed questionnaires, including measures of personality (neuroticism, extraversion, and interpersonal self-efficacy), social support, and caregiving burden. Their level of depressive symptoms was measured with self-report (Center for Epidemiologic Studies Depression Scale) and interviewer (Hamilton Depression Rating Scale) ratings. Structural equation modeling showed that neuroticism was directly associated with greater depressive symptoms and indirectly associated with less social support and greater caregiving burden. Interpersonal self-efficacy was indirectly associated with the severity of depressive symptoms through both social support and caregiving burden. These findings have implications for identifying spouses of individuals with lung cancer who are vulnerable to depression and could inform the design of programs to reduce depressive symptoms in the context of cancer caregiving.