Private Practice Sample Research Articles

Time savings and accuracy of a simulated flexible and conditional administration of the MMPI-2-RF in presurgical psychological evaluations of bariatric surgery candidates

BackgroundThe Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) has empirically validated utility in presurgical psychological evaluations of bariatric surgery patients. However, clinicians may prefer shorter, symptom-focused measures. ObjectivesThe purpose of the present study is to evaluate the feasibility and potential administration time savings of a proposed flexible and conditional (FCA) administration of the MMPI-2-RF in presurgical evaluations of bariatric surgery candidates. SettingBariatric surgery candidates evaluated at a large hospital as well as a private practice in the Midwest. MethodsMMPI-2-RF scores were available for a total of 4099 adult bariatric surgery candidates from 2 separate samples. The hospital sample included 911 males and 2430 females. The average BMI was 49.3 kg/m2 (SD = 11.0). The private practice sample included 105 males, 640 females, and 13 individuals who did not report gender. The average BMI was 48.8 kg/m2 (SD = 8.4). The authors used a simulation design in which existing MMPI-2-RF responses were used to simulate an FCA administration. ResultsThe findings indicated that an FCA of the MMPI-2-RF closely approximates the amount of information typically gained from a full administration of the test in the 2 samples of bariatric surgery candidates. Items savings and estimated time savings ranged from 44% to 88% in both samples, depending on the number of conditionally administered scales. ConclusionsThe present study supports the feasibility of an FCA of the MMPI-2-RF, potentially shortening administration time and reducing patient burden. However, the findings are limited because the accuracy and time savings are based on a simulation, not actual FCA administrations.

A Comparison of the Descriptive Information from the MMPI–2 and MMPI–2–RF

Do MMPI–2 or MMPI–2–RF profiles differ in how accurately they depict examinees? To explore this question, we examined differences in clinical descriptions of equivalent profiles from the two instruments. Fourteen valid MMPI–2 protocols from an archival private practice sample were scored as both the MMPI–2 and the MMPI–2–RF. The resulting 28 profiles were coded separately by four raters using the Midwestern Q-Sort. Examinee descriptions from the two instruments were compared in terms of their (a) similarity, operationalized by q-correlations between corresponding MMPI–2 and MMPI–2–RF ratings; (b) descriptive validity, operationalized by correlations with q-sorts provided by the examinees’ therapists; and (c) incremental descriptive validity, operationalized by incremental prediction of the therapist q-sorts by the MMPI–2 and MMPI–2–RF, one over the other. Descriptions from corresponding MMPI–2 and MMPI–2–RF score reports were highly intercorrelated. Ratings from both were valid predictors of therapist descriptions, and neither clearly outperformed the other in terms of incremental validity.

Associations between MMPI-2-RF Scale Scores and Self-Reported Personality Disorder Criteria in a Private Practice Sample

The current study examined the associations between MMPI-2-RF scales and self-reported DSM-5 Section II personality disorder (PD) criteria in a large (n = 640) outpatient independent practice sample. We utilised correlation and regression analyses to evaluate the predictive utility of MMPI-2-RF scale scores in predicting latent PD scores. Results generally conformed to theoretical expectations and supported the MMPI-2-RF as a successful assessment tool of Section II PDs. Specifically, the majority of hypotheses between individual MMPI-2-RF scales and PD symptom scores were supported at the zero-order level, and regression analysis revealed unique predictors for each PD that were largely consistent with theoretical expectations. Further, these results provide additional evidence that DSM-5 Section II PDs can be represented in a dimensional framework using the MMPI-2-RF, which is pertinent when applying the current results within a broader context of evolving theoretical understanding of the composition and assessment of PDs, particularly with regard to the DSM-5 Section III personality model.

Dr Google, MD: A Survey of Mental Health-Related Internet Use in a Private Practice Sample

The aim of this study was to evaluate the use of the internet to access mental health-related information in a private practice sample, and to understand how this influenced health behaviours in this group. We undertook a cross-sectional survey of adult outpatients attending two group psychiatric practices. The content included internet usage, types of information located, disclosure with treating psychiatrist, and perceived influence on decision-making. We collected both quantitative and qualitative data. The internet was often used to access mental health-related information. Respondents most commonly looked for information about symptoms, treatment, side effects and diagnoses. Approximately one-third of those who sought mental health information on the internet discussed this with their psychiatrist, and those who did so were more likely to report an influence of this information on their decision-making. Respondents' comments suggested an appreciation of the utility of the internet, combined with an understanding of its limitations. Private practice patients frequently access mental health information from the internet. When discussed within the therapeutic setting, it appears more likely to influence health-related decision-making. As part of ongoing therapy, clinicians should actively discuss what patients have read on the internet.

The Ruff Neurobehavioral Inventory: Validity Indicators and Validity

This study examined the test validity of the respondent validity scales of the Ruff neurobehavioral inventory (RNBI). In a private practice sample of motor vehicle accident pain patients (n = 54) without neurologic injury, the scores obtained for these scales were compared with and correlated with equivalent ones on the Millon clinical multi-axial inventory III (MCMI III) and the Detailed assessment of post-traumatic stress (DAPS). Results revealed that there was a consistent pattern of convergence and divergence in response styles across the three instruments. In terms of the RNBI interscale correlations, in particular, the results suggested that premorbid positive impression management and postmorbid negative impression management are related in this type of sample. These findings add to the concurrent validity of the RNBI, suggesting that the instrument provides relevant incremental information about the type of population studied. Limitations of the study and ideas for future research were discussed.

Incremental Validity of the MMPI–2 Restructured Clinical (RC) Scales in a Private Practice Sample

Building on results reported in Sellbom, Graham, and Schenk (2005), in this study, we examined the incremental validity of the newly introduced MMPI–2 (Butcher et al., 2001) Restructured Clinical (RC) scales (Tellegen et al., 2003) over both the Clinical and Content scales. Participants were 647 clients in private practice who were administered the MMPI–2 and the Multiaxial Diagnostic Inventory (Doverspike, 1990) early in therapy. The results indicate that the RC scales had acceptable internal consistency, reduced intercorrelations (compared to the Clinical scales), and promising convergent and discriminant validity. Hierarchical regression analyses revealed that the RC scales added incrementally to both the Clinical and Content scales in predicting self reported clinical symptoms. These findings suggest that the RC scales are relatively homogenous measures of core clinical constructs that can add unique information to the understanding of private practice clients above and beyond the Clinical and Content scales.

Increased Maintenance of Obsessive-Compulsive Disorder Remission after Integrated Serotonergic Treatment and Cognitive Psychotherapy Compared with Medication Alone

Background: Both medication and psychotherapy are effective in obsessive-compulsive disorder (OCD). However, they both have disadvantages. We aimed at studying the long-term effectiveness of integrated treatment compared with medication alone. Methods: A private practice sample of 20 consecutive patients with OCD (DSM-III-R) who achieved remission or marked improvement [Yale-Brown Obsessive-Compulsive Scale (YBOCS) score ≤10 and Global Assessment of Functioning (GAF) scale score ≧70] after drug treatment (clomipramine or selective serotonin reuptake inhibitors for 12–24 months) with or without concurrent cognitive psychotherapy were followed up. In the integrated treatment group, psychotherapy was started on the second or third visit and was timed to end after medication. Efforts were applied to integrate treatments within a biopsychosocial theoretical framework. As randomisation was not feasible in the study setting, treatment allocation was based on patients’ preference. Patients were assessed before treatment, after treatment and at each follow-up contact with the YBOCS, the Hamilton Depression Rating Scale, and the GAF scale. Kaplan-Meier survival analysis was performed on the time to OCD relapse. Results: Of the factors studied (gender, age, duration of disorder, severity of OCD symptoms at baseline), only treatment was associated with outcome. Of 10 patients treated with medication alone, 8 relapsed. Of 10 patients who received integrated treatment, only 1 relapsed. The estimated mean survival time was significantly higher (p < 0.001) in the integrated treatment group (132 months, 95% CI 107–157) than in the medication group (25 months, 95% CI 12–38). Conclusions: Although our results need confirmation by further, more robust studies, the long-term superiority of integrated treatment over medication alone was large. Patients with OCD might have viable options other than long-term drug treatment.

Biphasic course in bipolar II outpatients: Prevalence and clinical correlates of a cyclic pattern described by Baillarger and Falret in hospitalised patients in 1854

Background Biphasic course refers to a mood episode immediately followed by one of opposite polarity and then usually by a free interval. It was described under the rubric of folie à double forme among psychiatric inpatients by the French psychiatrist Baillarger 150 years ago. A rapid cycling form (folie circulaire) was also described in the same year by his compatriot Falret. These patients would probably have today met the criteria for bipolar I. Our aim was to find the prevalence and clinical correlates of biphasic course in bipolar II (BP II) in contemporary ambulatory patients. Methods Consecutive 206 BP II outpatients were interviewed in the first author's private practice, using a modified Structured Clinical Interview for DSM-IV. To assign a patient to biphasic episode, it must have occurred at least once when not on an antidepressant. Results Frequency of biphasic course was 80%. Biphasic vs. non-biphasic course was significantly higher in polyepisodic major depressive episode (MDE) and those with antidepressant-associated hypomania; the same was true for index melancholic subtype, where index of Global Assessment of Functioning scale (GAF) score was lower. Female gender, age at onset, mixed depressive episodes and bipolar family history were not significantly different between the two groups. Limitations Patients were not observed on a prospective basis. We cannot report on the relative proportion of MDE preceded vs. followed by hypomania, because such distinction was not part of FB's naturalistic database. Conclusions Strikingly in line with Baillarger's observation 150 years ago, biphasic course represented the typical pattern in this outpatient private practice sample of BP II. That antidepressant-associated hypomania was significantly more common in the biphasic course variety suggests that when MDE preceded hypomania—in such patients, antidepressants might have simply accentuated the natural cycle rather than causing it. Switching in the clinical setting then seems to depend on a biphasic cyclic baseline aggravated by antidepressant use. The fact that mixed states were equally prevalent in both course patterns suggests that the mechanisms involved in switching and mixity may be distinct. The significantly higher number of melancholic episodes with lower GAF scores indicates that—in line with Falret's description—overall, the biphasic course represents a relatively unfavorable outcome pattern.

P.3.11 Cognitive function and psychomotor performance in schizophrenic patients

Biphasic course refers to a mood episode immediately followed by one of opposite polarity and then usually by a free interval. It was described under the rubric of folie à double forme among psychiatric inpatients by the French psychiatrist Baillarger 150 years ago. A rapid cycling form (folie circulaire) was also described in the same year by his compatriot Falret. These patients would probably have today met the criteria for bipolar I. Our aim was to find the prevalence and clinical correlates of biphasic course in bipolar II (BP II) in contemporary ambulatory patients.Consecutive 206 BP II outpatients were interviewed in the first author's private practice, using a modified Structured Clinical Interview for DSM-IV. To assign a patient to biphasic episode, it must have occurred at least once when not on an antidepressant.Frequency of biphasic course was 80%. Biphasic vs. non-biphasic course was significantly higher in polyepisodic major depressive episode (MDE) and those with antidepressant-associated hypomania; the same was true for index melancholic subtype, where index of Global Assessment of Functioning scale (GAF) score was lower. Female gender, age at onset, mixed depressive episodes and bipolar family history were not significantly different between the two groups.Patients were not observed on a prospective basis. We cannot report on the relative proportion of MDE preceded vs. followed by hypomania, because such distinction was not part of FB's naturalistic database.Strikingly in line with Baillarger's observation 150 years ago, biphasic course represented the typical pattern in this outpatient private practice sample of BP II. That antidepressant-associated hypomania was significantly more common in the biphasic course variety suggests that when MDE preceded hypomania—in such patients, antidepressants might have simply accentuated the natural cycle rather than causing it. Switching in the clinical setting then seems to depend on a biphasic cyclic baseline aggravated by antidepressant use. The fact that mixed states were equally prevalent in both course patterns suggests that the mechanisms involved in switching and mixity may be distinct. The significantly higher number of melancholic episodes with lower GAF scores indicates that—in line with Falret's description—overall, the biphasic course represents a relatively unfavorable outcome pattern.

Increased Probability of Remaining in Remission from Panic Disorder with Agoraphobia after Drug Treatment in Patients Who Received Concurrent Cognitive-Behavioural Therapy: A Follow-Up Study

Background: Many short-term trials suggested that the combination of psychotherapy with medication might be more effective than either treatment alone. However, only few studies examined the long-term effectiveness of this combination. Methods: A private practice sample of consecutive patients with DSM-III-R panic disorder with agoraphobia who achieved remission after drug treatment with or without concurrent cognitive-behavioural psychotherapy were followed up. Patients were assessed before treatment, after treatment and at each follow-up contact with the Marks-Sheehan Phobia Scale, the Hamilton Anxiety Rating Scale, and the Hamilton Depression Rating Scale. Kaplan-Meier survival analysis was performed on the time to panic disorder relapse. Cox regression analysis was used to control for the possible confounding effect of factors other than treatment. Results: Of patients who received medication alone (n = 32), 25 (78.1%) relapsed, prevalently (65.6%) during the first year. The estimated mean survival time was 12 months (95% CI 7–17). Of patients who received integrated treatment (n = 21), only 3 (14.3%) relapsed. The estimated mean survival time was 65 months (95% CI 44–86). Treatment was the only variable associated with the occurrence of relapse, with a hazard ratio of 12.6 (95% CI 2.5–63.3) for patients who received only medication. Conclusions: Some methodological limitations, such as treatment allocation by preference, suggest caution in the interpretation of our results. However, the long-term therapeutic advantage of integrated treatment over medication alone was large and independent from known prognostic factors. The long-term effectiveness of integrated treatment should be tested with a randomised controlled trial.

Results of randomized controlled trials of cognitive therapy for depression generalize to private practice

We compared outcomes of 45 depressed patientstreated in private practice with cognitive therapy orwith cognitive therapy plus pharmacotherapy to outcomesof patients receiving those treatments in two randomized controlled trials. Private practiceand research samples differed considerably, with privatepractice patients having more psychiatric and medicalcomorbidities and a greater range of initial depression severity. Treatment in privatepractice and research settings also differed, withprivate practice treatment conducted in a more flexiblemanner using an idiographic, formulation-drivenapproach. As predicted, private practice patients showedstatistically significant reductions in depressivesymptomatology over the course of treatment, and at posttreatment, Beck Depression Inventory (BDI) scores of patients treated in private practice andresearch settings were not statistically significantlydifferent. Clinical significance of outcomes was alsocomparable in the clinical and research samples. Of the variables measuring demographic,illness, and treatment factors, only pretreatment BDIscore predicted post treatment BDI score in the privatepractice sample.

Parent-child relationships and the management of insulin-dependent diabetes mellitus.

Several dimensions of parent-child relationships were examined as predictors of adherence to treatment and metabolic control in a multi-informant study of 88 children and adolescents with insulin-dependent diabetes mellitus who were recruited from 2 endocrinology clinics. Ratings of parent-child discipline, warmth, and behavioral support were not significantly associated with diabetes outcome, but parent-child conflict was a consistent correlate of both adherence and metabolic control. Within a public hospital subsample, conflict was related to parent, child, and nurse ratings of adherence and to a physiological index of metabolic control. These results were partially replicated in a private practice sample where conflict was significantly related to parents' ratings of adherence and to metabolic control. Conflict accounted for unique variance in diabetes outcome beyond that associated with other measures of the parent-child relationship, but the relation between conflict and metabolic control was no longer significant when adherence ratings were entered into regression equations first.

Personality, motivation, and Holland type in a private-practice sample

Variations in personality and motivational patterns among Holland types were investigated. Motive was measured by the Motivational Analysis Test (MAT), personality by the Sixteen Personality Factor Questionnaire (16PF), and Holland type was derived from scores on the Strong-Campbell Interest Inventory (SCII) or the California Occupational Preference System (COPS). The results of these tests were obtained from a private-practice data base including 206 clients seeking career counseling or therapy. It was expected that certain levels of personality factors and motivational patterns would be characteristic of persons in the various Holland types. The results suggest that motivational patterns tend to be more similar across Holland types, whereas analyses of variance found significant variability between the Holland types on the personality factors extraversion, practicality, and independence. Interpretations were offered and theoretical implications discussed.

Personality disorder concept scales and 16 PF dimensions.

Using 148 clients from a private practice sample, concurrent scores on the Morey, Waugh, and Blashfield Minnesota Multiphasic Personality Inventory Scales and the Sixteen Personality Factor Questionnaire were factor analyzed in an attempt to map the Axis II disorders within a circumplex of interpersonal behavior. Individual predictions about the 16 PF primaries were made and then equations were developed to predict the Morey, Waugh, Blashfield MMPI scales from the 16 PF scores. Using a separate sample of 43 clients and 21 students, a cross-validation of concepts was performed by using the 16 PF to generate the MMPI scores and correlating the predicted scores with concurrent Millon Clinical Multiaxial Inventory scores. Concordance of the personality disorder characterizations across the instruments was high. Many of the predicted personality disorder characteristics were supported by the research, and 10 of 11 correlations with the Millon were significant. This research suggests the 16 PF is useful for generating hypotheses about personality disorders and that the Axis II conceptualizations fit as expected within normal personality space.

PERSONALITY DISORDER CONCEPT SCALES AND 16 PF DIMENSIONS

Using 148 clients from a private practice sample, concurrent scores on the Morey, Waugh, and Blashfield Minnesota Multiphasic Personality Inventory Scales and the Sixteen Personality Factor Questionnaire were factor analyzed in an attempt to map the Axis II disorders within a circumplex of interpersonal behavior. Individual predictions about the 16 PF primaries were made and then equations were developed to predict the Morey, Waugh, Blashfield MMPI scales from the 16 PF scores. Using a separate sample of 43 clients and 21 students, a cross-validation of concepts was performed by using the 16 PF to generate the MMPI scores and correlating the predicted scores with concurrent Millon Clinical Multiaxial Inventory scores. Concordance of the personality disorder characterizations across the instruments was high. Many of the predicted personality disorder characteristics were supported by the research, and 10 of 11 correlations with the Millon were significant. This research suggests the 16 PF is useful for generating hypotheses about personality disorders and that the Axis II conceptualizations fit as expected within normal personality space.

Supernumerary mandibular premolars: report of cases

Six cases, totaling seven supernumerary mandibular premolars, were seen in a sample population of 4,000 patient records. Four were from a suburban private practice sample of 2,000, the others from a similar group randomly drawn from an urban dental school. Five of seven appeared on the left side, six of seven were impacted or erupted ectopically. Only one patient was female. Four were of Spanish or Hispanic descent, one was white and one was black. The only other supernumerary teeth seen in the population sampled were two paramolars and one mesiodens. The recommended course of treatment is extraction of the supernumerary teeth, unless they may be useful for orthodontic purposes or if the surgery would be unjustifiably hazardous to adjacent structures. Complications could result in resorption of other teeth, malocclusion, and possible cystic degeneration and ameloblastoma formation.