Screening Instrument For Personality Disorders Research Articles

Screening for Personality Disorders: A Comparison of the Dimensional NEO-FFI with the Categorical SAPAS-SR

In psychiatric outpatients, the usefulness of the dimensional NEO-FFI as a screening instrument for personality disorders (PDs) was compared with the categorical screening instrument SAPAS-SR using the SCID-II as the gold standard. Major research questions are: 1) is the NEO-FFI a useful screening instrument for PDs? 2) does the NEO-FFI outperform a categorical screening instrument (SAPAS-SR)? 3) does combining both instruments improve the screening results? Extreme raising on Big Five personality trait domains (NEO-FFI) domain scores were examined in relation to the presence and the number of PDs as diagnosed, with to the SCID-II. Additionally, the NEO-FFI, in conjunction with a short self-report screening instrument (SAPAS-SR), was analysed with respect to sensitivity and specificity for screening of PDs. According to the SCID II, 97 patients (50%) were suffering from a PD. The majority of them had no (35.9%) or only one (40%) extreme score on one of the Big Five personality domains. There were no significant relationships between separate extreme traits on PD or five factor profiles, as proposed in the literature, and the presence of a SCID-II PD. Comparisons of the NEO-FFI with the SAPAS-SR showed no significant relationships. Using both screeners in conjunction resulted in an increase in specificity and the number of correctly classified cases at the expense, however, of the sensitivity. Correlation and regression analyses showed that personality traits are statistically significant predictors for each of the12 PDs. However, the associations between NEO-FFI scores and the DSM-VI-TR PD criteria were rather modest. Support could not be obtained for the view that separate extreme scores on basic personality traits or combinations of such scores in five-factor profiles will provide adequate screening possibilities for PDs. The SAPAS-SR has better screening potential than the NEO-FFI or the SAPAS-SR and the NEO-FFI together.

The Standardized Assessment of Personality—Abbreviated Scale as a screening instrument for personality disorders in substance‐dependent criminal offenders

Personality disorders (PDs) are considered to be potential predictors of treatment outcome in substance-dependent patients and potential treatment matching variables. There is a need for a brief and simple screening instrument for PDs that can be used in routine psychological assessment, especially in a treatment setting for previously substance-dependent criminal offenders, where a high prevalence of PDs is expected. This study investigated the psychometric properties of the Standardized Assessment of Personality-Abbreviated Scale (SAPAS), a commonly used screening interview for PDs, in a population of inpatient criminal offenders with a history of substance dependence. Various statistical procedures were used to establish reliability and validity measures, such as Kuder-Richardson 20, confirmative factor analysis, receiver operating characteristic analysis and multitrait multimethod matrix. The SAPAS was administered to 101 inpatient criminal offenders with a history of substance dependence at baseline. Within three weeks, participants were administered the Structured Interview for DSM-IV Personality in order to assess the presence of PDs. Results show limited evidence to make firm conclusions on the psychometric qualities of the SAPAS as a screening instrument for comorbid PDs in a substance dependence treatment setting for criminal offenders. Suggestions for improvement concerning the psychometric qualities of the SAPAS as a screening instrument for this population are noted.

Validity of the Personality Diagnostic Questionnaire—4 (PDQ-4+) among Mentally Ill Prison Inmates in Singapore

We examined the validity of the Personality Diagnostic Questionnaire--4+ (PDQ-4+) as a screening instrument for personality disorders among mentally ill prison inmates in Singapore. A total of 313 prison inmates completed the PDQ-4+ and the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). The subjects were 303 (96.8%) males and 10 (3.2%) females with a mean (SD) age of 40.7 (8.8) years. Kappa agreement between PDQ-4+ and SCID-II for the presence at least one personality disorder was moderate with high sensitivity and low specificity. For specific personality disorders and clusters, we found that the PDQ-4+ diagnosed more subjects as having each of the personality disorders than SCID-II with high negative predictive values. The area under the curve indicated moderate discriminatory capabilities. Our results suggest that the PDQ-4+ could be used as a potential screening instrument for personality disorders in prison inmates.

Quick Personality Assessment Schedule (PAS-Q): Validation of a Brief Screening Test for Personality Disorders in a Population of Psychiatric Outpatients

The internal consistency, test-retest reliability, and validity of the Quick Personality Assessment Schedule (PAS-Q), as a screening instrument for personality disorders were studied in a random sample of 195 Dutch psychiatric outpatients, using the SCID-II as a gold standard. All patients were interviewed with the PAS-Q. With an interval of 1 to 2 weeks, they were interviewed with the SCID-II. Three weeks later the PAS-Q was re-administered. According to the SCID-II, 97 patients (50%) were suffering from a personality disorder. The PAS-Q correctly classified 81% of all participants. Sensitivity and specificity were 0.80 and 0.82, respectively. The results provide evidence for the usefulness of the PAS-Q as a screening instrument for personality disorders in clinical populations.

A cross-sectional testing of The Iowa Personality Disorder Screen in a psychiatric outpatient setting

BackgroundPatients suspected of personality disorders (PDs) by general practitioners are frequently referred to psychiatric outpatient clinics (POCs). In that setting an effective screening instrument for PDs would be helpful due to resource constraints. This study evaluates the properties of The Iowa Personality Disorder Screen (IPDS) as a screening instrument for PDs at a POC.MethodsIn a cross-sectional design 145 patients filled in the IPDS and were examined with the SCID-II interview as reference. Various case-findings properties were tested, interference of socio-demographic and other psychopathology were investigated by logistic regression and relationships of the IPDS and the concept of PDs were studied by a latent variable path analysis.ResultsWe found that socio-demographic and psychopathological factors hardly disturbed the IPDS as screening instrument. With a cut-off ≥4 the 11 items IPDS version had sensitivity 0.77 and specificity 0.71. A brief 5 items version showed sensitivity 0.82 and specificity 0.74 with cut-off ≥ 2. With exception for one item, the IPDS variables loaded adequately on their respective first order variables, and the five first order variables loaded in general adequately on their second order variable.ConclusionOur results support the IPDS as a useful screening instrument for PDs present or absent in the POC setting.

P02-423 - How to choose the best screening instrument for personality disorder for your specific practice

IntroductionPersonality disorders (PD) are common in psychiatric services and can adversely affect the management and outcome of mental illnesses. Therefore assessment of the personality is an essential part of initial psychiatric examination. To diagnose a PD takes time and competence. A screening instrument in the diagnostic phase can be a solution.AimThe goal of the study was to provide clinicians a powerful screening tool for personality disorders that is ‘quick and dirty’.MethodNine screening instruments were studied in a prospective, observational, test development study with a random sample of Dutch psychiatric outpatients, using the SCID-II as the gold standard. There were three short questionnaires (Standardized Assessment of Personality- Abbreviated Scale (SAPAS), Iowa Personality Disorder Screen (IPDS), Short version of the SCID-II), three longer questionnaires (the SCID-II Personality Questionnaire, the NEO Five-Factor Inventory (NEO-FFI), Inventory of Interpersonal Problems (IIP-PD/C;) one short semi structured interview (Quick Personality Assessment Schedule (PAS-Q.) and two informant interviews (Standardised Assessment of personality (SAP), the Standardized Assessment of Personality- Abbreviated Scale for informants (SAPAS-INF)) involved.ResultsThe three short questionnaires and the semi structured interview were very useful for determining the presence/absence of PD. The other instruments can be used in particular situations for example to determine a specific PD or if the patient is not able to accomplish the test.ConclusionBefore deciding which screening instrument for PD is the best for your practice, you have to consider psychometric values as well as practical circumstances.

The Iowa Personality Disorder Screen

The internal consistency, test-retest reliability, and predictive validity of the Iowa Personality Disorder Screen (IPDS) as a screening instrument for personality disorders (PDs) were studied in 195 Dutch psychiatric outpatients, using the SCID-II as the gold standard. All patients completed a self-administered version of the IPDS. Internal consistency was moderate (0.64), and the test-retest reliability was good (0.87). According to the SCID-II, 97 patients (50%) had at least one personality disorder (PD). The IPDS correctly classified 81.0 percent of all participants in the category PD present/absent. The sensitivity and specificity were 77% and 88%, respectively. Positive and negative predictive values were 83% and 79%. Test-retest reliability after a 2-week interval was 0.87. These results are comparable with those reported in earlier studies with respect to the interview version of the IPDS and more promising than previously reported results obtained with a self-report version of the IPDS. Therefore, it is concluded that a self-report version of the IPDS may be useful as a screening measure for determining the presence/absence of PD in a population of psychiatric outpatients.

The Self‐report Standardized Assessment of Personality‐abbreviated Scale: Preliminary results of a brief screening test for personality disorders

AbstractObjective The internal consistency, test–retest reliability and validity of the Self‐report Standardized Assessment of Personality‐abbreviated Scale (SAPAS‐SR) as a screening instrument for personality disorders were studied in a random sample of 195 Dutch psychiatric outpatients, using the Structured Clinical Interviews for DSM‐IV Personality Disorders (SCID‐II) as a gold standard.Method All patients completed a self‐report version of the SAPAS. One week later, they were interviewed with the SCID‐II. Two weeks later, the SAPAS‐SR was re‐administered.Results According to the SCID‐II, 97 patients (50%) were suffering from a personality disorder. The SAPAS‐SR correctly classified 81% of all participants. Sensitivity (0.83) and specificity (0.80) were slightly lower compared with the original English version. This difference may be explained by the lower prevalence and severity of personality disorders in the study population.Conclusion The results provide evidence for the usefulness of the SAPAS as a self‐administered instrument for screening personality disorders in clinical populations. Copyright © 2008 John Wiley & Sons, Ltd.

The temperament and character inventory (TCI) as a screening instrument for personality disorders in anxiety disorders

We still lack operative and theoretically founded definitions of what a personality disorder (PD) is, as well as empirically validated and feasible instruments to measure the disorder construct. The Temperament and Character Inventory (TCI) is the only personality instrument that explicitly distinguishes personality style and disordered functioning. Here, we seek to (1) confirm in a clinical sample that the character dimensions of the TCI capture a general construct of PD across all specific PD subtypes, (2) determine whether such core features can be used to detect the presence of PD, and (3) analyze whether such detection is affected by the presence and severity of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I symptoms. Two hundred five anxious/depressed outpatients were evaluated with the Structural Clinical Interview for DSM-IV Axis I and II Disorders. Assessment also included the TCI, the Hamilton rating scales for depression and anxiety, and the Panic and Agoraphobia Scale. Sixty-one patients (29.8%) were diagnosed as having a DSM-IV PD. Self-directedness and Cooperativeness, but no other TCI dimensions, predicted the presence of PD (Nagelkerke R2 = 0.35-0.45) and had a moderate diagnostic utility (κ = 0.47-0.58) when Axis I symptoms were absent or mild. However, accuracy decreased in anxious or depressed patients. Our study supports the hypothesis of a disorder construct that is not related to the intensity of any specific PD subtype but which is common to all PDs. This construct relies largely on internal representations of the self revealing ineffectiveness and uncooperativeness.

DSM-IV and ICD-10 personality disorders: a comparison of a self-report questionnaire (DIP-Q) with a structured interview

Diagnosing personality disorders according to structured expert interviews is time-consuming and costly. For epidemiological studies, self-report instruments have several advantages. The DSM-IV and ICD-10 personality questionnaire (DIP-Q) is a selfreport questionnaire constructed to identify personality disorder according to DSM-IV and ICD-10. The DIP-Q is validated vs a structured expert interview in a clinical sample of 138 individuals. In addition, prevalence rates yielded by DIP-Q among 136 healthy volunteers are assessed and compared to expected prevalence. For DSM-IV the agreement for any personality disorder as measured by Cohen's Kappa was 0.61 and 0.56 for ICD-10. Overall sensitivity for any personality disorder was for DSM-IV 0.84 and for ICD-10 0.85. However, specificity was lower: 0.77 and 0.70, respectively. When dimensional scores between self-report and interview for each personality disorder were compared, the intraclass correlation for the DSMIV entities was 0.37-0.87 and for the ICD-10 entities 0.33-0.73. Among healthy volunteers the base rate of personality disorders was found to be 14%. DIP-Q can be used as a screening instrument for personality disorders according to DSM-IV and ICD-10. Self-report questionnaires such as DIP-Q will probably play an increasingly important role in future epidemiological studies.

The Tridimensional Personality Questionnaire as an Instrument for Screening Personality Disorders: Use in Patients with Generalized Anxiety Disorder

Forty-eight patients with generalized anxiety disorder (GAD) were administered the Tridimensional Personality Questionnaire (TPQ), and then they were interviewed by the means of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Agreement between the two instruments about absence of personality disorder (PD) was found in 30 patients. There were only 3 patients who were diagnosed with a PD on the basis of the TPQ scores but did not receive a SCID-II diagnosis of PD. The TPQ appears to have high sensitivity in detecting personality disorders (PDs) among GAD patients and it might be a useful screening instrument for PDs in patients with anxiety disorders in general. The paper also compares results of the two approaches to PD assessment in GAD patients: dimensional, as embodied in the TPQ; and categorical, as represented by the SCID-II and DSM-III-R.

Interrater Reliability of ICD-10 Guidelines for the Diagnosis of Personality Disorders

The reliability of the clinical diagnosis of personality disorder remains unacceptably low. This study shows satisfactory inter-rater reliability (r > 0.70) for all except 7 out of the 56 guidelines in the 10th edition of the International Classification of Diseases (ICD-10) for the diagnosis of personality disorder. The intraclass correlation coefficients for categories of personality disorder derived from these guidelines were also satisfactory, ranging from 0.75 to 0.97. A brief interview schedule derived from a semistructured personality inventory (PAS) demonstrated useful characteristics (sensitivity 95.1%; specificity 49.9%) as a screening instrument for personality disorder as defined by ICD-10 and may be clinically useful.