Psychological test characteristics of depressed and panic patients

Agreement Between Self- and Informant-Reported Ratings of Personality Traits: The Moderating Effects of Major Depressive and/or Panic Disorder

Several personality traits are risk factors for psychopathology. As symptoms of psychopathology may influence self-rated personality, informant reports of personality are also sometimes collected. However, little is known about self-informant agreement in individuals with anxiety and/or depression. We investigated whether self-informant agreement on positive and negative affectivity (PA and NA) and anxiety sensitivity differs for individuals with major depressive disorder (MDD) and/or panic disorder (PD; total n = 117). Informant- and self-reported PA was correlated among those with MDD, but not among those without MDD. Informant- and self-reported anxiety sensitivity was correlated among those with PD, but not among those without PD. Informant- and self-reported NA was correlated irrespective of diagnosis. Results indicate that the agreement of self- and informant-reported personality may vary as a function of depression and/or anxiety disorders.

Emotional Intelligence and Personality in Anxiety Disorders

Anxiety disorders (AD) are by far the most frequent psychiatric disorders, and according to epidemiologic data their chronicity, comorbidities, and negative prognostic constitute a public health problem. This is why it is necessary to continue exploring the factors which contribute to the incidence, appearance, and maintenance of this set of disorders. The goal of this study has been to analyze the possible relationship between Emotional Intelligence (EI) and personality disorders (PersD) in outpatients suffering from AD. The sample was made up of 146 patients with AD from the Mental Health Center at the Health Consortium of Maresme, who were evaluated with the STAI, MSCEIT, and MCMI-II questionnaires. The main findings indicate that 89,4% of the patients in the sample met the criteria for the diagnosis of some PersD. The findings also confirm that patients with AD present a low EI, especially because of difficulties in the skills of emotional comprehension and regulation, and the lack of these skills is related to a higher level of anxiety and the presence of PersD. These findings suggest the need to consider emotional skills of EI and personality as central elements for the diagnosis and treatment of AD.

Personality self-reports are concurrently reliable and valid during acute depressive episodes

BACKGROUND

It is alleged that depression distorts the assessment of general personality traits. To test that hypothesis, we examined scores on the Revised NEO Personality Inventory (NEO-PI-R) administered to acutely depressed patients at baseline and 14 to 26 weeks after treatment with antidepressant medication.

METHOD

Two hundred and fifty patients completed the NEO-PI-R at baseline, 109 patients after 14 to 26 weeks of antidepressant pharmacotherapy. 48 patients (49.5%) were identified as responders while 49 (50.5%) were identified as non-responders. The remaining 12 patients were excluded because they met HRSD response criteria but not the SCID-I MDD criteria at treatment completion.

RESULTS

At baseline, NEO-PI-R scales showed high internal consistency and replicated the normative factor structure, suggesting that psychometric properties were preserved. Among non-responders, retest correlations were uniformly high (rs=.50 to .88) and mean levels showed little change, providing evidence for the consistency of personality self-reports during an acute depressive episode. NEO-PI-R scales showed construct validity in the concurrent prediction of a number of clinical criteria. Effective treatment had significant effects on the mean levels of neuroticism, which decreased, and extraversion, openness, and conscientiousness, which increased.

LIMITATIONS

The participants were from a clinical database and were not randomly assigned for the treatment.

CONCLUSIONS

The results suggest that the effect of acute depression is to amplify somewhat the personality profile of people prone to depression. Rather than regard these depression-caused changes in assessed personality trait levels as a distortion, we interpret them as accurate reflections of the current condition of the individual. Personality traits have biological bases, and when they are changed (by disease or therapeutic interventions) trait levels change.

Pregnancy anxiety and comorbid depression and anger: effects on the fetus and neonate

One hundred sixty-six women were classified as experiencing high or low anxiety during the second trimester of pregnancy. The high anxiety women also had high scores on depression and anger scales. In a follow-up across pregnancy, the fetuses of the high anxiety women were noted to be more active and to experience growth delays. The high anxiety mothers' high prenatal norepinephrine and low dopamine levels were followed by their neonates having low dopamine and serotonin levels. The high anxiety mothers' newborns also had greater relative right frontal EEG activation and lower vagal tone. Finally, the newborns of high anxiety mothers spent more time in deep sleep and less time in quiet and active alert states and showed more state changes and less optimal performance on the Brazelton Neonatal Behavior Assessment Scale (motor maturity, autonomic stability and withdrawal). These data highlight the need for prenatal intervention for elevated anxiety symptoms during pregnancy.

Anxiety/aggression--driven depression. A paradigm of functionalization and verticalization of psychiatric diagnosis

A new subtype of depression is proposed, named: anxiety/aggression-driven depression. The psychopathological, psychopharmacological and biochemical evidence on which this construct is based, is being discussed. Selective postsynaptic 5-HT1A agonists together with CRH and/or cortisol antagonists are hypothesized to be a specific biological treatment for this depression type, in conjunction with psychological interventions to raise the stressor-threshold and to increase coping skills. The development of this depression construct has been contingent on the introduction of two new diagnostic procedures, called functionalization and verticalization of psychiatric diagnosis. These procedures are explained and it is stressed that they are essential to psychiatric diagnosing, in order to put this process on a scientific footing.

Discriminant validity of the illness behavior questionnaire and Millon Clinical Multiaxial Inventory-III in a heterogeneous sample of psychiatric outpatients

The discriminant validity of measures of abnormal illness behaviors and psychopathology was examined in three samples differing in illness proneness: a sample of young healthy university students (n = 38), a general community sample (n = 36), and a sample of clinical psychiatric outpatients (n = 36). Adjustment to illness was measured using the Illness Behaviour Questionnaire (IBQ; Pilowsky & Spence, 1994), while the Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, 1994) was used to measure clinical syndromes and personality. MANCOVAs were performed across the three groups on the IBQ and the MCMI-III categories, separately. As expected, clinical outpatients obtained significantly higher scores than did nonclinical groups on most of the IBQ scales, suggesting discernible discriminant validity. However, the lack of discrimination between groups on several of the MCMI-III scales raises questions about the test validity of this multidimensional instrument.

Personality differences in the Munich Personality Test between patients with major depression and panic disorder

This study attempted to determine whether patients with major depression and panic disorder could be differentiated by personality features, measured by the Munich Personality Test (MPT). One of the six MPT personality dimensions, 'rigidity', was developed in relation to the 'melancholic type of personality', which may be a specific personality feature of depressive subjects. We therefore hypothesized that the MPT might be sensitive to possible personality differences between patients with major depression and panic disorder. Sixty-six patients with major depression and 27 patients with panic disorder, taken from consecutive intakes at an outpatient unit, were compared in terms of six personality dimensions of the MPT. The results demonstrated that rigidity could significantly differentiate the two patient groups, even after the possible confounding effects on the personality assessments were statistically partialled out. The MPT was suggested to be powerful for describing distinctive personality features of depressive subjects from anxiety subjects.

Evaluating the diagnostic specificity of the Munich Personality Test dimensions in major depression

This study explored the diagnostic specificity of the Munich Personality Test (MPT) in major depression, comparing its scores between patients with major depression, patients with panic disorder and control subjects. One of the 6 dimensions of the MPT, Rigidity, had been developed based on Tellenbach's description of depressive personality, and it was expected that especially this personality dimension would demonstrate a good facility for describing a specific personality feature of major depression. Comparisons were made in 2 ways: ignoring the effects of current depression and anxiety on the personality scorings; and partialling out these effects. Results of the 2 analyses differed radically. Scores on Rigidity and isolation Tendency were significantly different between groups, even after the effects of current depression and anxiety were partialled out. The multiple comparison procedure revealed that the depressive patients were differentiated from both the panic patients and the controls only in the dimension of Rigidity. The results of this study suggest that the Rigidity dimension of MPT may have a strong capability for describing the specific personality feature of depressive patients, and that the MPT may be quite useful for studies, particularly prospective ones, investigating premorbid personality of depression.

Excessive dependency and depression: is the relationship specific?

Excessive dependency has been hypothesized to be both a risk factor and a complication of depression. The purpose of this study was to test the specificity of the relationship between DSM-III-R dependent personality disorder (DPD) and depressive disorders. Two hundred subjects were independently administered the Structured Clinical Interview for DSM-III-R (SCID) and the Personality Disorder Examination (PDE) face-to-face by two experienced clinicians. Comorbidity of DPD and axis I disorders of five different types was examined. Dependent personality disorder was associated with mood disorders, both bipolar disorder and major depression, but was also associated with several anxiety disorders, bulimia, and nonaffective psychotic disorders. Dependent-personality disorder was associated with borderline, avoidant, schizotypal, obsessive-compulsive, narcissistic, and paranoid personality disorder made no significant additional contribution to the association between personality disorder and axis I disorder. These results suggest the DPD represents maladaptive traits and behaviors that cut across a range of personality psychopathology and are related to a variety of types of psychological distress. Thus, a specific++ relationship od DPD to depression was not supported.

Assessment of depression: using the MMPI, Millon, and Millon-II

The analysis examined how the MMPI, original Millon, and Millon-II may be used for the assessment of clinical and personality characteristics of depressed patients. High-point code-type analysis of data from 133 depressed inpatients yielded seven MMPI personality profiles (incapacitated-depressive, intropunitive-depressive, caught psychopath, hysteroid-dysphoric, schizotypal-depressive, ruminative-depressive, and psychotic-depressive) and eight Millon personality profiles (avoidant-depressive, conforming-depressive, hostile-depressive, hysteroid-depressive, disenfranchised-depressive, guilty-depressive, passive aggressive-depressive, and anaclitic-depressive). These profiles reflect important similarities in the personalities of the tested depressed inpatients and differences among them as well. Our interpretive framework is speculative but offers a basis for clinical hypothesis generation.

Hostility and irritable mood in panic disorder with agoraphobia

Twenty patients suffering from panic disorder with agoraphobia were administered the hostility subscale of Kellner's Symptom Questionnaire and the irritability scales of Paykel's Clinical Interview for Depression and of Kellner's Anxiety Rating Scale before and after behavioral treatment of agoraphobia. A matched control group of normal subjects had the same assessments at two similar points in time. Hostility and irritable mood decreased and friendliness increased in patients with panic disorder after treatment; upon recovery, there were no significant differences in hostility between patients and controls, whereas such differences were striking during the illness. The results suggest that increased hostility and irritable mood may be symptoms of panic disorder and improve with the treatment of agoraphobia.

The diagnosis and assessment of depression, mania, and psychosis by self-report

We examined the usefulness of the Minnesota Multiphasic Personality Inventory (MMPI), the original and revised versions of the Millon Clinical Multiaxial Inventory (MCMI and MCMI-II), and the Symptom Checklist-90-R (SCL-90-R) for the diagnosis and assessment of depression, mania, and psychosis in a heterogeneous group of 272 psychiatric inpatients. We examined the following: diagnostic efficiency of single scales at specified cutoff scores for these conditions, multidimensional test profiles, MMPI high-point codes, and associated MCMI and MCMI-II personality disorders. The reported findings are discussed in terms of how these tests may and may not be used to answer particular assessment questions and what the self-report vantage contributes to the entire clinical assessment process.

Personality and psychopathology: an application of the five-factor model

Our review is concerned with the relationship of the five-factor model of personality to psychopathology, focusing in particular on Axis II personality disorders and depression. The five factors provide a particularly compelling model for interpreting the Axis II personality disorders as maladaptive variants of normal personality traits. However, we also discuss methodological and conceptual limitations of this application. There has been little research on the relationship of Openness, Agreeableness, and Conscientiousness to Axis I mental disorders, but considerable attention has been given to Neuroticism and Extraversion. We focus in particular on the difficulty in distinguishing between the various ways in which personality can relate to depression, either as a predisposition to, a complication of, a pathoplastic effect upon, or a spectrum variant of the mental disorder. We conclude with recommendations for future research.

Prevalence of personality disorders in patients with major depression and dysthymia

The authors administered the Structured Clinical Interview for DSM-III-R Axis I (SCID-P) and Axis II (SCID-II) Disorders to 197 patients with major depression, 63 patients with dysthymia, and 32 patients with both major depression and dysthymia ("double depression"). Fifty percent of major depressive patients, 52% of dysthymic patients, and 69% of patients with double depression were diagnosed as having at least one personality disorder. Patients with a personality disorder had higher scores on the Beck Anxiety and Depression Inventories. The most commonly diagnosed personality disorders were from the anxious/fearful cluster, most notably avoidant and dependent personality disorders.

Major depression and personality disorder

The authors examined an interview and paper-and-pencil assessment of the DSM-III personality disorders (PDs) in depressed inpatients, and depressed relatives of psychiatric patients and never-ill controls who had a lifetime history of major depression. The rates of PDs according to the Structured Interview for DSM-III Personality Disorders (SIDP) were similar in the two groups, except for borderline PD which was more frequent in the inpatients. Of the individuals with a PD, the patients were more likely than the relatives to have two or more PDs, and the borderline and histrionic patients were more prototypic of these disorders than were the borderline and histrionic relatives. In contrast to the SIDP results, the rates of PDs according to the Personality Disorders Questionnaire (PDQ) were higher in the patient sample. These results thus extend the previously described high rates of PDs in depressed patients to a sample of individuals with a lifetime history of treated or untreated depression, and they suggest that interview assessments of personality may be less sensitive to the state effects of depression than are questionnaires.