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Biomedical subjects

L A Clark

Publications and source records attributed to L A Clark.

At least 19 recordsLinked to original sources
PubMed2001

Predicting dimensions of personality disorder from domains and facets of the Five-Factor Model.

We compared the utility of several trait models for describing personality disorder in a heterogeneous clinical sample (N = 94). Participants completed the Schedule for Nonadaptive and Adaptive Personality (SNAP; Clark, 1993b), a self-report measure that assesses traits relevant to personality disorder, and two measures of the Five-Factor Model: the Revised NEO Personality Inventory (NEO-PI-R; Costa and McCrae, 1992) and the Big Five Inventory (BFI; John, Donahue, & Kentle, 1991). Regression analyses indicated substantial overlap between the SNAP scales and the NEO-PI-R facets. In addition, use of the NEO-PI-R facets afforded substantial improvement over the Five-Factor Model domains in predicting interview-based ratings of DSM-IV personality disorder (American Psychiatric Association, 1994), such that the NEO facets and the SNAP scales demonstrated roughly equivalent levels of predictive power. Results support assessment of the full range of NEO-PI-R facets over the Five-Factor Model domains for both research and clinical use.

Adaptation, Psychological↗
PubMed2001

Detection of deception on the Schedule for Nonadaptive and Adaptive Personality: validation of the validity scales.

This study used a simulation design to investigate the validity scales of the Schedule for Nonadaptive and Adaptive Personality (SNAP). Undergraduates (N=192) were randomly assigned to two positive distortion (PD) groups, two negative distortion (ND) groups, and a control group. Controls responded normally, whereas the deception groups responded according to assigned characters. Preliminary analyses indicated no significant differences within distortion valence; thus, the groups were collapsed into single PD (n=76), ND (n=79), and control groups (n=37). Mean-level analyses revealed that, consistent with previous studies, ND profiles are easier to detect than PD profiles. Cutoff scores were suggested, and the classification accuracy of these scores converged with the results of several discriminant function analyses to indicate that Rare Virtues and Deviance predict group membership at least as well as MMPI-2 validity scales. Structural analyses revealed that two moderately correlated factors-positive distortion and negative distortion-underlie scores on these validity scales.

Adult↗
PubMed2000

Mothers' personality and its interaction with child temperament as predictors of parenting behavior.

In this longitudinal, multimethod investigation, the authors examined mothers' personality and its interaction with infants' negative emotionality as predictors of parenting behavior. When infants were 8-10 months old (N = 112), mothers completed personality self-reports, and the authors observed infants' negative emotionality in both standard procedures and naturalistic daily contexts. When infants were 13-15 months old (N = 108), the authors observed two aspects of parenting, power assertion and maternal responsiveness, in mother-child interactive contexts. Maternal personality alone and also in interaction with child emotionality predicted future parenting behaviors. The longitudinal links established between personality and parenting behaviors indicate the predictive utility of personality. Findings also highlight the bidirectionality of the early parent-child relationship.

Adult↗
PubMed2000

Toward DSM-V and the classification of psychopathology.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) developed by the American Psychiatric Association (1994) is a compelling effort at a best approximation to date of a scientifically based nomenclature, but even its authors have acknowledged that its diagnoses and criterion sets are highly debatable. Well-meaning clinicians, theorists, and researchers could find some basis for fault in virtually every sentence, due in part to the absence of adequate research to guide its construction. Some points of disagreement, however, are more fundamental than others. The authors discuss issues that cut across individual diagnostic categories and that should receive particular attention in DSM-V: (a) the process by which the diagnostic manual is developed, (b) the differentiation from normal psychological functioning, (c) the differentiation among diagnostic categories, (d) cross-sectional vs. longitudinal diagnoses, and (e) the role of laboratory instruments.

Humans↗
PubMed2000

Growth factor enhanced retroviral gene transfer to the adult central nervous system.

The use of viral vectors for gene delivery into mammalian cells provides a new approach in the treatment of many human diseases. The first viral vector approved for human clinical trials was murine leukemia virus (MLV), which remains the most commonly used vector in clinical trials to date. However, the application of MLV vectors is limited since MLV requires cells to be actively dividing in order for transduction and therefore gene delivery to occur. This limitation precludes the use of MLV for delivering genes to the adult CNS, where very little cell division is occurring. However, we speculated that this inherent limitation of ML V may be overcome by utilizing the known mitogenic effect of growth factors on cells of the CNS. Specifically, an in vivo application of growth factor to the adult brain, if able to induce cell division, could enhance MLV-based gene transfer to the adult brain. We now show that an exogenous application of basic fibroblast growth factor induces cell division in vivo. Under these conditions, where cells of the adult brain are stimulated to divide, MLV-based gene transfer is significantly enhanced. This novel approach precludes any vector modifications and provides a simple and effective way of delivering genes to cells of the adult brain utilizing MLV-based retroviral vectors.

Animals↗
PubMed2000

Universal newborn hearing screening.

BACKGROUND: New technology has made universal newborn hearing screening possible. Our goal was to investigate the feasibility of universal newborn screening using distortion product otoacoustic emissions (DPOAE) on infants in a community hospital in a normal newborn nursery. METHODS: We used DPOAE to screen newborn infants from February 1997 to March 1999. RESULTS: Of 1002 infants, 111 failed the initial screen (11.1%). When screening was repeated, only 2 infants failed. One infant failed the second screen and a tympanogram. He was treated and he passed a third use of DPOAE. An additional infant failed the repeat screen but passed the tympanogram. That infant was referred on for auditory brain response testing. CONCLUSIONS: DPOAE testing can be accomplished easily in a normal newborn nursery with an acceptable false-positive rate when a two-stage approach is used. The cost for each test was $19.88. The cost to find the 1 infant with sensory neural hearing loss was $22,114.

Acoustic Impedance Tests↗
PubMed1999

Introduction to the special section on the concept of disorder.

Despite the absence of a consensual definition of disorder, considerable research and clinical work is based on the categorization and diagnosis of mental disorder. This article introduces a special section of the Journal of Abnormal Psychology that expands the debate between J. C. Wakefield (1999), who has proposed a "harmful dysfunction" analysis of disorder and S. O. Lilienfeld and L. Marino (1995, 1999), who offer an alternative "Roschian" or prototype analysis. This introduction summarizes the main arguments of Wakefield's target article and 8 critiques and discusses the conceptual value of the debate, especially an integration of diverse viewpoints and stimulation to further consideration of this important topic.

Humans↗
PubMed1999

Diagnostic change and personality stability following functional restoration treatment in chronic low back pain patients.

This study examined personality pathology in a group of patients with chronic low back pain (CLBP) using both diagnostic interviews and dimensional self-report instruments. A group of CLBP patients (N = 125) was assessed before functional restoration treatment and compared with a matched normal comparison group (N = 75). The CLBP group evidenced broad personality pathology in all assessment modes pretreatment relative to the normal comparison sample. In addition, two subsamples of CLBP patients (n = 49 and n = 56) were assessed after treatment. Reductions in personality pathology between pre- and posttreatment assessments were more pronounced for diagnostic interview than dimensional self-report assessments. These results are discussed in the context of personality assessment and CLBP.

Adolescent↗
PubMed1999

Short forms of the Schedule for Nonadaptive and Adaptive Personality (SNAP) for self- and collateral ratings: development, reliability, and validity.

Researchers and clinicians alike increasingly seek brief, reliable, and valid measures to obtain personality trait ratings from both selves and peers. We report the development of a paragraph-descriptor short form of a full-length personality assessment instrument, the Schedule for Nonadaptive and Adaptive Personality (SNAP) with both self- and other versions. Reliability and validity data were collected on a sample of 294 college students, from 90 of whom we also obtained parental ratings of their personality. Internal consistency reliability was good in both self- and parent data. The factorial structures of the self-report short and long forms were very similar. Convergence between parental ratings was moderately high. Self-parent convergence was variable, with lower agreement on scales assessing subjective distress than those assessing more observable behaviors; it also was stronger for higher order factors than for scales.

Adaptation, Psychological↗
PubMed1999

The Iowa Personality Disorder Screen: development and preliminary validation of a brief screening interview.

The length and expense of comprehensive personality disorder interviews makes them unwieldy for routine use. A brief but sensitive screen could eliminate administration of longer instruments in many instances. We describe the development of the Iowa Personality Disorder Screen (IPDS)--a mini-structured interview which can be completed in less than 5 minutes. Retrospective analyses using 1,203 SIDP-R interviews suggested that the IPDS items should provide good sensitivity and specificity. We present results from a prospective validation study, using a mixed group of 52 nonpsychotic inpatients and outpatients who were diagnosed using the SIDP-IV. Blind administration of the IPDS yielded excellent sensitivity (92%) and good specificity (79%), using a subset of five screening items. Addition of two more items leads to an estimated sensitivity of 79% and specificity of 86%. The IPDS shows promise as a quick personality disorder screen for use in research settings or standard clinical interviews.

Adult↗
PubMed1999

Hyperbaric oxygen in the treatment of life-threatening soft-tissue infections.

Necrotizing soft-tissue infections are rapidly spreading bacterial infections that account for a relatively small proportion of infections, but are aggressive in nature and nearly uniformly fatal if left untreated. Prompt recognition, antibiotic therapy, aggressive surgical debridement, and hyperbaric oxygen (HBO) therapy have reduced the mortality resulting from these infections. Oxygen, at increased pressures, augments tissue oxygen partial pressure, allowing increased bacterial killing by providing substrate for the formation of oxygen free radicals and augmenting respiratory burst. During the healing process, hyperoxia causes increased formation of capillaries for oxygen, nutrient, and antibiotic delivery, leading to increased efficacy of some antibiotics in the high oxygen environment, and possibly more rapid overall wound healing. Although there are no randomized trials of HBO in these infections, in vitro data and meta-analysis of clinical cases strongly support the use of HBO.

Combined Modality Therapy↗
PubMed1998

Comorbidity of anxiety and unipolar mood disorders.

Research on relationships between anxiety and depression has proceeded at a rapid pace since the 1980s. The similarities and differences between these two conditions, as well as many of the important features of the comorbidity of these disorders, are well understood. The genotypic structure of anxiety and depression is also fairly well documented. Generalized anxiety and major depression share a common genetic diathesis, but the anxiety disorders themselves are genetically hetergeneous. Sophisticated phenotypic models have also emerged, with data converging on an integrative hierarchical model of mood and anxiety disorders in which each individual syndrome contains both a common and a unique component. Finally, considerable progress has been made in understanding cognitive aspects of these disorders. This work has focused on both the cognitive content of anxiety and depression and on the effects that anxiety and depression have on information processing for mood-congruent material.

Anxiety Disorders↗
PubMed1998

Diagnostic assignment of criteria: clinicians and DSM-IV.

The study examined clinician matching of diagnostic criteria to selected DSM-IV Axis I and II disorders. A national sample of clinical psychologists and psychiatrists assigned symptom criteria, presented in scrambled order by axis, to DSM-IV diagnoses with which they believed the criteria belonged, without using the DSM. On average, clinicians assigned 69% of Axis I criteria and 75% of Axis II criteria to the designated DSM-IV diagnosis. The Axis II data represent increased agreement over the 66% found for DSM-III-R. Reasons for the increase are discussed, focusing on modifications made in DSM-IV and increased familiarity with personality disorders. The significantly higher rate of agreement for Axis II over Axis I contrasts with typical reliability data which suggests that Axis I disorders are better defined. Specific points of disagreement between clinician criteria assignments and the DSM-IV are discussed.

Behavioral Symptoms↗
PubMed1997

Implications of mothers' personality for their parenting and their young children's developmental outcomes.

Using a recent model (Watson, Clark, & Harkness, 1994), we examined implications of mothers' personality (N = 103) for parenting and children's developmental outcomes, using multiple personality self-reports, lengthy, repeated naturalistic observations, and mothers' reports about parenting and their child. Mothers high in negative emotionality and disagreeableness showed more negative affect and their children were more defiant and angry; they also reported more power-assertive and less nurturant parenting, as well as less secure attachment, more behavioral problems, and lower internalization of rules in their children. Mothers high in constraint and California Psychological Inventory (CPI) socialization reported more secure attachment and better internalization of rules; CPI socialization also correlated negatively with observed maternal verbal power assertion and children's defiance and anger, and positively with compliance. Regression analyses indicated that mothers' personality, particularly negative emotionality and socialization, influenced broadly conceptualized adaptive child outcomes, even after the influence of parenting was controlled.

Adult↗
PubMed1997

Personality disorder assessment: the challenge of construct validity.

We begin with a review of the data that challenge the current categorical system for classifying personality disorder, focusing on the central assessment issues of convergent and discriminant validity. These data indicate that while there is room for improvement in assessment, even greater change is needed in conceptualization than in instrumentation. Accordingly, we then refocus the categorical-dimensional debate in assessment terms, and place it in the broader context of such issues as the hierarchical structure of personality, overlap and distinctions between normal and abnormal personality, sources of information in personality disorder assessment, and overlap and discrimination of trait and state assessment. We conclude that more complex conceptual models that can incorporate both biological and environmental influences on the development of adaptive and maladaptive personality are needed.

Humans↗
PubMed1995

Testing a tripartite model: II. Exploring the symptom structure of anxiety and depression in student, adult, and patient samples.

L. A. Clark and D. Watson (1991) proposed a tripartite model of depression and anxiety that divides symptoms into 3 groups: symptoms of general distress that are largely nonspecific, manifestations of anhedonia and low positive affect that are specific to depression, and symptoms of somatic arousal that are relatively unique to anxiety. This model was tested by conducting separate factor analyses of the 90 items in the Mood and Anxiety Symptom Questionnaire (D. Watson & L. A. Clark, 1991) in 5 samples (3 student, 1 adult, 1 patient). The same 3 factors (General Distress, Anhedonia vs. Positive Affect, Somatic Anxiety) emerged in each data set, suggesting that the symptom structure in this domain is highly convergent across diverse samples. Moreover, these factors broadly corresponded to the symptom groups proposed by the tripartite model. Inspection of the individual item loadings suggested some refinements to the model.

Adult↗