Biomedical subjects

L C Morey

Publications and source records attributed to L C Morey.

At least 19 recordsLinked to original sources

PubMed2006

Hierarchical relationships between borderline, schizotypal, avoidant and obsessive-compulsive personality disorders.

OBJECTIVE: Comorbidity among personality disorders is widely considered problematic. The validity of one proposed solution, diagnostic hierarchies, was investigated in the current study with respect to borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders. METHOD: One approach used discriminant functions, derived from multiple psycho-social domains, that were used to classify comorbid individuals from the Collaborative Longitudinal Personality Disorder study (CLPS) to explore the possibility of hierarchical precedence of one personality disorder over another. A second approach examined the incremental increase in R(2)-value in predicting functioning and personality provided by each diagnosis over each other diagnosis. RESULTS: Obsessive-compulsive personality disorder was consistently subordinate to other diagnoses, whereas other indications of hierarchical relationships were domain-specific. CONCLUSION: Results indicate minimal support for an over-arching hierarchical pattern among studied personality disorders, and suggest the inclusion of all relevant diagnoses in clinical practice.

Adolescent↗

PubMed2004

Longitudinal diagnostic efficiency of DSM-IV criteria for obsessive-compulsive personality disorder: a 2-year prospective study.

OBJECTIVE: To examine the longitudinal diagnostic efficiency of the DSM-IV criteria for obsessive-compulsive personality disorder (OCPD). METHOD: At baseline, criteria and diagnoses were determined using diagnostic interviews, and blinded assessments were performed 24 months later with 550 participants. Diagnostic efficiency indices (conditional probabilities, total predictive power, and kappa) were calculated for each criterion determined at baseline, using the independent OCPD diagnosis at follow-up as the standard. RESULTS: Longitudinal diagnostic efficiencies for the OCPD criteria varied; findings suggested the overall predictive utility of 'preoccupied with details', 'rigid and stubborn', and 'reluctant to delegate'. CONCLUSION: These findings suggest the predictive validity of three cognitive-interpersonal OCPD criteria.

Adult↗

PubMed2001

Internal consistency, intercriterion overlap and diagnostic efficiency of criteria sets for DSM-IV schizotypal, borderline, avoidant and obsessive-compulsive personality disorders.

OBJECTIVE: To evaluate performance characteristics of DSM-IV Personality Disorders (PDs) criteria. METHOD: Six hundred and sixty-eight adults recruited for the Collaborative Longitudinal Personality Disorders Study (CLPS) were assessed with diagnostic interviews. RESULTS: Within-category inter-relatedness was evaluated by Cronbach's alpha and median intercriterion correlations (MIC). Cronbach's alpha ranged from 0.47 to 0.87 (median=0.71); seven of the 10 PDs had alphas greater than 0.70. Between-category criterion overlap was evaluated by "inter-category" intercriterion correlations between all PD pairs (ICMIC). ICMIC values (median=0.08) were lower than MIC values (median=0.23). Diagnostic efficiency statistics (sensitivity, specificity, positive predictive power and negative predictive power were calculated for schizotypal, borderline, avoidant and obsessive-compulsive PDs. CONCLUSION: DSM-IV PD criteria sets have some convergent validity and discriminant validity: criteria for individual PDs correlate better with each other than with criteria for other PDs. Diagnostic efficiency statistics provide guidance regarding usefulness of criteria for inclusion or exclusion.

Adolescent↗

PubMed2001

Use of structured self-report assessment to diagnose borderline personality disorder during major depressive episodes.

Diagnosis of borderline personality disorder (BPD) during episodes of major depression (MDE), although clinically important, is complicated in several respects when using self-report methods. Structured interview data were used to select a group of patients with comorbid BPD (n=21) from a sample of outpatients presenting with MDE. This group was compared with a group of MDE patients without BPD (n=24) and with a group of community controls (n=20) using self-report data from the Personality Assessment Inventory (PAI), the revised Personality Diagnostic Questionnaire (PDQ), and the Beck Depression Inventory (BDI). Analyses revealed that the BPD group obtained significantly higher scores on PAI and PDQ scales measuring features of BPD and on the PAI Negative Impression Management scale. The severity and type of MDE symptoms reported on the PAI and BDI did not differentiate the clinical groups. These data show that useful information for the diagnosis of BPD during depressive episodes can be gathered from self-report assessment instruments like the PAI.

Adult↗

PubMed2000

The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co-occurrence.

OBJECTIVE: To describe baseline diagnostic co-occurrence in the Collaborative Longitudinal Personality Disorders Study. METHOD: Six hundred and sixty-eight patients were reliably assessed with diagnostic interviews for DSM-IV Axis I and II disorders to create five groups: Schizotypal (STPD), Borderline (BPD), Avoidant (AVPD), Obsessive-Compulsive (OCPD) and Major Depressive Disorder (MDD) without personality disorder (PD). RESULTS: Mean number of Axis I lifetime diagnoses was 3.4; STPD and BPD groups had more diagnoses than AVPD, OCPD, and MDD groups. Significant Axis I co-occurrences emerged for Social Phobia/ AVPD, PTSD/BPD and Substance Use/BPD. Mean number of co-occurring PDs was 1.4; STPD had more than BPD group which had more than AVPD and OCPD groups. Significant PD co-occurrence emerged for: STPD/ Paranoid and Schizoid PDs, BPD with Antisocial and Dependent PDs, and lower frequency for OCPD/Antisocial PD. CONCLUSION: Diagnostic co-occurrences generally followed base rates, while significant departures resemble those of controlled literature.

Follow-Up Studies↗

PubMed2000

Borderline personality: traits and disorder.

Although the 5-factor model (FFM) has been advocated as an alternative to representing the construct of borderline personality, some argue that this diagnosis carries essential information that is not well captured by the FFM. The present study examined antecedent, concurrent, and predictive markers of construct validity in a sample of 362 patients with personality disorders. The results indicated that neuroticism best distinguished borderline and nonborderline patients, whereas the FFM as a whole captured a sizable proportion of the variance in the borderline diagnosis. However, the residual of the borderline diagnosis that was not explained by the FFM was found to be significantly related to childhood abuse history, family history of mood and substance use disorders, concurrent symptoms, and 2-year and 4-year outcomes. Thus, some elements of the borderline diagnosis may not be fully captured in a 5-factor representation.

Adolescent↗

PubMed2000

Dimensions and categories: the "big five" factors and the DSM personality disorders.

The five-factor model of personality, which has been widely studied in personality psychology, has been hypothesized to have specific relevance for DSM-defined personality disorders. To evaluate hypothesized relationships of the five-factor model of personality to personality disorders, 144 patients with personality disorders (diagnosed via a structured interview) completed an inventory to assess the five-factor model. Results indicated that the majority of the personality disorders can be differentiated in theoretically predictable ways using the five-factor model of personality. However, while the personality disorders as a whole appear to be differentiable from normal personality functioning on the five factors, the patterns are quite similar across the disorders, a finding that may provide some insight into the general nature of personality pathology but may also suggest problems with discriminant validity. Third, it does not appear that considering disorders as special combinations of features (as might be expected in some categorical models) is more informative than considering them as the sum of certain features (as might be expected in a dimensional model).

Adolescent↗

PubMed2000

The Collaborative Longitudinal Personality Disorders Study: reliability of axis I and II diagnoses.

Both the interrater and test-retest-retest reliability of axis I and axis II disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). Fair-good median interrater kappa (.40-.75) were found for all axis II disorders diagnosed five times or more, except antisocial personality disorder (1.0). All of the test-retest kappa for axis II disorders, except for narcissistic personality disorder (1.0) and paranoid personality disorder (.39), were also found to be fair-good. Interrater and test-retest dimensional reliability figures for axis II were generally higher than those for their categorical counterparts; most were in the excellent range (> .75). In terms of axis I, excellent median interrater kappa were found for six of the 10 disorders diagnosed five times or more, whereas fair-good median interrater kappa were found for the other four axis I disorders. In general, test-retest reliability figures for axis I disorders were somewhat lower than the interrater reliability figures. Three test-retest kappa were in the excellent range, six were in the fair-good range, and one (for dysthymia) was in the poor range (.35). Taken together, the results of this study suggest that both axis I and axis II disorders can be diagnosed reliably when using appropriate semistructured interviews. They also suggest that the reliability of axis II disorders is roughly equivalent to that reliability found for most axis I disorders.

Diagnosis, Differential↗

PubMed2000

The Collaborative Longitudinal Personality Disorders Study: development, aims, design, and sample characteristics.

This paper describes the aims, background, design, and methods used in a collaborative longitudinal study of Axis II personality disorders (PDs). This study examines the putative stability of selected PD diagnoses and criteria, what factors affect their course, and whether their stability and course distinguishes them from a representative Axis I disorder. This article also describes the acquisition and demographics of the sample on whom the study is being done. A prospective, repeated measures investigation of the stability of PDs is now underway at multiple clinical settings in four collaborating urban sites in Boston. New Haven, New York, and Providence. Diagnostic assignments are based on semistructured interview assessments (by clinically trained raters) and confirmed by at least one additional contrasting diagnostic method. The sample consists of 668 treatment seeking and reliably diagnosed adults recruited from a broad range of clinical sites. By design, patients in the sample met standards for one of five diagnostic subgroups: (a) schizotypal (N = 86); (b) borderline (N = 175); (c) avoidant (N = 157); (d) obsessive-compulsive (N = 153) personality disorders or a control group having (e) major depressive disorder without personality disorder (N = 97).

Adolescent↗

PubMed1999

Passive-aggressive personality disorder: the demise of a syndrome.

This article presents an explanation and critique of the rationale for dropping passive-aggressive personality disorder (PAPD) from DSM-IV. The clinical and research literature on PAPD is reviewed along with the historical changes in definition, diagnostic criteria, and usage. PAPD can be reliably diagnosed, is fairly prevalent, and has good internal consistency. Because PAPD is no less valid than other personality disorders, and describes clinical phenomena that are unique among personality disorders, we recommend the reinstatement of PAPD in the official diagnostic nomenclature.

Diagnosis, Differential↗

PubMed1999

Applicability of personality disorder criteria to hospitalized adolescents: evaluation of internal consistency and criterion overlap.

OBJECTIVE: The authors examined the applicability of personality disorder criteria to adolescent inpatients by evaluating internal consistency and criterion overlap. METHOD: Thirty-eight adolescents and 28 adults were assessed with the Personality Disorder Examination. Within-category cohesiveness (internal consistency) of the criteria was evaluated by examining intercriterion correlations as well as coefficient alpha. In addition, between-category criterion overlap was evaluated by examining "intercategory" intercriterion correlations between all pairs of disorders. Separate analyses were conducted for adolescents and adults, and the groups were compared. RESULTS: Internal consistency appeared to be lower in adolescents, as measured by intercriterion correlation and coefficient alpha, with the largest differences being identified for most cluster B disorders. Intercategory analysis indicated that criterion overlap may be greater among adolescents. CONCLUSIONS: Overall, this psychometric analysis suggests that there may be limitations to the DSMs approach to categorizing personality disorders. For both adolescents and adults, modest degrees of within-category cohesiveness (internal consistency) and between-category criterion overlap were observed. Comparatively, personality disorder criteria in adolescents tended to have lower internal consistency and less discriminant validity. The data raise questions about the construct validity of these disorders--or the applicability of these criteria--within this age group.

Adolescent↗

PubMed1999

Co-occurrence of mood and personality disorders: a report from the Collaborative Longitudinal Personality Disorders Study (CLPS).

The purpose of this study was to examine the relationship of subtypes and particular clinical features of mood disorders to co-occurrence with specific personality disorders. Five hundred and seventy-one subjects recruited for the Collaborative Longitudinal Personality Disorders Study (CLPS) were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). Percent co-occurrence rates for current and lifetime mood disorders with personality disorders were calculated. Logistic regression analyses examined the effects of clinical characteristics of depressive disorders (e.g., age at onset, recurrence, symptom severity, double depression, and atypical features) on personality disorder co-occurrence. In comparison with other DSM-IV personality disorders, avoidant, borderline, and dependent personality disorders (PDs) were most specifically associated with mood disorders, particularly depressive disorders. Severity and recurrence of major depressive disorder and comorbid dysthymic disorder predicted co-occurrence with borderline and to a lesser extent research criteria depressive personality disorders. The results are consistent with the view that a mood disorder with an insidious onset and recurrence, chronicity, and progression in severity leads to a personality disorder diagnosis in young adults.

Adolescent↗

PubMed1998

Operating characteristics of six response distortion indicators for the personality assessment inventory.

The characteristics of six different indicators of response distortion on the Personality Assessment Inventory (PAI; Morey, 1991) were evaluated by having college students complete the PAI under positive impression management, malingering, and honest responding conditions. The six indicators were the PAI Positive Impression (PIM) and Negative Impression (NIM) scales, the Malingering and Defensiveness Indexes, and two discriminant functions, one developed by Cashel and the other by Rogers. Protocols of students asked to malinger were compared with those of actual clinical patients, while protocols of students asked to manage their impression in a positive direction were compared with those of students asked to respond honestly. Comparisons between groups were accomplished through the examination of effect sizes and receiver operating characteristic (ROC) curves. All six indicators demonstrated the ability to distinguish between actual and feigned responding. The Rogers function was particularly effective in identifying malingering. The Cashel function was less effective than other measures in identifying positive impression management, although it appears to also have promise as an indicator of malingering.

Adult↗

PubMed1998

Negativism in evaluative judgments of words among depressed outpatients with borderline personality disorder.

This study contrasted the frequency of negativistic evaluative judgments to words of various emotional content between two groups of patients with Major Depressive Disorder (MDD) (20 patients with a comorbid diagnosis of Borderline Personality Disorder (BPD) and 20 patients without BPD) and a group of 20 community adult Controls. BPD patients made more "dislike" judgments with neutral words than MDD patients and Controls. The performances of the MDD patients were more similar to the Control group than to the BPD group, despite negligible differences between the two patient groups in the severity of depressive symptoms and overall psychopathology. As a whole, these data indicate that the presence of borderline features in patients with MDD can be an important qualifier in terms of patients attitudinal dispositions.

Adult↗

PubMed1996

Detection of feigned mental disorders on the personality assessment inventory: a discriminant analysis.

Psychological assessment with multiscale inventories is largely dependent on the honesty and forthrightness of those persons evaluated. We investigated the effectiveness of the Personality Assessment Inventory (PAI) in detecting participants feigning three specific disorders: schizophrenia, major depression, and generalized anxiety disorder. With a simulation design, we tested the PAI validity scales on 166 naive (undergraduates with minimal preparation) and 80 sophisticated (doctoral psychology students with 1 week preparation) participants. We compared their results to persons with the designated disorders: schizophrenia (n = 45), major depression (n = 136), and generalized anxiety disorder (n = 40). Although moderately effective with naive simulators, the validity scales evidenced only modest positive predictive power with their sophisticated counterparts. Therefore, we performed a two-stage discriminant analysis that yielded a moderately high hit rate (> 80%) that was maintained in the cross-validation sample, irrespective of the feigned disorder or the sophistication of the simulators.

Adult↗

PubMed1994

The MMPI/MMPI-2 Personality Disorder scales: contemporary norms for adults and adolescents.

Eleven personality disorder scales for the MMPI, as described in DSM-III, were derived by Morey and his colleagues from the original MMPI item pool through a combination of rational and empirical strategies. These new scales have enjoyed popularity among clinicians. Normative tables for each of these scales, with and without overlapping items, were constructed from MMPI responses from a large contemporary normal reference sample of adults and adolescents without any physical or mental handicaps who were selected randomly from a three-state area in the Midwest. Some items from the Morey Personality Disorder scales were deleted during development of the MMPI-2; separate normative tables have been prepared for the scales so affected, which allows clinicians who are using the MMPI-2 to continue to use these slightly modified scales.

Adolescent↗

PubMed1992

Early manifestations of dementing illness: treatment with glycosaminoglycan polysulfate.

1. In a multicenter, placebo-controlled, double-blind clinical trial in 156 elderly patients with psychopathologic symptoms, glycosaminoglycan polysulfate was found to be a therapeutically effective agent in the treatment of the earliest manifestations of a dementing process. 2. Treatment with glycosaminoglycan polysulfate in the daily dosage of 600 LRU, administered on the basis of a divided dosage schedule for 24 weeks, was significantly superior to an inactive placebo on several outcome measures including the SCAG Total and factor scores (i.e., Cognitive Dysfunction, Withdrawal, Agitation/Irritability and Depression), the NOWLIS Total and Fatiguability factor scores, the MMSE, the HAM-D Total and Vegetative Symptoms factor score and the CGI Severity of Illness and Global Improvement. 3. The drug was well tolerated; vital signs and laboratory measures did not show clinically significant changes within the experimental period.

Affect↗

PubMed1991

Glycosaminoglycan polysulfate in the treatment of old age dementias.

1. In a multicenter, placebo-controlled, double-blind clinical trial in 155 elderly patients with cognitive decline, glycosaminoglycan polysulfate was found to be a therapeutically effective agent in the treatment of old age dementias. 2. Treatment with glycosaminoglycan polysulfate in the daily dosage of 600 LRU, administered on the basis of a divided dosage schedule for 12 weeks, was significantly superior to an inactive placebo on several outcome measures including the Wechsler Memory Scale-Russell Revision (Easy Paired Associates Learning and Immediate Visual Reproduction), Mini Mental State Examination, the Sandoz Clinical Assessment Geriatric (Cognitive Dysfunction and Depression), Hachinski Dementia Scale, Brief Psychiatric Rating Scale (Confusion and Depressive Withdrawal) and Global Improvement Scale of the Clinical Global Impression. 3. Adverse effects with glycosaminoglycan polysulfate were few and mild. The drug was equally well tolerated and equally effective in the two major dementias of old age, i.e., primary degenerative and multi-infarct. The number of abnormal laboratory test readings remained essentially unchanged from pre-treatment to post-treatment.

Activities of Daily Living↗