Validity & Clinical Utility of 2-Part System for Personality Disorder Diagnosis

有效性

• 批准号: 8299623
• 负责人: Lee Anna Clark
• 金额: $ 59.87万
• 依托单位: UNIVERSITY OF NOTRE DAME
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-09 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8299623
• 关键词: Address; Behavioral; Categories; Characteristics; Client; Clinic; Clinical; Clinical assessments; Clinics and Hospitals; Communication; Communities; Complex; Consensus; DSM-V; Data; Development; Diagnosis; Diagnostic; Dimensions; Disease; Distress; Drug Formulations; Ensure; Evaluation; Family; Foundations; Friends; Functional disorder; Goals; Health Personnel; Impairment; Individual; Intake; Intervention; Interview; Iowa; Knowledge; Measures; Mental Health; Mental disorders; Methods; Modeling; Occupational; Outcome; Participant; Patient Self-Report; Patients; Personality; Personality Disorders; Personality Traits; Phase; Psychiatric Hospitals; Reporting; Research; Research Personnel; Sampling; Staging; Structure; Surveys; System; Teaching Hospitals; Techniques; Testing; Therapeutic; Time; Treatment outcome; Universities; Validity and Reliability; Work; base; experience; follow-up; functional disability; high risk; improved; innovation; instrument; longitudinal course; psychosocial; public health relevance; sound; tool; trait; treatment planning; treatment strategy

DESCRIPTION (provided by applicant): Personality disorder (PD) diagnosis is at a crossroads: There is broad acknowledgment of the significant, negative impact that PD has on individuals and on the course and outcome of comorbid disorders, as well as relatively widespread dissatisfaction with the current categorical system of PD diagnosis. Nonetheless, there also is reluctance to implement an alternative trait dimensional system because: (1) there is no consensus on which set of traits to assess, (2) current trait assessment methods do not reflect either dysfunction or the full range of clinical variability, and (3) the clinical utility of a trait-based system is unknown. The proposed research is significant because it will draw from the full spectrum of the personality trait domain to identify a comprehensive set of specific traits for PD diagnosis, demonstrate how PD characteristics are manifest in both stable and clinical-state-dependent forms, and provide a clinically useful PD diagnostic system that integrates assessment of trait dimensions and psychosocial functioning. The long-term goal of this research is to develop a trait-plus-dysfunction-based clinical assessment system for the reliable and valid diagnosis of personality disorder on which to base the development of effective, more specifically targeted interventions. The specific aims of the current proposal are (1) to establish a set of specific traits that collectively define the trait dimensions of individuals with PD, (2) to establish a set of psychosocial functioning dimensions that collectively define the functional impairment of individuals with PD, and (3) to evaluate prospectively the clinical utility of this two-pronged PD diagnostic system. We plan to do this in three stages: (1) Assessing a large sample on a wide range of measures of both traits and psychosocial function to determine the structure of each domain and ensure that we have identified all components needed to assess personality disorder comprehensively; (2) testing the identified components on another large sample of patients and high-risk individuals, including information provided by family and/or friends, and Axis I symptomatology, and (3) testing the clinical utility of the developed system by assessing a sample of new patients, providing the information to their mental health-care providers, surveying the clinicians for the usefulness and acceptability of the diagnostic system, and examining its predictive validity over 6 months post-intake. We expect that the newly developed system will have high predictive validity and be judged clinically useful; specifically, to be comprehensive and accurate, and useful for communication purposes, for formulating general and specific treatment plans, and for predicting general and specific treatment difficulties. PUBLIC HEALTH RELEVANCE: The current system for diagnosing personality disorder is widely recognized to have problems with both reliability and validity, and to provide little guidance for selecting an appropriate treatment strategy. The goal of this research, therefore, is to provide clinicians and researchers of personality disorder with a revised diagnostic system that is reliable, valid, and clinically useful. It will achieve these goals by identifying and providing the means to assess both the maladaptive trait components of personality disorder in both stable and unstable manifestations, and the ways in which individuals' psychosocial functioning is maladaptive. This will facilitate the development of treatment strategies that target specific maladaptive traits and types of psychosocial dysfunction.

描述（由申请人提供）：人格障碍（PD）诊断正处于十字路口：广泛承认PD对个体以及共病疾病的病程和结局具有显著的负面影响，以及对当前PD诊断分类系统的相对普遍不满。尽管如此，也不愿意实施替代的特质维度系统，因为：（1）对于评估哪组特质没有共识，（2）当前的特质评估方法不能反映功能障碍或临床变异的全部范围，以及（3）基于特质的系统的临床效用是未知的。拟议的研究是重要的，因为它将从人格特质领域的全方位，以确定一套全面的具体特征PD诊断，演示PD特征是如何表现在稳定和临床状态依赖的形式，并提供了一个临床上有用的PD诊断系统，集成的特质维度和心理社会功能的评估。 本研究的长期目标是开发一个基于特质加功能障碍的临床评估系统，用于可靠和有效的人格障碍诊断，并以此为基础制定有效的，更有针对性的干预措施。当前提案的具体目标是：（1）建立一组特定特质，共同定义PD个体的特质维度;（2）建立一组心理社会功能维度，共同定义PD个体的功能障碍;（3）前瞻性评估这种双管齐下的PD诊断系统的临床效用。 我们计划分三个阶段进行：（1）对大样本进行广泛的特质和心理社会功能的评估，以确定每个领域的结构，并确保我们已经确定了全面评估人格障碍所需的所有组成部分;（2）在另一个大样本的患者和高风险个体上测试所识别的成分，包括由家人和/或朋友提供的信息，和Axis I神经病学，以及（3）通过评估新患者的样本来测试所开发系统的临床效用，将信息提供给他们的精神卫生保健提供者，调查临床医生对诊断系统的有用性和可接受性，并在摄入后6个月内检查其预测有效性。我们希望新开发的系统将具有较高的预测有效性，并被判定为临床有用;具体而言，是全面和准确的，并用于通信目的，制定一般和具体的治疗计划，并预测一般和具体的治疗困难。 公共卫生相关性：目前的人格障碍诊断系统被广泛认为在可靠性和有效性方面都存在问题，并且对选择适当的治疗策略提供的指导很少。因此，本研究的目的是为临床医生和人格障碍研究人员提供一个可靠、有效和临床有用的修订诊断系统。它将通过确定和提供评估稳定和不稳定表现的人格障碍的适应不良特征成分以及个人心理社会功能适应不良的方式来实现这些目标。这将促进针对特定适应不良特征和心理社会功能障碍类型的治疗策略的制定。