RESUMEN
OBJECTIVE: To describe the creation and validation of the Jamaica Personality Disorder Inventory (JPDI) screening questionnaire. METHOD: Using the phenomenological triad of power management, dependency and psychosexual issues, drafts of the JPDI were piloted on patients from psychiatric and medical wards. The JPDI consisted of 38 close-ended, yes/no questions. Validation was conducted in a sample of 200 patients, using the International Personality Disorder Examination-Screening Instrument (IPDE-S), the Brief Screen for Depression and consultant psychiatrists' Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) personality disorder interview. Construct validity was assessed through principal component factor analysis; Spearman correlation was used to assess criterion-related and discriminant validity; Cronbach's alpha was used to assess reliability of the entire scale as well as the resulting factors. The Multitrait Multimethod Matrix (MTMM) was used to assess discriminant and construct validity. RESULTS: Factor analysis revealed eight clusters consisting of 30 of the 38 questions, which had close congruence with the clinical triad. Cronbach's alpha for the entire scale was α = 0.79, ranging from a high 0.70 to 0.82 to low 0.63 to 0.45. The JPDI exhibited a sensitivity of 95.06% and a specificity of 67.71%. Significant correlation of scores for the JPDI and IPDE-S (r = 0.432, p = 0.000) and the JPDI and the DSM IV-TR diagnosis (r = 0.598, p = 0.000) established concurrent validity for the JPDI. Correlations (r = 0.293, p = 0.000) suggested that the JPDI possessed predictive validity. The complete sample matrix of the MTMM provided evidence of both convergent and discriminant validity, and thereby, construct validity. CONCLUSION: The JPDI demonstrated reliability, and criterion-related and discriminant validity.
Asunto(s)
Trastornos de la Personalidad/diagnóstico , Inventario de Personalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Jamaica/epidemiología , Masculino , Persona de Mediana Edad , Trastornos de la Personalidad/epidemiología , Trastornos de la Personalidad/psicología , PsicometríaRESUMEN
OBJECTIVE: To examine the distribution and clinically significant patterns of the phenomenology of a cohort of Jamaican patients with a Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis II diagnosis of personality disorder and to clarify the conventional diagnostic deficiencies of DSM-based personality disorder categories. METHODS: In a case-control study from the naturalistic clinical setting of a private psychiatric practice in Kingston, Jamaica, between 1974 and 2007, the phenomenology of a cohort of 351 patients with an Axis II DSM diagnosis of personality disorder is qualitatively described and quantitatively compared with that of a control group of patients with an Axis I DSM clinical diagnosis, matched for age, gender and socio-economic class. RESULTS: There were 166 males (47.3%); 238 (67.8%) of the patients were between age 18 and 39 years. Ethnically, 325 (92.6%) were Black, 10 (2.8%) White and 16 (4.6%) Other. The majority of patients (20.7%) had a DSM-IV diagnosis of dependent personality disorder. Patients with an Axis II diagnosis were significantly more likely to display symptoms of a 'clinical triad' of power management, dependency and psychosexual issues. Qualitative analysis of the phenomenological symptoms of personality disorder diagnosed patients suggests aetiological interconnections based on early childhood experiences as explained by object relations and attachment theories. CONCLUSIONS: The phenomenological approach to personality disorder may be a viable replacement for the four-cluster classification of DSM-IV in a Jamaican population with the clinical triad called Shakatani, derived from the Swahili words shaka (problem) and tani (power). This phenomenological approach may provide more clinical utility to practitioners.
Asunto(s)
Trastornos de la Personalidad/clasificación , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Jamaica/epidemiología , Masculino , Persona de Mediana Edad , Trastornos de la Personalidad/epidemiología , Trastornos de la Personalidad/psicologíaRESUMEN
OBJECTIVE: To describe the creation and validation of the Jamaica Personality Disorder Inventory (JPDI) screening questionnaire. METHOD: Using the phenomenological triad of power management, dependency and psychosexual issues, drafts of the JPDI were piloted on patients from psychiatric and medical wards. The JPDI consisted of 38 close-ended, yes/no questions. Validation was conducted in a sample of 200 patients, using the International Personality Disorder Examination-Screening Instrument (IPDE-S), the Brief Screen for Depression and consultant psychiatrists' Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) personality disorder interview. Construct validity was assessed through principal component factor analysis; Spearman correlation was used to assess criterionrelated and discriminant validity; Cronbach's alpha was used to assess reliability of the entire scale as well as the resulting factors. The Multitrait Multimethod Matrix (MTMM) was used to assess discriminant and construct validity. RESULTS: Factor analysis revealed eight clusters consisting of 30 of the 38 questions, which had close congruence with the clinical triad. Cronbach's alpha for the entire scale was α = 0.79, ranging from a high 0.70 to 0.82 to low 0.63 to 0.45. The JPDI exhibited a sensitivity of 95.06% and a specificity of 67.71%. Significant correlation of scores for the JPDI and IPDE-S (r = 0.432, p = 0.000) and the JPDI and the DSM IV-TR diagnosis (r = 0.598, p = 0.000) established concurrent validity for the JPDI. Correlations (r = 0.293, p = 0.000) suggested that the JPDI possessed predictive validity. The complete sample matrix of the MTMM provided evidence of both convergent and discriminant validity, and thereby, construct validity. CONCLUSION: The JPDI demonstrated reliability, and criterion-related and discriminant validity.
OBJETIVO: Describir la creación y validación del cuestionario de tamizaje del Inventario de Trastornos de la Personalidad en Jamaica (JPDI). MÉTODO: Usando la tríada fenomenológica de manejo del poder, dependencia y problemas psicosexuales, se realizaron pruebas pilotos usando versiones p rovisionales del JPDI con pacientes de salas médicas y psiquiátricas. El JPDI constaba de 38 preguntas cerradas, del tipo que requieren sí o no. La validación se realizó con una muestra de 200 pacientes, usando el Instrumento de Tamizaje del Examen Internacional de los Trastornos de Personalidad (IPDE-S), la Prueba Breve para la Depresión, y el Manual Diagnóstico y Estadístico de los Trastornos Mentales, cuarta edición (DSM-IV) de los psiquiatras consultantes, para entrevistas de trastornos de personalidad. La validez de constructo se evaluó a través de análisis factorial de componentes principales. El coeficiente de correlación de Spearman se utilizó para evaluar la validez de criterio y la validez discriminante. El coeficiente Alfa de Cronbach fue utilizado para evaluar la fiabilidad de toda la escala, así como los factores resultantes. La matriz multirasgo-multimétodo (MTMM) fue utilizada para evaluar la validez de constructo y la validez discriminante. RESULTADOS: El análisis factorial reveló ocho clústeres que constaban de 30 de las 38 preguntas, las cuales presentaban una estrecha congruencia con la tríada clínica. El Alfa de Cronbach para toda la escala fue α = 0.79, fluctuando desde valores altos de 0.70 a 0.82 hasta valores bajos de 0.63 a 0.45. El inventario JPDI mostró una sensibilidad de 95.06% y una especificidad de 67.71%. La correlación significativa de las puntuaciones para el JPDI y el IPDE-S (r = 0.432, p = 0.000) y el JPDI y el diagnóstico de DSM IV-TR (r = 0.598, p = 0.000) estableció una validez concurrente para el JPDI. Las correlaciones (r = 0.293, p = 0.000) sugirieron que el JPDI poseía validez predictiva. La matriz completa de la muestra de la MTMM proporcionó evidencia tanto de la validez discriminante como de la validez convergente, y por ende, de la validez de constructo. CONCLUSIÓN: El inventario JPDI demostró fiabilidad, así como validez de criterio y validez discriminante.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Trastornos de la Personalidad/diagnóstico , Inventario de Personalidad , Trastornos de la Personalidad/psicología , Trastornos de la Personalidad/epidemiología , Psicometría , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Jamaica/epidemiologíaRESUMEN
OBJECTIVE: To examine the distribution and clinically significant patterns of the phenomenology of a cohort of Jamaican patients with a Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis II diagnosis of personality disorder and to clarify the conventional diagnostic deficiencies of DSMbased personality disorder categories. METHODS: In a case-control study from the naturalistic clinical setting of a private psychiatric practice in Kingston, Jamaica, between 1974 and 2007, the phenomenology of a cohort of 351 patients with an Axis II DSM diagnosis of personality disorder is qualitatively described and quantitatively compared with that of a control group of patients with an Axis I DSM clinical diagnosis, matched for age, gender and socio-economic class. RESULTS: There were 166 males (47.3%); 238 (67.8%) of the patients were between age 18 and 39 years. Ethnically, 325 (92.6%) were Black, 10 (2.8%) White and 16 (4.6%) Other. The majority of patients (20.7%) had a DSM-IV diagnosis of dependent personality disorder. Patients with an Axis II diagnosis were significantly more likely to display symptoms of a 'clinical triad' of power management, dependency and psychosexual issues. Qualitative analysis of the phenomenological symptoms of personality disorder diagnosed patients suggests aetiological interconnections based on early childhood experiences as explained by object relations and attachment theories. CONCLUSIONS: The phenomenological approach to personality disorder may be a viable replacement for the four-cluster classification of DSM-IV in a Jamaican population with the clinical triad called Shakatani, derived from the Swahili words shaka (problem) and tani (power). This phenomenological approach may provide more clinical utility to practitioners.
OBJETIVO: Examinar la distribución y los patrones clínicamente significativos de la fenomenología de una cohorte de pacientes jamaicanos con diagnóstico de trastornos de personalidad de eje II según el Manual Estadístico Diagnóstico (DSM), y aclarar las deficiencias diagnósticas convencionales de categorías de trastorno de la personalidad basadas en DSM. MÉTODOS: Se describe cualitativamente la fenomenología de una cohorte de 351 pacientes con diagnóstico de trastorno de la personalidad de eje II DSM, en un estudio de caso control a partir de un contexto clínico naturalista en una práctica psiquiátrica privada de Kingston, Jamaica, entre 1974 y 2007. Dicha fenomenología fue comparada cuantitativamente con la de un grupo control de pacientes con un diagnóstico clínico de eje I DSM, pareados por edad, género y clase socio-económica. RESULTADOS: Hubo 166 varones (47.3%); 238 (67.8%) de los pacientes tenían entre edades entre 18 y 39 años. Étnicamente, 325 (92.6%) eran negros, 10 (2.8%) blancos, y 16 (4.6%) étnicamente diversos. La mayoría de los pacientes (20,7%) tenía un diagnóstico DSM-IV de trastorno de personalidad dependiente. Los pacientes con un diagnóstico de eje II tuvieron significativamente más probabilidades de mostrar síntomas de una 'tríada clínica' de manejo del poder, dependencia y problemas psicosexuales. El análisis cualitativo de los síntomas fenomenológicos de los pacientes diagnosticados con trastorno de personalidad, sugiere interconexiones etiológicas basadas en experiencias de la niñez temprana, tal cual lo explican la teoría de la relación de objetos y la teoría del apego. CONCLUSIONES: El enfoque fenomenológico de los trastornos de personalidad puede ser un substituto viable para la clasificación de cuatro clústeres de DSM-IV en una población jamaicana con la tríada clínica denominada Shakatani, término derivado de las palabras Swahili shaka (problema) y tani ("poder"). Este enfoque fenomenológico puede ofrecer mayor utilidad clínica a los profesionales.