Million Clinical Multiaxial Inventory IV

Transcription

1 MCMI-IV Million Clinical Multiaxial Inventory IV CHARLES J VELLA PHD 2016

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3 Normality and pathology of personality exist on a continuum.

4 Quick facts

5 Scales

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8 MCMI-IV Languages: English, Spanish Completion Time: 25 to 30 minutes The record forms (which is a 2-in-1 form with both the questions and answer column) are in the file cabinets. Similar to the MCMI-III, it is scored using the Q-local computer scoring program. Scores/Interpretation: Adult inpatient and outpatient clinical sample; nor for normals Scoring Options: Q-global web-based, Q Local software, or Mail-in Report Options: Interpretive and Profile Reports

9 MCMI-IV The MCMI-IV offers: updated norms that are based on a clinical adult population, a new scale, DSM-5 and ICD-10-CM alignment, updated narrative content a new and deeper therapeutic focus. The brevity of the MCMI-IV allows clinicians to maintain an efficient and productive clinical practice.

10 New Full normative update, more closely representing the current clinical adult population New Turbulent scale, providing deeper understanding of those patients presenting with this unbridled personality type New and updated test items characterizing the evolution of Dr. Millon's personality theory, refreshed to increase clarity and clinical relevance New and improved narrative content that better integrates results with therapeutic practice and links to personalized treatment

11 New features Aligns with DSM-5; includes ICD-10 code sets New option to present scale scores using scale abbreviations Brevity, allowing clinicians to maintain an efficient and productive clinical practice 5th Grade reading level Seven new Noteworthy Response categories New digital manual in Q-global Resource Library

12 Psychometrics The extensive normative sample for the MCMI-IV consists of a nationally representative sample of 1,547 males and females with a wide variety of diagnoses. This combined-gender sample includes adult patients seen in a wide array of settings, such as clinics, independent practices, mental health centers, residential facilities, and hospitals.

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19 Use of BR scores: actuarial base data Does not assume normal curve; most tests standardize all scales to same mean and sd BR (Base Rate): pts according to percentages that reflect underlying clinical prevalence; BR score scaled to reflect differing prevalence rates of the disorder Percentiles also used for Personality Pattern, clinical syndromes, and facet scales; % signify rarity & percentage of population that scored at or below a given BR score

20 MCMI: Scoring and Interpreting Base Rate Anchors 115 Maximum raw score 85 Prevalence PD disorder (1-8) or Prev of prominent disorder (A-PP) 75 Prev of PD traits or Prev of present disorder (A-PP) 60 Median for patients 0 Minimum raw score Gender differences: Females score higher: internalizing Melancholic, Dependent, Somatic, Persistent Depression, Post-Traumatic Stress, & Major Depression Males: externalizing Antisocial, Alcohol Use, Drug Use, Narcissistic

21 Base Rate Adjustments Raw score converted to BRs 2 adjustments may be necessary X (Disclosure) degree of rankness and self-revelation vs reticence & guardedness 1 point for each true on 121 items from scales 1 to 8B Low score = underreporting symptoms; high scores = exaggeration of clinical picture If X is less than 21 or greater than 60, BRs increased or decreased X scores less than 7 or greater than 114 are invalid Anxiety/Depression (A/CC): if too anxious or depressed Add together the number of BR points that exceed 75 (minimum for clinical syndrome) for Anxiety & Major Depression Scales Applied to 2A (Avoidant), 2B (Melancholic), 8B (Masochistic), S (Schizotypal), & C (Borderline); decreased scores

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23 Administration Administration Scorability Rules The administration of the assessment cannot be scored if any of the following conditions are true: Examinee s identification number is missing or invalid and examinee s first or last name is missing or invalid Birth date is missing or invalid Test date is missing or invalid Examinee s age at testing is less than 18 Gender is missing or invalid Number of omits or invalid test responses is greater than 13 If an administration is unscorable, you must fill in the appropriate responses or raw scores before you can score the instrument.

24 Administration: Invalidity Report invalidity rules describe circumstances in which a valid interpretation cannot be made. Common examples are too many missing responses, a client s age that is outside the appropriate range, an abnormal score on an assessment s validity index, and an uninterpretable profile configuration. This report is invalid if any of the following conditions are true: Raw V (Invalidity) is greater than 1 Raw X (Disclosure) is less than 7 or greater than 114 All Clinical Personality Patterns BR scores (1-8B) are less than 60 Raw W (Inconsistency) is greater than 19 Unless you have modified your default system settings, you will always be asked whether or not you want to print an invalid report. An on-screen message will briefly describe the invalidity condition and the data you will receive if you print the report. For example, an invalid report might include a printout of raw and transformed scores, but the scores would not be plotted and no interpretation would be attempted. Scale Invalidity Rules If 5 or more items are missing from a scale then the scale is considered invalid.

25 New Turbulent scale Scale 4B: Ebullient Exuberant Turbulent Spectrum The Turbulent scale on the MCMI-IV provides clinicians with a deeper understanding of adult patients experiencing abnormal personality traits, such as a lost sense of reality or unwavering optimism. "Turbulent" refers to the more severe (disorder) end of the personality functioning spectrum. The Ebullient Exuberant Turbulent personality pattern as typically energetic and buoyant in manner and prone to vigorous pursuits of happiness. The high energy and generally positive attitude of moderated variants of this pattern can show considerable characterological strengths. Patients with less integrated variations of this pattern may be prone to scatteredness, overstimulation, overanimation, and an inability to maintain balance within their environment which can adversely affect their relationships with others.

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27 Scales: 3 Levels of functioning The MCMI -IV overtly conceptualizes personality patterns on a new continuum, or spectrum, ranging from adaptive to maladaptive levels of functioning. The MCMI-IV personality patterns, or scale spectrums, capture the patient's broad range of personality by way of three levels of personality functioning: Normal Style: Generally adaptive personality patterns Abnormal Traits/Type: Moderately maladaptive personality attributes Clinical Disorder: Likelihood of greater personality dysfunction For example: The CENarc spectrum Normal Style: Confident Abnormal Traits/Style: Egotistic Clinical Disorder: Narcissistic

28 12 Clinical Personality Patterns

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30 3 Severe Personality Pathology

31 7 Clinical Syndrome Scales Formerly Somatoform Formerly Bipolar: Manic Formerly Dysthymia Formerly Dependence

32 Severe Clinical Syndromes

33 Grossman Facet Scales

34 Stage 1 Interpretation Need clinical history Review of personality scales: Which exceed relatively functional BR 60 level BR 60 to 74 = personality style Less functional BR 75 to 85 = clinically significant personality type (can be debilitating); i.e. BR of 79 on Narcissistic implies pattern of entitlement or grandiosity At or above BR 85 = personality disorder Clinical Syndrome scales: BR 75 to 84 = syndrome present At BR 85 = syndrome prominent; can review prototypical items (appendix C) for dx Scores below 75 should be noticed, as well as combinations (Narciss-Depend vs Narciss-ASP)

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37 Evaluating Noteworthy Responses Special attention items grouped into 13 categories: Adult ADHD Autism spectrum Childhood abuse Eating disorder Emotional dyscontrol Explosively angry Health preoccupied Interpersonally alienated Prescription drug abuse Self-destructive potential Self-injurious behavior/tendency Traumatic brain injury Vengefully prone

38 5 Validity Scales

39 Evaluating validity and modifying Indices Random Response Indicators (Scales V & W) V (Invalidity) = 3 items for which a True response is highly implausible (Have not seen a car in 10 years) W (Inconsistency)= 25 similar item response pairs; look for discrepancy Index combing V and W identifies questionable or invalid protocols because of random responding Disclosure Index (Scale X) Frank and open (high) or reticent and secretive (low) Both low and high scores are clinically interpretable; below 7 or above 114 = invalid Desirability Index (Scale Y) Inclination to appear socially attractive, morally virtuous, or emotionally composed; BR of 75 and higher = tendency to place oneself in favorable and appealing light; higher = more concealment Debasement Index (Scale Z) Opposite of Scale Y; but both can be high in unusually self-disclosing BR of 75 + = inclination to depreciate or devalue oneself; extremely high may = cry for help

40 Response Style considerations Configural patterns of Scales X, Y, and Z: Low Disclosure and Desirability and high debasement: moderate exaggeration of current emotional problems, but does not affect validity Low X and Y and Z high: endorses antithetical sxs and characteristics; raises validity?;? Of agitated depression Best possible light pts: low X and high Y; can have high Depend, Narciss, Compulsive scales Cry for help: more impaired than they are; X & Z elevated, as well as many severe scales

41 Stage 2 Interpretation: Exam Single Scale and Multiscale elevations and configurations Very rare for individual to present clinically as a pure prototype; even rarer for single personality scale will elevate with a single clinical syndrome scale. Single scale elevations: recommend focusing on top 3-4 highest scales & severe pathology Greater the number of scales elevated above BR 75, the greater the extent of personality pathology. Severe Personality Pathology Scales: Scales S (Schizotypal), C (Borderline) & P (Paranoid) Start with highest elevation and work down BR of 75 indicative of personality types that approximate DSM-5 diagnoses BR of 85 = personality disorder If any of these elevations are present, and are highest elevations in profile, probable DSM-5 diagnosis Elevations of BR 60 or higher when not highest in profile consider as colorization for other scales (S diffusion of motivating aims; C conflict; P immobilize and constrict

42 Stage 2: Clinical Personality patterns Scales 1 thru 8B should be considered next 3 highest constitute high-point code BR of 60 = similar to standardization sample evidencing traits of given prototype, reflecting generally adaptive personality style with moderate or occasional difficulty BR of 75 or 85 = less adaptive personality types or clinical personality disorders respectively If none are elevated to BR60, protocol invalid; not for dx purposes

43 Multiscale Elevations and Configurations Except where highest scale is elevated above any other to a significant degree, 2ndary scales are always meaningful Configural analysis: i.e. 2 high Dependent 1 with 2 nd Avoidant; 2 with 2 nd Histrionic Examine Severe Personality Pathology Elevations These are extreme dysfunctional variants of Clinical Personality Patterns More dysfunctional variants of schizoid and avoidant blend into schizotypal Masochistic and sadistic blend into either borderline or paranoid Dependent and histrionic blend into borderline Narcissistic and antisocial blend into paranoid Compulsive and negativistic blend into borderline or paranoid Any elevation of Scales S, C and P may serve to colorize interpretations of other scales

44 Grossman Facet Scales 45 facet scales for Analysis of 15 scales: 12 Clinical and 3 Severe Each has 3 facet scales: discriminating, salient features of larger scale aimed at therapeutic interpretations Must be BR of 60 + Graph of facets of 3 highest personality scales; interpret only those with BR of 75+ Represent areas of more difficulty Hypothesis-building tools Interpretation: Which of 2 primary personality scales has higher elevation and how significant Are facets related in some meaningful way? What are relative elevations of overlapping facets? If 2 primaries are high, look at facets.

45 Psychopathology Scales BR elevations for Clinical Syndrome and Severe Clinical Syndrome scales: BR scores 60 to 74 = suggestive but not sufficient of pathology unless they are highest scale BR of 75 to 84 = suggest that clinical syndrome is present BR of 85 = syndrome is prominent Double depression = Major Depression and Persistent Depressive Disorder Always begin with Severe Clinical Syndrome scales; meaningfully colorize the interpretation of Clinical Syndrome scales

46 Stage 3 Interpretation MCMI-IV is only 1 facet of total patient evaluation Need psychosocial history

47 Special consideration for 3 scales Research indicates that elevation on Histrionic, Narcissistic, and Compulsive Scales (4A, 5, 7) may reflect personality strengths rather than pathology Measurement of these is psychometrically problematic, esp. because they excel at minimizing problems, denying difficulties, and presenting a favorable self picture. Tend, at modest levels of elevation, to include traits that or normal or adaptive: sociability, self esteem, and prudence are beneficial Shape of these 3 constructs is curvilinear: high and low levels of each are maladaptive, but modest levels are healthy. Interpretation: Higher the BR, more likely it is pathology Presence of significant clinical syndrome pathology supports presence of PD Presence of personality pathology can be judged by level of 3 Severe scales Number of falsely keyed items from these 3 scales has been reduced from 50% on MCMI-III to 22% on MCMI-IV; makes it less likely for absence of personality pathology to elevate them.

48 Profile Report The Profile Report provides base rate scores for all 28 scales in an easy-to-read graph. This report can help clinicians to quickly identify clients who may require more intensive evaluation. Do DSM-5 diagnosis given

49 Interpretive Report This report provides an in-depth analysis of personality and symptom dynamics. Written with a therapeutic focus, the interpretive report provides the clinician with a foundation upon which treatment plans can readily be made and includes action-oriented suggestions for therapeutic management. This report also provides: Patient's demographic information Graphic presentation of base rate scores for all scales Listing of possible DSM-5 diagnoses and the associated ICD-10 code sets Treatment Guide - provides short-term treatment options based on individual results Brief Report Summary of results - helping clinicians to begin a course of treatment right away

50 Administration, Scoring, Reporting Administration, Scoring and Reporting for the MCMI-IV is available on: Q-global web-based scoring and reporting platform Q Local software system Q-global offers: 24/7 secure, web-based access Portability: Q-global can be used on mobile devices such as a laptop or tablet On-demand, reliable scoring and comprehensive reporting solutions Pricing on a per-report basis Mail-in Scoring is also available for the MCMI-IV.

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53 Motivating Aims of Personality: 3 basic Polarities State of Being Survival Nurturance See page 43 of manual of Table 4.1: Polarity Structure of Personality Prototypes

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74 MCMI: Strengths Relatively brief, easy to administer Easy computer-scoring Good reliability Tied to Millon s theory Tied to DSM-V dx (including PD) Use of base rates Some research support (manual lists 500 studies; but none presented)

75 MCMI: Limitations Difficult to score by hand Descriptions and predictions are more theoretically than empirically based Tied to Millon s personality theory Interpretation, especially of Axis I disorders, is not as easy as it looks

76 Sample Report

77 Sample Report

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