The provision of health care over the Internet is a rapidly evolving and potentially beneficial means of delivering treatment otherwise unsought or unobtainable. Internet interventions are typically behavioral treatments operationalized and transformed for Web delivery with the goal of symptom improvement. The literature on the feasibility and utility of Internet interventions is limited, and there are even fewer outcome study findings. This article reviews empirically tested Internet interventions and provides an overview of the issues in developing and/or using them in clinical practice. Future directions and implications are also addressed. Although Internet interventions will not likely replace face-to-face care, there is little doubt that they will grow in importance as a powerful component of successful psychobehavioral treatment.

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This study compares the relationship between personality disorders and interpersonal problems as obtained by self-report and peer-report measures. Participants (N = 393) were administered selfand peer-report versions of the Peer Inventory for Personality Disorder and the Inventory of Interpersonal Problems-64. Canonical analyses demonstrated similar relationships between personality disorder features and interpersonal problems as measured by either self or peer. Analyses between self and peer found little shared variance across sources, indicating a large method variance. Results indicate that although similar constructs are identified by self and peers in their understanding of personality pathology and associated interpersonal problems, self-report information overlaps very little with information obtained from peers, underscoring the importance of obtaining multiple sources of information. Keywordsself-report; peer report; personality disorders; interpersonal problems Personality disorders (PDs) are described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) on the basis of specific personality features for each disorder. However the DSM-IV also requires that any PD, regardless of type, must result in interpersonal impairment or subjective distress. In other words, simply displaying a pattern of problematic traits and characteristics is not enough, if these traits do not lead to additional problems such as difficulty relating to others. Morey (1997) underscored the importance of interpersonal dysfunction in PDs, stating that "the maladaptiveness which qualifies personality disorders as mental disorders can only be evident in an interpersonal context" (p. 937). Unfortunately, most research on PDs has neglected the issue of interpersonal problems, focusing instead on the conscribed features of specific disorders. Without a better appreciation of their interpersonal consequences, our understanding of PDs is necessarily limited. Copyright 2005 by the American Psychological AssociationCorrespondence concerning this article should be addressed to Allan Clifton, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213. cliftonad@upmc.edu. Allan Clifton is now at the Department of Psychiatry, University of Pittsburgh School of Medicine. Thomas F. Oltmanns is now at the Department of Psychology, Washington University in St. Louis. Allan Clifton, Eric Turkheimer, and Thomas F. Oltmanns, Department of Psychology, University of Virginia. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptMeasures of interpersonal difficulty focus on specific types of problems that become evident in interactions with other people. A large body of literature suggests a convergence between DSM PDs and patterns of maladaptive interpersonal behavior. PD traits have been associated with impaired social functioning in both clinical (e.g., Skodol et al., 2002) and nonclinical (e.g., Oltmanns, Melley, & Turkheimer, 2...

The interpersonal dysfunction that characterizes borderline personality disorder (BPD) has generally been studied using broad global measures, leading to a lack of precision. We report on a novel methodology using social network analysis (SNA) to quantify interactions with others in the patient's social world. We assessed the social networks of 22 clinical patients, diagnosed with either BPD (N = 11) or no personality disorder (No PD; N = 11). The social networks of patients with BPD contained a greater number of former romantic partners, and a greater number of relationships that had been terminated. Mixed model analyses found that the No PD group reported higher levels of positive relationships (e.g., trust, social support) with more central members of their social networks, whereas the BPD group did not discriminate among members of their networks. Results suggest deficits in social cognition for positive relations, but not for negative relations such as interpersonal conflict.

The neurotransmitter serotonin has been implicated in the pathophysiology of psychosis. The serotonin transporter (5-HTT) plays a critical role in regulation of serotonergic function. A recently identified polymorphism in the promoter region of the 5-HTT gene (5-HTTLPR) produces significant differences in 5-HTT expression and function and was found to be associated with anxiety-related traits in healthy volunteers. We investigated whether 5-HTTLPR is associated with psychosis in neuroleptic-free schizophrenic or schizoaffective patients. Fifty patients with schizophrenia or schizoaffective disorder by DSM-III-R criteria were genotyped at 5-HTTLPR and underwent double-blind Brief Psychiatric Rating Scale (BPRS) ratings while neuroleptic-free for approximately 4 weeks. Patients with the 5-HTTLPR ll genotype (n = 19) had significantly higher BPRS ratings for psychosis than patients with the ls (n = 25) or ss (n = 6) genotypes. Examination of individual items revealed a specific significant increase in intensity of hallucinations in patients with the 5-HTTLPR ll genotype. These data provide preliminary evidence for a role of serotonin in the pathophysiology of hallucinations and may represent the identification of an allelic variant that modifies the complex clinical presentation of schizophrenia.Keywords: psychosis; schizophrenia; serotonin; polymorphism; hallucinations; gene Several lines of evidence suggest that abnormalities in serotonin (5-HT) function are involved in the pathophysiology of psychosis and, in particular, hallucinations. The 5-HT partial agonist lysergic acid diethylamide (LSD) produces psychotic symptoms such as paranoia and hallucinations in normal controls 1-3 while the 5-HT agonist, m-chlorophenylpiperazine (mCPP), can exacerbate psychosis in schizophrenia. 4,5 Post-mortem studies have revealed alterations in 5-HT 2 receptor densities in limbic 6,7 and prefrontal cortical [8][9][10][11] brain regions of schizophrenic patients. Finally, clozapine, the most effective antipsychotic agent for treatment-resistant schizophrenia, has potent effects at several 5-HT receptor subtypes. [12][13][14] 5-HT re-uptake plays a critical role in the regulation of 5-HT neurotransmission. The 5-HT transporter (5-HTT) terminates the synaptic actions of serotonin by sodium-dependent re-uptake into the presynaptic terminal. Recently, Lesch and colleagues have identified and functionally characterized a polymorphism of the 5-HTT transcriptional control (promoter) region designated 5-HTTLPR. 15,16 The polymorphism consists of a Correspondence to AK Malhotra at his current address: Unit of Molecular Psychiatry, Hillside Hospital, Research, 75-59 263rd St, Glen Oaks, NY 11004, USA Received 23 January 1998; revised and accepted 16 March 1998 44-bp insertion (the l or long allele) or deletion (the s or short allele). 15,16 Lymphoblast cell lines transfected with the l variant exhibit significantly greater basal transcriptional activity than the s allele. 15 Moreover, mRNA concentrations, [ 125 I]RTI-55 binding and [ 3 H]...