Public health consequences of different thresholds for the diagnosis of mental disorders

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston 29425, USA.
Comprehensive Psychiatry (Impact Factor: 2.25). 03/2000; 41(2 Suppl 1):14-8. DOI: 10.1016/S0010-440X(00)80003-6
Source: PubMed


The acceptance of subthreshold disorders in psychiatry is a controversial topic with multiple implications for public health policy. Using subthreshold depression as an example, we provide documentation based on data from epidemiologic and clinical studies suggesting that subthreshold conditions are not uncommon, there is significant associated disability (with significant societal costs), and the course of illness often leads to the development of the full-blown disorder. The potential societal benefits of developing and testing low-cost, low-risk, and nontraditional treatments are considered. The recommendations are to match treatment intensity and cost with severity level in a staged approach.

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    • "It also decreases quality of life and impairs physical functioning (Lyness et al., 2007; Rowe and Rapaport, 2006). Even at sub-syndromal levels, depressive symptoms are associated with increased risk of disability and mortality (Magruder and Calderone, 2000). A greater understanding of the biological mechanisms that link established risk factors, such as trait Neuroticism, and depressive symptoms may help inform interventions that aim to reduce the prevalence and course of depressive symptomatology across the lifespan. "
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    ABSTRACT: Mood disorders in old age increase the risk of morbidity and mortality for individuals and healthcare costs for society. Trait Neuroticism, a strong risk factor for such disorders into old age, shares common genetic variance with depression, but the more proximal biological mechanisms that mediate this connection are not well understood. Further, whether sex differences in the neural correlates of Neuroticism mirror sex differences in behavioral measures is unknown. The present research identifies sex differences in the stable neural activity associated with Neuroticism and tests whether this activity prospectively mediates Neuroticism and subsequent depressive symptoms. A total of 100 (46 female) older participants (>55years) underwent a resting-state PET scan twice, approximately two years apart, and completed measures of Neuroticism and depressive symptoms twice. Replicating at both time points, Neuroticism correlated positively with resting-state regional cerebral blood-flow activity in the hippocampus and midbrain in women and the middle temporal gyrus in men. For women, hippocampal activity mediated the association between Neuroticism at baseline and depressive symptoms at follow-up. The reverse mediational model was not significant. Neuroticism was associated with stable neural activity in regions implicated in emotional processing and regulation for women but not men. Among women, Neuroticism prospectively predicted depressive symptoms through greater activity in the right hippocampus, suggesting one neural mechanism between Neuroticism and depression for women. Identifying responsible mechanisms for the association between Neuroticism and psychiatric disorders may help guide research on pharmacological interventions for such disorders across the lifespan.
    Journal of Affective Disorders 12/2010; 127(1-3):241-7. DOI:10.1016/j.jad.2010.06.004 · 3.38 Impact Factor
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    • "Here, we present the adapted web-based version of this treatment, and the results of a RCT in which we compared the effects of this treatment with those of a waiting-list. Prevalence rates of minor forms of panic disorder are known to be high and individuals with minor forms of panic disorder suffer a similar impact on their quality of life and functioning as those with full-blown panic disorder (Batelaan, De Graaf, Van Balkom, Vollebergh, & Beekman, 2007; Kessler et al., 2006; Magruder & Calderone, 2000; W. H. O. World Mental Health Survey Consortium, 2004). Therefore, to increase the external validity of the study, we aimed to ascertain a community sample with varying intensities of panic symptoms. "
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    ABSTRACT: Internet-delivered treatment may reduce barriers to care in those unwilling or unable to access traditional forms of treatment. To assesses the efficacy of web-based therapist-assisted cognitive behavioral treatment (web-CBT) of panic symptoms. A randomized waiting-list controlled trial with an uncontrolled three-year follow-up. A community sample of 58 participants with chronic panic symptoms of varying severity (immediate treatment: n=27, waiting-list control: n=31). The primary outcome measures were a one-week Panic Diary and the Panic Disorder Severity Scale - Self-Report (PDSS-SR); secondary measures were the Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ), the Mobility Inventory - Alone subscale (MI-AAL), and the Depression Anxiety Stress Scales (DASS-42). In the RCT, 54 participants (93%) completed posttest measurements. With regard to the primary outcome measures, intention-to-treat ANCOVAs revealed that participants in the treatment condition improved more than the participants in the waiting-list control condition (p<.03), with a pooled between-group effect size of d=.7. After three years (n=47; 81% study compliance), effects were more pronounced. The results demonstrate the efficacy of therapist-assisted web-CBT in the treatment of panic symptoms.
    Journal of anxiety disorders 02/2010; 24(4):387-96. DOI:10.1016/j.janxdis.2010.01.010 · 2.68 Impact Factor
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