Diagnostic co-morbidity in 2300 psychiatric out-patients presenting for treatment evaluated with a semi-structured diagnostic interview
ABSTRACT The largest clinical epidemiological surveys of psychiatric disorders have been based on unstructured clinical evaluations. However, several recent studies have questioned the accuracy and thoroughness of clinical diagnostic interviews; consequently, clinical epidemiological studies, like community-based studies, should be based on standardized evaluations. The Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project is the largest clinical epidemiological study using semi-structured interviews assessing a wide range of psychiatric disorders conducted in a general clinical out-patient practice. In the present report we examined the frequency of DSM-IV Axis I diagnostic co-morbidity in psychiatric out-patients.
A total of 2300 out-patients were interviewed with the Structured Clinical Interview for DSM-IV (SCID) upon presentation for treatment.
The mean number of current and lifetime DSM-IV Axis I disorders in the 2300 patients was 1.9 (s.d.=1.5) and 3.0 (s.d.=1.8) respectively. The majority of patients were diagnosed with two or more current disorders, and more than one-third were diagnosed with three or more current disorders. Examination of the most frequent current disorders in the patients with the 12 most common principal diagnoses indicated that the pattern of co-morbidity differed among the disorders. The highest mean number of current co-morbid disorders was found for patients with a principal diagnosis of post-traumatic stress disorder and bipolar disorder.
Clinicians should assume that psychiatric patients presenting for treatment have more than one current diagnosis. The pattern of co-morbidity varies according to the principal diagnosis.
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- "Kappa coefficients for the disorders of PTSD (k = 0.87) and major depressive disorder (MDD; k = 0.90) were high. Please see Zimmerman et al. (2008) for a full explanation of data collection. "
ABSTRACT: Subthreshold posttraumatic stress disorder (PTSD), whether due to absence of symptom development or partial remission, is the subject of research and clinical work despite being absent from the DSM. A problem with the literature is that subthreshold definitions are inconsistent across studies and therefore aggregating results is difficult. This study compared the diagnostic hit rates and validity of commonly used definitions of Subthreshold PTSD in a single sample. Three definitions of Subthreshold PTSD were extracted from the literature and two were formed, including a model of DSM-5 PTSD-criterion sets, and a definition that requires six or more PTSD symptoms, but no particular criterion set. Participants (N = 654) with a criterion A stressor, but without full PTSD diagnosis, were included. Most individuals did not meet any definition of Subthreshold PTSD. Findings are discussed in light of previous research and need for increased understanding of the diagnostic implications of Subthreshold PTSD.The Journal of nervous and mental disease 07/2015; 203(8). DOI:10.1097/NMD.0000000000000332 · 1.69 Impact Factor
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- "The rate is more comparable to the rate of 8.6% current PTSD in a representative primary care study (Kroenke et al., 2007). When more leniently rating PTSD symptoms as positive when present once a week or less (Foa et al., 1997, 1993), the prevalence was 16.5% and became even somewhat higher than the rate of 12.8 current PTSD found in a large study in unselected psychiatric outpatient samples (Zimmerman et al., 2008). Direct comparisons of study results, however, are hampered by differences in sampling, point versus period prevalence estimates, measurements used, and operationalization of PTSD. "
ABSTRACT: The present study aims to assess comorbidity of posttraumatic stress disorder (PTSD) in anxiety and depressive disorders and to determine whether childhood trauma types and other putative independent risk factors for comorbid PTSD are unique to PTSD or shared with anxiety and depressive disorders. The sample of 2402 adults aged 18–65 included healthy controls, persons with a prior history of affective disorders, and persons with a current affective disorder. These individuals were assessed at baseline (T0) and 2 (T2) and 4 years (T4) later. At each wave, DSM-IV-TR based anxiety and depressive disorder, neuroticism, extraversion, and symptom severity were assessed. Childhood trauma was measured at T0 with an interview and at T4 with a questionnaire, and PTSD was measured with a standardized interview at T4. Prevalence of 5-year recency PTSD among anxiety and depressive disorders was 9.2%, and comorbidity, in particular with major depression, was high (84.4%). Comorbidity was associated with female gender, all types of childhood trauma, neuroticism, (low) extraversion, and symptom severity. Multivariable significant risk factors (i.e., female gender and child sexual and physical abuse) were shared among anxiety and depressive disorders. Our results support a shared vulnerability model for comorbidity of anxiety and depressive disorders with PTSD. Routine assessment of PTSD in patients with anxiety and depressive disorders seems warranted.Child abuse & neglect 08/2014; 38(8). DOI:10.1016/j.chiabu.2014.01.017 · 2.34 Impact Factor
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- "The Family History Research Diagnostic Criteria (FH-RDC; Andreasen et al., 1977) interview was used to assess family history of psychiatric disorders among first degree relatives. The inter-rater reliability of the diagnoses in the MIDAS study is adequate (Zimmerman and Mattia, 1999; Zimmerman et al., 2005) with a previously reported Kappa coefficient, κ = 0.91 for PTSD and κ = 0.64 for AUD (Zimmerman et al., 2008). The Rhode Island Hospital institutional review board approved the research protocol and after complete description of the study written informed consent was obtained from each participant. "
ABSTRACT: This study compared outpatients (n = 196) with PTSD versus PTSD + alcohol use disorders (AUD) on clinical measures. PTSD + AUD patients were more likely to meet criteria for Borderline and Antisocial Personality Disorders. Emotion dysregulation may help account for the relationship between PTSD and AUD.Psychiatry Research 11/2009; 170(2-3-170):278-281. DOI:10.1016/j.psychres.2008.10.015 · 2.47 Impact Factor