Diagnostic co-morbidity in 2300 psychiatric out-patients presenting for treatment evaluated with a semi-structured diagnostic interview

Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA.
Psychological Medicine (Impact Factor: 5.94). 03/2008; 38(2):199-210. DOI: 10.1017/S0033291707001717
Source: PubMed


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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    • "First, it needs to be asked whether children of parents with various mental disorders should be regarded and studied as a homogenous or heterogeneous group. Since mental disorders seldom exist on their own but are frequently accompanied by other diagnoses (comorbidity) (Kessler et al. 2005; Zimmerman et al. 2008), we also need to question whether multifinality should merely be regarded as a consequence of parental comorbid diagnoses. The second question is whether it is appropriate to offer similar preventive interventions to children whose parents have a mental illness regardless of the parental diagnosis, as is the case in some countries (e.g., Australia, the Netherlands) (Reupert and Maybery 2009; Van Doesum and Hosman 2009). "
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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. "
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