Frederic Kass

• Medical Doctor at Columbia University

One hundred homeless schizophrenic men and 100 never homeless schizophrenic men were compared in terms of symptom ratings on the Positive and Negative Syndrome Scale (PANSS), which yields a positive, negative, and general psychopathology scale score, as well as evaluated on a number of other variables. The homeless group obtained significantly high...

A national field trial of the criteria for self-defeating personality disorder was conducted in 1986. Among psychiatrists with a special interest in personality disorders there was a lack of consensus as to the need for the category in DSM-III-R. Although the diagnosis was more commonly made for female patients, the disorder was by no means rare in...

One of the major controversies during the development of DSM-III-R was the possible inclusion of self-defeating personality disorder. The authors review the clinical literature that serves as the conceptual basis for this diagnosis. The development of the diagnostic criteria is described, including the rationale for specific criteria and the object...

Recently there has been considerable debate with regard to the addition of masochistic (self-defeating) personality disorder to DSM-III. Proponents of the diagnosis have stated that masochistic personality is a common disorder, particularly in outpatient practice, with important prognostic and treatment considerations (Asch, 1985; Gunderson, 1983;...

The authors collected therapists' ratings of 10 masochistic personality traits in 59 patients who were in psychotherapy. The traits were found to be common and to have good internal consistency. These data were presented to the Advisory Committee on Personality Disorders of the Work Group to Revise DSM-III to facilitate discussion of the possible i...

The authors describe the use of a 4-point rating scale for DSM-III axis II categories in a hospital-based outpatient clinic. Fifty-one percent of the sample met the criteria for one or more DSM-III personality disorders. This increased to 88% when the sample also included patients rated as having "some traits" or "almost meets DSM-III criteria." Fr...

Various cost-efficient and space-efficient methods were used to expand outpatient services to the elderly at a teaching hospital's psychiatry clinic over a 2-year period. During this time the active treatment census of elderly patients more than doubled, to 185 patients. Only one enrolled patient required psychiatric hospitalization, and none requi...

The authors describe the use of diagnostic supervision to identify common errors made by trainees in the application of DSM-III to multiaxial evaluations in an outpatient clinic. Errors on all five axes were due primarily to misapplications of diagnostic criteria and conventions. Errors on axes I, IV, and V were most frequent. Axis I errors were co...

In Reply.— Dr Derogatis called the SCL-90¹ an "early prototype" and a "primitive version" of the SCL-90-R,² the final version of the scale. In fact, the scales are similar; only several minor modifications were made in the SCL-90. Eighty-seven of the 90 items are identical; SCL-90 item 3 was reworded and items 80 and 86 were changed. The SCL-90 ask...

Responds to M. Kaplan's assertion that society encourages women to behave histrionically and dependently and then through the use of sex-biased diagnostic criteria, such as the DSM-III, labels these same women as mentally ill. To test Kaplan's hypothesis, the sex ratios of all of the DSM-III Axis II personality disorders were determined in 2 sample...

This study examines the symptom checklist 90 (SCL-90), a patient self-report rating scale, as a screening and baseline psychopathology measure in an outpatient clinic. A low correlation (r = .17) was found between the SCL-90 and the SCL analogue, a matched psychopathology instrument rated by clinicians. The most common causes of discordance in rati...

This study examines the symptom checklist 90 (SCL-90), a patient self-report rating scale, as a screening and baseline psychopathology measure in an outpatient clinic. A low correlation (r=.17) was found between the SCL-90 and the SCL analogue, a matched psychopathology instrument rated by clinicians. The most common causes of discordance in rating...

The authors conducted quality review of outpatient psychopharmacological practice in 180 cases with the screening criteria of the APA Task Force on Psychopharmacological Criteria Development and a subset of 12 criteria involving higher-risk practices. Excessive duration of drug treatment was the most common questionable practice, and no relationshi...

Psychiatric diagnoses based on data collected during routine clinical intake evaluations done by trainees are often later used in research studies and in program evaluation. It is commonly assumed that the supervisory process can effectively overcome errors that trainees make in diagnosis. We designed a study to assess the adequacy of patient-in-ab...

The authors explain how they empirically derived a brief patient asset scale and present data on its reliability. They believe the scale is a first step in systematic investigation of the relation between patient assets and treatment variables.

As part of their clinical experience in hospital outpatient clinics, residents and medical students are often required to evaluate new psychiatric patients for eventual treatment or referral. This is a difficult assignment. The present study attempts both to improve our understanding of the factors which are most troublesome for trainees, and to al...

The major goals of the present study were to identify and quantify the mistakes made most frequently by trainees and practitioners early in their group therapy experience and to use this information as a guide for determining priorities in the training and supervision of group psychotherapists.

In this study 32 randomly selected psychiatric emergency room patients, who were in concurrent psychotherapy, completed the SCL-90 and a clinically oriented questionnaire. Their therapists independently rated the patients' degree of psychopathology on the nine SCL-90 symptom scales. Therapists were highly efficient in recognizing depression (94% of...

The authors raise the question of whether the directly supervised initial evaluation of outpatients by psychiatric residents influences the quality of patient care. The charts of 78 patients with direct supervision and 78 patients with traditional supervision were randomly selected for review four months after the initial interview. More than twice...

A surprisingly large number of visits to a crisis intervention service are made by patients engaged in ongoing psychotherapy elsewhere. Data are presented from patients and their therapists that support the concept of a psychotherapy crisis as a major precipient of such visits. A typology for the therapy crisis is elaborated, and guidelines for the...

The authors found that more than one-third of emergency room patients were participating in concurrent psychiatric treatment. Exploration of the relationship between patient and therapist proved to be a valuable tool in formulating consultation and in ensuring continuity of care.

Of 167 patients appearing in the psychiatric emergency room of a metropolitan hospital, 68 were categorized as significantly depressed by the Zung depression scale but only 43 were considered depressed by clinician-interviewers. The use of a patient self-rating scale, which in this setting permitted the identification of deficiencies in the recogni...