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The Structured Clinical interview for DSM-III-R: 1. History, rationale and description
... On the other hand, to increase the validity and reliability of psychiatric diagnoses, different diagnostic interviews have been designed to assess psychiatric disorders in a systematic and standardised manner in accordance with main diagnostic criteria (such as those outline by the DSM and ICD) in order to eliminate biases. These interviews include the Schedule For Affective Disorders And Schizophrenia (SADS) (Endicott and Spitzer, 1978), the Structured Clinical Interview for DSM (SCID) (Spitzer et al., 1992) and the Composite International Diagnostic Interview (CIDI) (WHO, 1990). Their use reduces variability and improves diagnosis agreement and also helps to identify several clinical aspects that, in the past, tended to go unnoticed after the principal diagnosis had been made. ...
... It is designed to identify psychiatric disturbances in the domains of mood disorders, anxiety disorders and psychotic disorders that may need further assessment. The questions are based on gateway questions and threshold criteria found in the DSM-IV, the Structured Clinical Interview for Diagnosis (Spitzer et al., 1992) ...
... The Structured Clinical Interview for DSM-IV disorders (SCID) has undergone a number of changes since its initial conceptualisation in 1983. There are now two distinct clinical interviews, one for the assessment of Axis-I disorders, SCID-I (Spitzer et al., 1992), and one for Axis-II disorders, SCID-II (First, 1997). Both require a trained mental health professional rater for their use. ...
... Finally, diagnostic interviews exist, which ask about a range of symptoms and use algorithms to generate operationally defined diagnoses based on the main diagnostic systems in psychiatry. These are the 'gold standard' and include the Schedule for Affective Disorders and Schizophrenia (SADS), 18 the Structured Clinical Interview for DSM (SCID), 19 the Revised Clinical Interview Schedule, 20 and Present State Examination. 21 They have the dis-advantage of being time-consuming, and therefore expensive to use, as well as cumbersome for some patients with advanced disease. ...
... This study produced another clinically important finding ± that the symptoms which doctors rated as most difficult to manage were also the most frequently overlooked. Weitzner et al. 63 44 hospice outpatients Self-report measure for depressive symptoms (CES-D) 6 Weitzner et al. 63 44 patients with cancer receiving outpatient hospice services SCID interview 19 with DSM-IV criteria SCID (using high-threshold criteria for the somatic items) ...
Objective: To identify all literature regarding depression in patients with advanced cancer and among mixed hospice populations, and to summarise the prevalence of depression according to different definitions.
Methods: A systematic review was performed using extensive electronic and hand searches. All studies with quantitative data on prevalence of depression were included and categorised according to their definition of depression.
Results: We identified 46 eligible studies giving information on the prevalence of depression, and a further four which gave information on case finding. The most widely used assessment of depression was the Hospital Anxiety and Depression Scale (HADS), which gave a median prevalence of ‘definite depression’ (i.e., a score on the depression subscale of 10 of 29%, (interquartile range, IQR, 19.50 34.25%). Studies that used psychiatric interviews indicated a prevalence of major depressive disorder ranging from 5% to 26%, with a median of 15%. Studies were generally small (median sample size 88.5, IQR 50 108), had high numbers of nonresponders, and rarely gave confidence intervals for estimates of prevalence.
Conclusions: Depression is a common problem in palliative care settings. The quality of much of the available research is poor, based on small samples of patients with very high nonparticipation rates. The clinical importance of depression is described in subsequent papers.
... We ask consenting participants to provide information about their socio-demographic background and assess their eligibility in more detail using semi-structured clinical interviews and self-completed questionnaires. The researchers assess current and past diagnostic status using the Structured Clinical Interview for DSM IV (SCID [16]), the Suicide Attempt Self Injury Interview (SASII [17]) and the Hamilton Rating Scale for Depression (HRSD [18]). They ask participants to complete a crisis card, and to describe past and current treatments for depression and past meditation and yoga experience. ...
... The primary outcome measure will be the time to relapse or recurrence meeting DSM-IV criteria for a major depressive episode (American Psychiatric Association, 1994) on the Structured Clinical Interview for DSM-IV (SCID, Spitzer et al., 1992). Occurrence of relapse or recurrence will be assessed after treatment (T1), and at three (T2), six (T3), nine (T4) and twelve (T5) months thereafter by trained psychologists blind to participants' treatment condition. ...
Depression is often a chronic relapsing condition, with relapse rates of 50-80% in those who have been depressed before. This is particularly problematic for those who become suicidal when depressed since habitual recurrence of suicidal thoughts increases likelihood of further acute suicidal episodes. Therefore the question how to prevent relapse is of particular urgency in this group.
This trial compares Mindfulness-Based Cognitive Therapy (MBCT), a novel form of treatment combining mindfulness meditation and cognitive therapy for depression, with both Cognitive Psycho-Education (CPE), an equally plausible cognitive treatment but without meditation, and treatment as usual (TAU). It will test whether MBCT reduces the risk of relapse in recurrently depressed patients and the incidence of suicidal symptoms in those with a history of suicidality who do relapse. It recruits participants, screens them by telephone for main inclusion and exclusion criteria and, if they are eligible, invites them to a pre-treatment session to assess eligibility in more detail. This trial allocates eligible participants at random between MBCT and TAU, CPE and TAU, and TAU alone in a ratio of 2:2:1, stratified by presence of suicidal ideation or behaviour and current anti-depressant use. We aim to recruit sufficient participants to allow for retention of 300 following attrition. We deliver both active treatments in groups meeting for two hours every week for eight weeks. We shall estimate effects on rates of relapse and suicidal symptoms over 12 months following treatment and assess clinical status immediately after treatment, and three, six, nine and twelve months thereafter.
This will be the first trial of MBCT to investigate whether MCBT is effective in preventing relapse to depression when compared with a control psychological treatment of equal plausibility; and to explore the use of MBCT for the most severe recurrent depression--that in people who become suicidal when depressed.
... Axis I Disorders (SCID): 13 This is a semistructured interview for making major DSM-IV-TR axis I diagnosis. The SCID-P version was used in this study and only the module on schizophrenia was used. ...
Evidence-based rehabilitative treatment is constrained due to limited knowledge about disability and its related factors among individuals with schizophrenia across West Africa. This study aims to investigate the pattern of disability, and the associated factors among individuals with schizophrenia. One hundred consecutively recruited consenting participants were subjected to designed questionnaire to inquire about their demographic and illness-related variables. This was followed by the administration of Structured Clinical Interview for DSM-IV-TR Axis I Disorders and Brief Psychiatric Rating Scale to confirm the diagnosis of schizophrenia and rate severity of symptoms respectively in them. In addition, the World Health Organisation Disability Assessment Scale II (WHODAS-II) was used to assess for disability in all participants. Different degrees of disability based on WHODAS-II mean score of 27.02±3.49 were noted among individuals with schizophrenia, and affectation of domains of disability like self care, getting along with others, life activities and participation in the society among others were observed. In addition, high level of disability was significantly associated with younger adults in the age group 18-44 years (P=0.007), unemployment status (P=0.003), remittance source of income (P=0.034) and ethnicity (P=0.017); conversely, less number of children (P=0.033), less amount spent on treatment (P<0.001) and lower BPRS score (P < 0.001) correlated negatively with high level of disability. In spite of clinical stability following treatment, individuals with schizophrenia were disabled to varied degrees, and socioeconomic as well as illness-related factors constituted important correlates. Integration of rehabilitation along with social intervention into treatment design to reduce disability is implied, and further research is also warranted.
... Axis I Disorders (SCID): 13 This is a semistructured interview for making major DSM-IV-TR axis I diagnosis. The SCID-P version was used in this study and only the module on schizophrenia was used. ...
Evidence-based rehabilitative treatment is constrained due to limited knowledge about disability and its related factors among individuals with schizophrenia across West Africa. This study aims to investigate the pattern of disability, and the associated factors among individuals with schizophrenia. One hundred consecutively recruited consenting participants were subjected to designed questionnaire to inquire about their demographic and illness-related variables. This was followed by the administration of Structured Clinical Interview for DSM-IV-TR Axis I Disorders and Brief Psychiatric Rating Scale to confirm the diagnosis of schizophrenia and rate severity of symptoms respectively in them. In addition, the World Health Organisation Disability Assessment Scale II (WHODAS-II) was used to assess for disability in all participants. Different degrees of disability based on WHODAS- II mean score of 27.02±3.49 were noted among individuals with schizophrenia, and affectation of domains of disability like self care, getting along with others, life activities and participation in the society among others were observed. In addition, high level of disability was significantly associated with younger adults in the age group 18-44 years (P=0.007), unemployment status (P=0.003), remittance source of income (P=0.034) and ethnicity (P=0.017); conversely, less number of children (P=0.033), less amount spent on treatment (P<0.001) and lower BPRS score (P<0.001) correlated negatively with high level of disability. In spite of clinical stability following treatment, individuals with schizophrenia were disabled to varied degrees, and socioeconomic as well as illness-related factors constituted important correlates. Integration of rehabilitation along with social intervention into treatment design to reduce disability is implied, and further research is also warranted.
... A senior clinical psychologist (T.R.), who was blinded to the PHQ results, interviewed all patients face-to-face within 48 hours after they completed the questionnaire, using the specific modules from the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (SCID) (32) and diagnostic questions from the original Primary Care Evaluation of Mental Disorders as described elsewhere (33). ...
Background:
Depression has been associated with higher rates of mortality in medical patients. The aim of the study was to evaluate the impact of depression in medical inpatients on the rate of mortality during a prolonged follow-up period.
Method:
This is a prospective follow-up study of a cohort of medical inpatients assessed during 1997-1998 in medical and surgical units at a tertiary university hospital in Spain and followed-up for a period ranging between 16.5 and 18 years. Eight hundred three patients were included; 420 (52.3%) were male, and the mean (SD) age was 41.7 (13.8) years. Main outcome was death for any cause during follow-up. The original full Patient Health Questionnaire (PHQ) was administered at baseline as self-report from which the PHQ-9 was derived. Depressive disorders were assessed using PHQ-9 and a structured clinical interview (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition).
Results:
Depressive disorders as defined by PHQ-9 were detected in 206 patients (25.7%), 122 (15.2%) of them fulfilling criteria for major depression. During follow-up, 152 patients (18.9%) died. A PHQ score indicating the presence of major depressive disorder predicted increased mortality (hazard ratio [HR], 2.44; 95% CI, 1.39-4.29), even after adjusting for important demographic and clinical variables. Similarly, the PHQ-9 score as a continuous measure of depression severity predicted increased mortality (HR, 1.06; 95% CI, 1.02-1.10). Results were similar for clinical interview diagnoses of major depression (HR, 2.07; 95% CI, 1.04-4.09).
Conclusions:
Medical inpatients with a PHQ depressive disorder had a nearly 2-fold higher risk of long-term mortality, even after adjustment for several confounders. Depression severity as represented by the PHQ-9 score was also a risk factor.
... And cerebrovascular disease defined stroke, cardiac disease as angina, myocardial infarction, heart failure, arrhythmia and respiratory disease defined it as pneumonia, COPD, pulmonary emphysema, tuberculosis, lung cancer (Table 1). A diagnosis of dementia was made according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-revised (DSM-III-R) [10]. ...
Hip fractures are frequent in elderly people, and subsequent Activities of Daily Living (ADL) depend on whether practical walking ability is achieved postoperatively. The aim of this study was to examine the factors affecting postoperative walking ability following a hip fracture. A retrospective study of 95 patients (85 females, 10 males, mean age 77.4 ± 10.8 years) was conducted. All patients were operated in our hospital between 2007 and 2014. Information about age, sex, type of fracture, complications, surgical method, preoperative walking ability, preoperative ADL, dementia, osteoporosis treatment, and preoperative wait (days) was obtained from the patients’ clinical records, and factors affecting postoperative walking ability were examined. On logistic regression analysis, age, bone and joint disease, and dementia were significant factors for failure to walk after hip fracture surgery.
... To allow for a DSM-IV (60) diagnosis to be ascertained or ruled out, all participants (including controls and unaffected family members) underwent a structured clinical interview with either the Schedule for Affective Disorders and Schizophrenia or the Structured Clinical Interview for DSM Disorders, or the Schedules for Clinical Assessment in Neuropsychiatry (61)(62)(63). Of the cases passing quality control, 784 met criteria for schizophrenia, 113 for bipolar disorder with a history of psychotic symptoms, 110 for psychotic disorder not otherwise specified, 97 for schizophreniform disorder, 64 for schizoaffective disorder, 44 for brief psychotic disorder, 20 for delusional disorder, and 7 for substance-induced psychosis. ...
Background:
Genome-wide association studies (GWAS) have identified several loci associated with schizophrenia and/or bipolar disorder. We performed a GWAS of psychosis as a broad syndrome rather than within specific diagnostic categories.
Methods:
1239 cases with schizophrenia, schizoaffective disorder, or psychotic bipolar disorder; 857 of their unaffected relatives, and 2739 healthy controls were genotyped with the Affymetrix 6.0 single nucleotide polymorphism (SNP) array. Analyses of 695,193 SNPs were conducted using UNPHASED, which combines information across families and unrelated individuals. We attempted to replicate signals found in 23 genomic regions using existing data on nonoverlapping samples from the Psychiatric GWAS Consortium and Schizophrenia-GENE-plus cohorts (10,352 schizophrenia patients and 24,474 controls).
Results:
No individual SNP showed compelling evidence for association with psychosis in our data. However, we observed a trend for association with same risk alleles at loci previously associated with schizophrenia (one-sided p = .003). A polygenic score analysis found that the Psychiatric GWAS Consortium's panel of SNPs associated with schizophrenia significantly predicted disease status in our sample (p = 5 × 10(-14)) and explained approximately 2% of the phenotypic variance.
Conclusions:
Although narrowly defined phenotypes have their advantages, we believe new loci may also be discovered through meta-analysis across broad phenotypes. The novel statistical methodology we introduced to model effect size heterogeneity between studies should help future GWAS that combine association evidence from related phenotypes. Applying these approaches, we highlight three loci that warrant further investigation. We found that SNPs conveying risk for schizophrenia are also predictive of disease status in our data.
... These tasks are often presented as a hand-administered or computerized card task, with each card representing different time delays and reward amounts (e.g., Petry, 2001). Using a delay discounting task, Petry (2001) found that alcohol dependent individuals (i.e., individuals meeting criteria for substance dependence on the Structured Clinical Interview for DSM; Spitzer, Williams, Gibbon, & First, 1992) were more likely to accept lesser immediate rewards over greater delayed rewards. This was true regardless of what type of reward, money or alcohol, was present. ...
... Lifetime and past-year major depression were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, 16 a semistructured assessment with high interrater reliability. 20 Each member of a twin pair was interviewed by different interviewers who were blinded to the depression status of the co-twin. 16 A 4-level variable was created to index each individual's aggregate genetic liability for major depression as reflected by their co-twin status: The variable was coded -1 for MZ twins whose co-twin had no history of depression; coded -0.5 for DZ twins whose co-twin had no history of depression; coded +0.5 for DZ twins whose co-twin had positive history of depression; and coded +1.0 for MZ twins whose co-twin had positive history of depression. ...
Objectives:
We tested 3 hypotheses-social causation, social drift, and common cause-regarding the origin of socioeconomic disparities in major depression and determined whether the relationship between socioeconomic status (SES) and major depression varied by genetic liability for major depression.
Methods:
Data were from a sample of female twins in the baseline Virginia Adult Twin Study of Psychiatric and Substance Use Disorders interviewed between 1987 and 1989 (n = 2153). We used logistic regression and structural equation twin models to evaluate these 3 hypotheses.
Results:
Consistent with the social causation hypothesis, education (odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.66, 0.93; P < .01) and income (OR = 0.93; 95% CI = 0.89, 0.98; P < .01) were significantly related to past-year major depression. Upward social mobility was associated with lower risk of depression. There was no evidence that childhood SES was related to development of major depression (OR = 0.98; 95% CI = 0.89, 1.09; P > .1). Consistent with a common genetic cause, there was a negative correlation between the genetic components of major depression and education (r(2) = -0.22). Co-twin control analyses indicated a protective effect of education and income on major depression even after accounting for genetic liability.
Conclusions:
This study utilized a genetically informed design to address how social position relates to major depression. Results generally supported the social causation model.
... Similar results emerged when the analyses were repeated separately for men and women. 22 In addition to the GHQ-30, the general population survey included a semistructured mental state interview, the Structured Clinical Interview for DSM IIIR (SCID), 23 to assess affective disorders (major depression, dysthymia, panic disorder, agoraphobia and generalised anxiety disorder) during the previous six months. For those reporting any disorder, help seeking was ascertained. ...
Mental health has long been a feature of the broader debates about ethnicity and health. It is an area where there has been considerable activity, although this has not always been for the benefit of minority ethnic populations. This chapter outlines the extent of mental health problems amongst people of South Asian origin living in the UK, possible determinants of their psychiatric morbidity and an overview of how the mental healthcare needs of this community are being addressed within current provisions of the NHS. In doing so, the chapter applies many of the ideas presented in Chapter 2 and identifies a number of key theo- retical and empirical issues which, it is argued, are relevant when considering the mental health needs of people of South Asian origin living in the UK, especially within primary care.
... Sensitivity and specificity of the PHQ-2 for screening of moderate-severe psychological distress found in the current study falls within a range of those previously reported in different populations of patients. For example, the initial PHQ-2 validation study in 580 primary care and obstetricsgynecology patients reported higher sensitivity (83%) and higher specificity (92%) of the traditional PHQ-2 scale at a cut-off value of ≥3 for identification of major depression established by psychological health professionals using the structured clinical interview for DSM (SCID) [30] and diagnostic questions from the PRIME-MD [29]. Another study in 690 outpatients with documented coronary artery disease reported sensitivity of 90% and specificity of 69% of the simplified version of the PHQ-2 scale (dichotomous yes/no answers) for screening of major depression according to the National Institute of Mental Health Diagnostic Interview Schedule [20,32]. ...
Objective:
Psychological distress is highly prevalent but often undiagnosed in brain tumor patients. We evaluated the psychometric properties of the Patient Health Questionnaire-2 (PHQ-2) for screening of distressed neurosurgical brain tumor patients.
Methods:
A total of 226 (69% women; mean age 55.6 ± 14.7 years) consecutive patients on admission for elective brain tumor surgery were evaluated for psychological distress using the PHQ-2, the Hospital Anxiety and Depression Scale (HADS; n = 206), and the Beck Depression Inventory-II (BDI-II; n = 196). At discharge, the patients were reevaluated using the PHQ-2 and HADS.
Results:
On admission, 43% and 18% of patients had moderate-severe psychological distress according to the HADS (HADS depression or anxiety score ≥ 11) and BDI-II (score ≥ 20), respectively. At discharge, there was a significant decrease in psychological distress among patients according to the PHQ-2 (p = 0.04) and HADS (p < 0.001) screening results. The PHQ-2 had marginal internal consistency (Cronbach's coefficient alpha = 0.68) and suboptimal test-retest reliability (intraclass correlation coefficient = 0.51). The PHQ-2 had acceptable psychometric properties for identifying patients with moderate-severe psychological distress according to the HADS (sensitivity = 74%, specificity = 68%, and positive predictive value (PPV) = 40%) and BDI-II (sensitivity = 71%, specificity = 65%, and PPV = 30%). Psychometric properties of the PHQ-2 were inferior for mild-severe psychological distress. Greater number of PHQ-2 depressive symptoms was associated with greater scores on the HADS and BDI-II (all ps < 0.001).
Conclusions:
Psychological distress is prevalent in brain tumor patients and can be successfully identified using the PHQ-2. The PHQ-2 has moderate internal consistency. The PHQ-2 should be considered for routine use in brain tumor patients for psychological distress screening purposes.
... 58 The SCID is a semi-structured clinical interview tool that uses diagnostic criteria from the DSM-IV along with a categorical system for rating the frequency and severity of symptoms and a scoring algorithm to determine the absence or presence (either full or subthreshold) of an Axis I diagnosis such as PTSD. 59 The PSS-I is a 17-item, semi-structured interview that assesses the presence, frequency, and severity of PTSD symptoms related to a single identified traumatic event. Foa and Tolin 60 have used all 3 of these assessment tools to demonstrate that the PSS-I and CAPS have comparable internal consistency coefficients (Cronbach α = 0.65-0.86 for the PSS-I and 0.71-0.85 ...
Objective:
Our study examines the association between suicidal ideation and and self-reported symptoms of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and alcohol use disorder (AUD) in a sample of treatment-seeking Canadian combat and peacekeeping veterans; and identifies potential predictors of suicidal ideation.
Methods:
Actively serving Canadian Forces and Royal Canadian Mounted Police members and veterans seeking treatment at the Parkwood Hospital Operational Stress Injury Clinic (n = 250) completed measures including the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, the Alcohol Use Disorder Identification Test, and the PTSD Checklist-Military Version (PCL-M) between January 2002 and December 2010. Regression analyses were used to determine the respective impact of PTSD, and self-reported symptoms of MDD, GAD, AUD, and anxiety on suicidal ideation.
Results:
Most people met PCL-M screening criteria for PTSD (73.6%, n = 184), while 70.8% (n = 177) screened positively for a probable major depressive episode. PTSD symptom was significantly associated with suicidal ideation (β = 0.412, P < 0.001). After controlling for self-reported depressive symptom severity, AUD severity, and generalized anxiety, PTSD severity was no longer significantly associated with suicidal ideation (β = 0.043, P = 0.58).
Conclusions:
Although PTSD alone is associated with suicidal ideation, after controlling for common comorbid psychiatric illnesses, self-reported depressive symptom severity emerged as the most significant predictor of suicidal ideation. These findings support the importance of screening for comorbidities, particularly an MDD, as potentially modifiable conditions that are strongly related to suicidal ideation in military personnel's endorsing criteria for PTSD.
... Several studies have used structured psychiatric interviews to assess depression according to diagnostic criteria, primarily as defined in DSM-III [12] or DSM-IV [13], while others have measured depressive symptoms using rating scales such as the Center for Epidemiological Studies Depression Scale (CES-D) [14], the Hospital Anxiety and Depression Scale (HADS) [15], or the Beck Depression Inventory (BDI), [16,17]. These instruments generally compare well [18,19] and seem suitable for assessing depression in cancer patients [19,20]. ...
Background Elevated levels of depressive symptoms are generally found among cancer patients, but results from existing studies vary
considerably with respect to prevalence and proposed risk factors. Purpose To study the prevalence of depressive symptoms and major depression 3–4months following surgery for breast cancer, and to
identify clinical risk factors while adjusting for pre-cancer sociodemographic factors, comorbidity, and psychiatric history.
Patients and methods The study cohort consists of 4917 Danish women, aged 18–70years, receiving standardized treatment for early stage invasive
breast cancer during the 2 1/2year study period. Of these, 3343 women (68%) participated in a questionnaire study 12–16weeks
following surgery. Depressive symptoms (Beck’s Depression Inventory II) and health-related behaviors were assessed by questionnaire.
The Danish Breast Cancer Cooperative Group (DBCG) and the surgical departments provided disease-, treatment-, and comorbidity
data for the study cohort. Information concerning sociodemographics and psychiatric history were obtained from national longitudinal
registries. Results The results indicated an increased prevalence of depressive symptoms and major depression (13.7%) compared to population-based
samples. The pre-cancer variables: Social status, net-wealth, ethnicity, comorbidity, psychiatric history, and age were all
independent risk factors for depressive symptoms. Of the clinical variables, only nodal status carried additional prognostic
information. Physical functioning, smoking, alcohol use, and BMI were also independently associated with depressive symptoms. Conclusion Risk factors for depressive symptoms were primarily restricted to pre-cancer conditions rather than disease-specific conditions.
Special attention should be given to socio-economically deprived women with a history of somatic- and psychiatric disease
and poor health behaviors.
... Characteristics of this patient group have been presented in previous reports (Krystal et al. 1994(Krystal et al. , 1996. Twenty-two male patients [age : 39.3 ± 1.7 years (SEM); weight: 73.7 ± 2.3 kg] meeting DSM-III-R criteria for alcohol dependence (APA 1987), determined by the Structured Clinical Interview for DSM-III-R (SCID; Spitzer et al. 1992) participated in testing. They began drinking at a mean age of 13.7 ± 0.8 years, regular drinking at 16.2 ± 0.5 years, regular drinking to intoxication at 20.5 ± 1.6 years, and their heaviest level of drinking at 24.6 ± 1.9 years. ...
Preclinical studies suggest that acoustic startle amplitude is increased during ethanol withdrawal. The current study evaluated
the effects of intravenous infusion of the α2-adrenergic antagonist, yohimbine (0.4 mg/kg), the serotonin partial agonist m-chlorophenylpiperazine (mCPP, 0.1 mg/kg), and placebo administered to 22 male patients meeting DSM-III-R criteria for alcohol
dependence and 13 male healthy subjects. Patients and healthy subjects completed 3 test days under double-blind conditions
in a randomized order. Patients were sober for 12–26 days prior to testing. On each test day, participants completed startle
testing 80 min following drug infusion. Stimuli with varying intensities (90, 96, 102, 108, 114 dB) were presented in a randomized
order balanced across four blocks. Stimuli consisted of 40-ms bursts of white noise administered every 45–60 s for 15–20 min
through headphones. Analyses indicated that patients exhibited elevated acoustic startle magnitudes on the placebo day relative
to healthy subjects. In patients, the magnitude of startle amplitudes elicited at 90 dB, but not 114 dB, correlated significantly
with the number of previous alcohol detoxifications. Yohimbine increased startle magnitudes and reduced startle latencies
relative to placebo and mCPP in both patients and healthy subjects. mCPP did not alter startle magnitude in either group.
Yohimbine also increased the probability that a 90-dB stimulus produced a startle response in healthy subjects, but not in
patients. Blunting of yohimbine effects on startle probability may reflect the baseline elevations in startle probability
levels in patients, but may also be consistent with other evidence of reduced postsynaptic, but not presynaptic, noradrenergic
function in these same patients. These data replicate and extend previous reports indicating that yohimbine facilitates the
acoustic startle response in humans. They also further implicate the number of episodes of ethanol withdrawal as a factor
influencing subsequent neurobiological responsivity in chronic alcoholic patients. Based on the current data, future research
should explore whether measurement of the acoustic startle response provides an objective quantitative severity measure of
ethanol withdrawal.
... In spite of this, if we deleted specific phobias from the any anxiety disorder category, sensitivity only increased 3.6 points-from 28% Table 2 Factors associated with concordant SCID-I/GP recognition of anxiety disorders (adjusted results) OR PNz 95% CI Table 3 Factors associated with false-positive diagnosis of anxiety disorders according to SCID-I ( to 31.65%-suggesting that the inclusion of specific phobia in our analyses did not affect sensitivity. We also had to bear in mind that some of our detected cases could be epidemiological false positives because, in epidemiological research studies, diagnostic criteria tend to be applied algorithmically and omit contextual aspects [30][31][32]. Finally, we are using a psychiatric diagnosis as a gold standard to assess GPs, and this may be inappropriate, as others have pointed out [33,34]. ...
... A similar section was developed for assessing tics, Tourette disorder, and other tic disorders. The Structured Clinical Interview for DSM-IV [15] was used for assessing other major Axis I diagnoses and the Kiddie SADS was used to classify SAD. [16] A semistructured assessment protocol was used for additional diagnoses of interest in OCD (pathologic nail biting, pathological skin picking, trichotillomania, gambling, kleptomania, and pyromania). ...
A history of separation anxiety disorder (SAD) is frequently reported by patients with obsessive-compulsive disorder (OCD). The purpose of this study was to determine if there are clinical differences between OCD-affected individuals with, versus without, a history of SAD.
Using data collected during the OCD Collaborative Genetic Study, we studied 470 adult OCD participants; 80 had a history of SAD, whereas 390 did not. These two groups were compared as to onset and severity of OCD, lifetime prevalence of Axis I disorders, and number of personality disorder traits.
OCD participants with a history of SAD were significantly younger than the non-SAD group (mean, 34.2 versus 42.2 years; P<.001). They had an earlier age of onset of OCD symptoms (mean, 8.0 versus 10.5 years; P<.003) and more severe OCD, as measured by the Yale-Brown Obsessive Compulsive Scale (mean, 27.5 versus 25.0; P<.005). In addition, those with a history of SAD had a significantly greater lifetime prevalence of agoraphobia (odds ratio (OR) = 2.52, 95% confidence interval (CI) = 1.4-4.6, P<.003), panic disorder (OR = 1.84, CI = 1.03-3.3 P<.04), social phobia (OR = 1.69, CI 1.01-2.8, P<.048), after adjusting for age at interview, age at onset of OCD, and OCD severity in logistic regression models. There was a strong relationship between the number of dependent personality disorder traits and SAD (adjusted OR = 1.42, CI = 1.2-1.6, P<.001).
A history of SAD is associated with anxiety disorders and dependent personality disorder traits in individuals with OCD.
... The Structured Clinical Interview for DSM IV (SCID; Williams et al., 1992;Spitzer et al., 1992) is a semi-structured interview. It assesses all major psychiatric disorders according to DSM IV criteria and has already been validated for the Brazilian population (Del-Ben et al., 1996). ...
As a consequence of the increasing urban violence in Brazil, many cases of posttraumatic stress disorder (PTSD) are now seen in the community and clinical settings. The main aim of this article is to assess the psychometric properties of the Clinician-Administered PTSD Scale (CAPS) to study factors related to the etiology, prognosis, and efficacy of interventions of PTSD in civilian populations. PTSD outpatients from a program of victims of violence and subjects identified in an epidemiological survey conducted in the city of Sao Paulo completed a battery of validated instruments and the CAPS. Instrument reliability and validity were measured. The comparison between the CAPS scores and the Structured Clinical Interview for DSM IV (SCID) interview resulted in the following validity coefficients: sensitivity=90%, specificity=95%, and misclassification rate=7.1%. The area under the receiver operating characteristic (ROC) curve was 0.97. There was a positive correlation between CAPS scores with Beck Depression Inventory (BDI; 0.70) and Beck Anxiety Inventory (BAI; 0.76) scores. The Kappa coefficients were all higher than 0.63 for all CAPS items. The internal consistency for all CAPS items resulted in a Cronbach's alpha coefficient of 0.97. The CAPS showed to be both an accurate and a reliable research instrument to identify PTSD cases in a civilian population.
... In this sense, the SCID-I could identify as depressed people that are not disabled enough by this condition to seek treatment, but who are going to the GP for other health matters. Furthermore, we know that the SCID-I is not a perfect instrument and that its reliability is far from ideal [48,49]. Additionally, one possible explanation for the low concordance between the SCID-I and GPs diagnoses could be the fact that we are comparing 4 different classification systems. ...
The aim of this study was to (1) to explore the validity of the depression diagnosis made by the general practitioner (GP) and factors associated with it, (2) to estimate rates of treatment adequacy for depression and factors associated with it and (3) to study how rates of treatment adequacy vary when using different assessment methods and criteria.
Epidemiological survey carried out in 77 primary care centres representative of Catalonia. A total of 3815 patients were assessed.
GPs identified 69 out of the 339 individuals who were diagnosed with a major depressive episode according to the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) (sensitivity 0.22; kappa value: 0.16). The presence of emotional problems as the patients' primary complaint was associated with an increased probability of recognition. Rates of adequacy differed according to criteria: in the cases detected with the SCID-I interview, adequacy was 39.35% when using only patient self-reported data and 54.91% when taking into account data from the clinical chart. Rates of adequacy were higher when assessing adequacy among those considered depressed by the GP.
GPs adequately treat most of those whom they consider to be depressed. However, they fail to recognise depressed patients when compared to a psychiatric gold standard. Rates of treatment adequacy varied widely depending on the method used to assess them.
... Há também a possibilidade de que questões remanescentes sejam ignoradas, caso critérios essenciais para o diagnóstico não sejam preenchidos (skip-out), o que permite o descarte rápido de diagnósticos irrelevantes. 5,6 No entanto, as mesmas características que tornam a aplicação do instrumento mais acessível poderiam ser fonte de erro e diminuir a confiabilidade e a validade das avaliações diagnósticas. Uma característica essencial da SCID é que, embora as perguntas sejam estruturadas, a pontuação se refere ao julgamento clínico do entrevistador, com relação à presença ou não de determinado critério, e não à resposta dada pelo paciente. ...
OBJETIVOS: Verificar a confiabilidade da "Entrevista Clínica Estruturada para o DSM-IV - Versão Clínica (SCID-CV)" traduzida para o português. MÉTODOS: Foram submetidos, a duas entrevistas independentes (teste-reteste), 45 pacientes psiquiátricos em seguimento no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HC-FMRP/USP). Os dados foram analisados pelo Coeficiente Kappa (K). RESULTADOS: O Kappa ponderado foi excelente (Kw=0,83). A confiabilidade foi estatisticamente significante em transtorno do humor (K=0,87); transtornos psicóticos (K=0,90); transtornos relacionados ao uso de substância (K=0,76); transtornos de ansiedade (K=0,61); e nas categorias diagnósticas específicas analisadas, exceto em agorafobia sem história de transtorno do pânico (K=-0,04). CONCLUSÕES: A SCID-CV traduzida e adaptada para o português apresenta, em geral, boa confiabilidade, mas a ausência de questões e critérios diagnósticos específicos no próprio instrumento em diagnósticos, como agorafobia sem história de transtorno de pânico, diminuiu sua confiabilidade.
... Psychiatric diagnoses were assessed by means of SCID-I for clinical syndromes and SCID-II for personality disorders, which are structured clinical interviews linked to the diagnostic system DSM III-R. 22 23 At a later stage all patients in the study were reassessed according to DSM IV criteria and the correct diagnosis was confirmed in all cases. Patients scored their level of psychological, social, and occupational functioning during the past year according to the axis V on DSM IV by means of a recently validated self report version of the global assessment of functioning score. ...
Previous studies have suggested associations between conversion and many different clinical characteristics. This study investigates these findings in a prospective design including a control group.
Thirty consecutive patients with a recent onset of motor disability due to a conversion disorder were compared with a control group of patients with corresponding motor symptoms due to a definite organic lesion. Both groups had a similar duration of symptoms and a comparable age and sex profile and were assessed on a prospective basis. Background information about previous somatic and psychiatric disease was collected and all patients were assessed by means of a structured clinical interview linked to the diagnostic system DSM III-R, the Hamilton rating depression scale, and a special life events inventory.
The conversion group had a higher degree of psychopathology with 33% of the patients fulfilling the criteria for psychiatric syndromes according to DSM-III-R axis I, whereas 50% had axis II personality disorders compared with 10% and 17% respectively in the control group. Conversion patients also had significantly higher scores according to the Hamilton rating depression scale. Although patients with known neurological disease were not included in the conversion group, a concomitant somatic disorder was found in 33% of the patients and 50% complained of benign pain. The educational background in conversion patients was poor with only 13% having dropped out of high school compared with 67% in the control group. Self reported global assessment of functioning according to the axis V on DSM IV was significantly lower in conversion patients, who also registered significantly more negative life events before the onset of symptoms than controls. Logistic regression analysis showed that low education, presence of a personality disorder, and high Hamilton depression score were significantly associated with conversion disorder.
The importance of several previously reported predisposing and precipitating factors in conversion disorder is confirmed. The results support the notion that conversion should be treated as a symptom rather than a diagnosis and that efforts should be made in diagnosing and treating possible underlying somatic and psychiatric conditions.
Background::
Betel quid is the fourth most popular psychoactive agent worldwide. Neuroimaging studies have suggested betel-quid dependence is accompanied by abnormality in brain structure and function. However, the neural correlates of executive function deficit and prefrontal cortical thickness associated with betel-quid chewing still remain unclear.
Objective::
The present study aimed to examine the relationship between executive function deficit and prefrontal cortical thickness in chronic betel-quid chewers.
Methods::
Twenty-three betel-quid-dependent chewers and 26 healthy controls were recruited to participate in this study. Executive function was tested using three tasks. Cortical thickness analysis was analyzed with the FreeSurfer software package.
Results::
Behavioral results suggested a profound deficit of executive function in betel-quid-dependent chewers. Cortical thickness analysis revealed thinner cortex in the bilateral dorsolateral prefrontal cortex in betel-quid-dependent chewers. Further analysis suggested that cortical thickness of the bilateral dorsolateral prefrontal cortex mediated the correlation of betel-quid chewing and executive function.
Conclusions::
These results suggest the important role of executive function and cortical thickness of the dorsolateral prefrontal cortex with betel-quid chewing. Our findings provide evidence that executive function deficit may be mediated by the cortical thickness of the dorsolateral prefrontal cortex. These results could potentially help us develop novel ways to diagnose and prevent betel-quid dependence.
Objective:
The harmonization of core outcome domains in clinical trials facilitates comparison and pooling of data, and simplifies the preparation and review of research projects, and comparison of risks and benefits of treatments. Therefore we provide recommendations for the core outcome domains that should be considered in clinical trials on the efficacy and effectiveness of interventions for somatic symptom disorder, bodily distress disorder, and functional somatic syndromes.
Methods:
The European Network on Somatic Symptom Disorders group (EURONET-SOMA) of more than 20 experts in the field met twice in Hamburg to discuss issues of assessment and intervention research in somatic symptom disorder, bodily distress disorder, and functional somatic syndromes. The consensus meetings identified core outcome domains that should be considered in clinical trials evaluating treatments for somatic symptom disorder and associated functional somatic syndromes.
Results:
The following core domains should be considered when defining ascertainment methods in clinical trials: (1) classification of somatic symptom disorder/bodily distress disorder, associated functional somatic syndromes, and comorbid mental disorders (using structured clinical interviews), duration of symptoms, medical morbidity, and prior treatments (2) location, intensity, and interference of somatic symptoms, (3) associated psychobehavioral features and biological markers, (4) illness consequences (quality of life, disability, health care utilization, health care costs), (5) global improvement, treatment satisfaction, and (6) unwanted negative effects.
Conclusions:
The proposed criteria are intended to improve synergies of clinical trials and to facilitate decision making when comparing different treatment approaches. These recommendations should not result in inflexible guidelines, but increase consistency across investigations in this field.
Background: There is considerable debate as to whether suicide is more likely to occur early in the course of major depressive disorder or by cumulative risk, with an increasing risk with each subsequent major depressive episode (MDE). By considering the number of MDEs among representative suicides, we aimed to further investigate the relationship between suicide outcome and the course of major depressive disorder. Method: A psychological autopsy method with best informants was used to investigate 154 consecutive suicides who died in the context of a DSM-IV MDE. Proxy-based interviews were conducted by using the Structured Clinical Interview for DSM-III-R; the Structured Clinical Interview for DSM-IV Axis II; and a series of behavioral and personality-trait assessments. Second, 143 living depressed outpatients of comparable age to the suicide group were assessed for their history of MDEs. The study was conducted between 2000 and 2005. Results: The distribution of MDEs among depressed suicide completers was as follows: first MDE, 74.7%; second MDE, 18.8%; more than 2 MDEs, 6.5%. This distribution is compared to 32.9% of depressed living outpatients with a single MDE. Increased levels of hostility were associated with single MDE suicide completers. The anxious trait of harm avoidance increased among multiple MDE suicide completers. Alcohol abuse increased among first MDE suicide completers. Conclusions: Suicide in major depressive disorder is most likely to occur during the first MDE, and this appears to be related to increased levels of the impulsive-aggressive diathesis.
Diagnosing and treating psychiatric comorbidity in substance abusers has become increasingly important in the last 10 years because of important consequences from a health and social point of view. The identification of reliable and valid diagnosis of psychiatric co morbidity in substance abusers has being improved using the "Psychiatric Research Interview for Substance and Mental Disorders" for DSM-IV criteria. This instrument is a structured interview designed "ad hoc" to diagnoses nonsubstance use disorders in substance abuser population. Compared to the Longitudinal, Expert, All Data (LEAD) procedure, as a "gold standard", the Spanish version of PRISM-IV seemed to be a valid instrument for diagnosing major depression, induced psychosis, anxiety disorders, antisocial and borderline personality disorders. Also the Spanish PRISM-IV resulted in better kappa statistics than the Spanish version of SCID-IV for diagnosing major depression, and borderline personality disorders in substance abusers. Many clinical studies have revealed a high degree of co-occurrence of opioid dependence and other psychiatric disorders, ranging from 44% to 93%. Major depression, anxiety disorders, antisocial and borderline personality disorders are the most prevalent non-substance use disorders in opioid dependent subjects. Most studies are needed to determinate the evidence based treatments for comorbid psychiatric disorders in opioid dependence. In the case of comorbid major depression in opioid abusers, after a systematic review of the randomized and controlled clinical trials available, new studies to clarify the evidence based treatments are required.
Early intervention in psychosis is an accepted policy internationally. When 'A Vision for Change', the national blueprint for mental health policy in Ireland, was published in 2007 there was one Irish pilot service for early intervention in psychosis. The National Clinical Mental Health Programme Plan (2011) identified early intervention in psychosis as one of three areas for roll out nationally. There is limited economic evaluation in the field of mental health in Ireland to guide service development. This is in part due to lack of robust patient level data.
The aim of the study was to investigate whether the introduction of an early intervention service in psychosis resulted in any change to the number and duration of admissions in people with first-episode psychosis.
We examined two prospective epidemiological cohorts of individuals presenting with first-episode psychosis to an urban community mental health service (population 172,000). The historical cohort comprised of individuals presenting from 1995 to 1998 and received treatment as usual (n=132). The early intervention cohort presented to the same catchment area between 2008 and 2011 (n=97) following the introduction of an early intervention service in 2005.
We found significant reductions in the rates admitted for treatment across the two time periods. Reduction in the rate of admission was larger in this catchment than the reduction in the rate of admission in the country as a whole. There were significant reductions in the duration of untreated psychosis arising from the early intervention programme. Significant reductions in length of stay were accounted for by differences in baseline age and marital status. The average cost of admission declined from 15,821 to 9,398 in the early intervention cohort.
The comparison pre and post early intervention service showed cost savings consistent with other studies internationally. Key issues are whether changes in the admission pattern were due to the implementation of early intervention or were explained by other factors. Examination of local and national factors showed that the dominant effect was from the implementation of early intervention. Limitations are that this is a comparison with a historical cohort and analysis is limited to in-patient costs only.
While there are cost savings, these represent opportunity cost savings, as the majority of costs associated with in-patient care are fixed. Studies such as this provide evidence that it is feasible to consider disinvestment strategies such as home care in the community.
It is difficult to generalize interventions shown to work in one country to other countries, as health service structures differ and there are both local and national variations in service structure and delivery. It remains important to evaluate whether a policy is applicable within its local context.
Further research in this area is required to evaluate contemporaneous services and to examine whether increased costs in the community incurred through implementation of early intervention negate the savings made through reduction of admissions.
A test-retest reliability study of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) was conducted on 284 subjects in four psychiatric patient sites and two nonpsychiatric patient sites. For the patient sites, kappas ranged from .24 for obsessive-compulsive personality disorder to .74 for histrionic personality disorder, with an overall weighted kappa of .53. For the nonpatients, however, agreement was considerably lower, with an overall weighted kappa of .38. Mean duration of administration time was 36 minutes. Results of this study and other studies using the SCID-II suggest that the reliability and validity of the SCID-II are comparable with other instruments that diagnose Axis II disorders of the Diagnostic and Statistical Manual of Mental Disorders, but this new instrument has the advantage of a shorter time of administration.
(11)C-carbonyl-URB694 ((11)C-CURB) is a novel (11)C-labeled suicide irreversible radiotracer for PET developed as a surrogate measure of activity of the endocannabinoid metabolizing enzyme fatty acid amide hydrolase. The aim of the study was to investigate the whole-body biodistribution and estimate the radiation dosimetry from (11)C-CURB scans in humans.
Six healthy volunteers (3 men and 3 women) completed a single whole-body scan (∼120 min, 9 time frames) on a PET/CT scanner after administration of (11)C-CURB (∼350 MBq and ∼2 μg). Time-radioactivity curves were extracted in 11 manually delineated organs and corrected for injected activity, specific organ density, and volume to obtain normalized cumulated activities. OLINDA/EXM 1.1 was used to estimate standard internal dose exposure in each organ. The mean effective dose was calculated using the male and female models for the full sample and female-only sample, respectively.
(11)C-CURB was well tolerated in all subjects, with no radiotracer-related adverse event reported. The mean effective dose (±SD) was estimated to be 4.6 ± 0.3 μSv/MBq for all subjects and 5.2 ± 0.3 μSv/MBq for the female sample. Organs with the highest normalized cumulated activities (in h) were the liver (0.117), gallbladder wall (0.046), and small intestine (0.033), and organs with the highest dose exposure (in μGy/MBq) were the gallbladder wall (111 ± 60), liver (21 ± 7), kidney (14 ± 3), and small intestine (12 ± 2).
Organ radiation exposure for the irreversible fatty acid amide hydrolase enzyme probe (11)C-CURB is within the same range as other radiotracers labeled with (11)C, thus allowing for safe, serial PET scans in the same individuals.
Copyright © 2014 by the Society of Nuclear Medicine and Molecular Imaging, Inc.
Objective
To determine the prevalence of anxiety and depression in axial spondyloarthritis (SpA) patients by a psychiatrist using the Chinese-bilingual Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition patient research version (CB-SCID-I/P), and to examine the effectiveness of the Hospital Anxiety and Depression Scale (HADS) as a screening tool.Methods
We recruited 160 Chinese axial-SpA patients to determine the prevalence of anxiety and depression using the CB-SCID-I/P. Recruited subjects were asked to complete the HADS. HADS, HADS-depression (HADS-D) subscale and HADS-anxiety (HADS-A) subscale were analyzed to determine their effectiveness in screening for depressive and anxiety disorders.ResultsThe prevalence of current major depressive disorder (MDD) and anxiety disorder were 10.6% and 15.6%, respectively. The full-scale HADS outperformed the HADS-D subscale in screening for current MDD (area under the curve [AUC] 0.889; 0.844) and all depressive disorders (AUC 0.885; 0.862) while the HADS-A subscale outperformed the full scale HADS in screening for anxiety disorders (AUC 0.894; 0.846). The optimal cut-off point of the full scale HADS for screening current MDD and all depressive disorders were 7/8 and 6/7, yielding a sensitivity of 82.4% and 83.9%, specificity of 78.7% and 74.8%, respectively. The optimal cut-off point of HADS-A subscale for screening anxiety disorders was 6/7, yielding a sensitivity of 88.0% and specificity of 74.4%.Conclusion
The prevalence of MDD and anxiety disorder in SpA patients were 10.6% and 15.6%, respectively. We recommend using the full-scale HADS in screening for depressive disorders and HADS-A subscale for anxiety disorders.
Background: Little is known about the effect of recurrent episodes of communal violence on mental health in countries recovering from mass conflict. We report results of a 6-year longitudinal study in post-conflict Timor-Leste assessing changes in mental health after a period of communal violence.
Methods: We assessed 1022 adults (600 from a rural village, 422 from an urban district) exposed to mass conflict during the Indonesian occupation after independence in 2004, and again in 2010–11, following a period of internal conflict. We took a census of all adults living at the two sites. The survey included measures of post-traumatic stress disorder, severe distress, traumatic events, poverty, ongoing conflict, and injustice.
Findings: 1247 (80%) of 1554 invited adults participated in the baseline survey. 1038 (89% of those eligible) were followed up. The analysis included 1022 people who had sufficient data at baseline and follow-up. The prevalence of post-traumatic stress disorder increased from 23 of 1022 (2·3%) in 2004, to 171 of 1022 (16·7%) in 2010. The prevalence of severe distress also increased, from 57 of 1022 (5·6%) in 2004, to 162 of 1022 (15·9%) in 2010. Both these outcomes were associated with disability at follow-up. Having post-traumatic stress at follow-up was associated with being a woman (odds ratio [OR] 1·63, 95% CI 1·14–2·32), experience of human rights trauma (OR 1·25, 95% CI 1·07–1·47), or exposure to murder (OR 1·71, 95% CI 1·38–2·10) during the Indonesian occupation (1975–99), human rights trauma during the period of internal violence in 2006–07 (OR 1·46, 95% CI 1·04–2·03), and ongoing family or community conflict (OR 1·80, 95% CI 1·15–2·80) or preoccupations with injustice for two or three historical periods (OR 4·06, 2·63–6·28). Severe distress at follow-up was associated with health stress (OR 1·47, 1·14–1·90), exposure to murder (OR 1·57, 1·27–1·95), and natural disaster (OR 1·65, 1·03–2·64) during the Indonesian occupation, conflict-related trauma during the internal violence (OR 1·33, 1·02–1·74), and ongoing poverty (OR 1·53, 1·36–1·72) or preoccupations with injustice for two or three historical periods (OR 2·09, 1·25–3·50).
Interpretation: Recurrent violence resulted in a major increase in post-traumatic stress disorder and severe distress in a community previously exposed to mass conflict. Poverty, ongoing community tensions, and persisting feelings of injustice contributed to mental disorders. The findings underscore the importance of preventing recurrent violence, alleviating poverty, and addressing injustices in countries emerging from conflict.
Funding: Australian National Health and Medical Research Council.
The purpose of this study was to formulate and test two case-mix models for depression treatment that permit comparisons of patient outcomes across diverse clinical settings. It assessed demographics; eight, diagnostic-specific, case-mix variables; and clinical status at baseline and follow-up for 187 patients. Regressions were performed to test two models for four dependent variables including depression severity and diagnosis. Individual treatment settings were then ranked based on a comparison of actual versus predicted outcomes using regression coefficients and predictor variables. A model inclusive of baseline physical health status and depression severity predicted depression severity, mental health, and physical health functioning at follow-up. A simpler model performed well in predicting depression remission. This study identifies variables to be included in case-mix adjustment models and demonstrates statistical methods to control for differences across settings when comparing depression outcomes.
Efforts to predict psychosis in individuals at high risk for schizophrenia have focused on the identification of sub-threshold clinical criteria and neurobiological markers, including neuropsychological assessment, structural and functional brain imaging, and psychophysiological testing. We sought to evaluate the relative utility of "psychosis-proneness" measures for prospective prediction of psychotic disorders in a group of young relatives at familial risk for schizophrenia.
We examined the receiver operating characteristics of sub-threshold symptoms in predicting conversion to psychosis in a group of 97 young first- and second- degree relatives of persons with schizophrenia over a 2-year period. Towards this end, we utilized the Structured Interview of prodromal symptoms to derive measures of two of the four Scale of Prodromal Symptoms subscales (positive and disorganized) and the Chapman Magical Ideation and Perceptual Aberration scales. These four measures were, together, taken to reflect a putative index of psychosis-proneness.
Eleven of the 97 subjects developed a psychotic disorder over 2 years of follow-up. Seventeen of the 97 subjects tested positive on this index of psychosis-proneness at baseline and of these 10 converted to psychosis. The sensitivity and specificity of the test were 91 percent and 92 percent respectively. The positive predictive value of the test was 59 percent and its negative predictive value was 99 percent. Addition of measures of cognitive or social function to the index decreased its predictive ability, reducing its specificity and/or sensitivity.
A relatively simple set of clinical measures can be utilized to prospectively identify familial high risk individuals who convert to psychosis with high specificity and sensitivity. Implications for the proposed addition of an "attenuated psychosis syndrome" in DSM-5 are discussed.
The aim of this study was to compare 5-HT(1A) availability in vivo in individuals with schizophrenia before and during treatment with the atypical antipsychotic ziprasidone. Six individuals with schizophrenia underwent two PET scans with [(11)C]WAY 100635; the first while medication-free (baseline) and the second while taking the atypical antipsychotic ziprasidone (on-medication). Regional volumes of distribution (V(T), mL g(-1)) were derived using a two-tissue compartment kinetic model. Outcome measures included binding potential relative to the plasma (BP(P), mL g(-1)) and the binding potential relative to the nonspecific distribution volume (BP(ND), unitless). No significant differences were observed in regional BP(P) or BP(ND) with ziprasidone treatment. A significant correlation was noted between BP(P) measured in the orbitofrontal cortex during the on-medication condition and degree of improvement in negative symptoms with treatment (r = 0.96, p = 0.004). Consistent with the published literature of changes in 5-HT(1A) binding during treatment with 5-HT(1A) receptor agonists, this study did not detect a significant reduction in 5-HT(1A) binding with ziprasidone. The finding of a relationship between 5-HT(1A) binding and the degree of improvement in negative symptoms provides further support for the role of the 5-HT(1A) receptor in the pathophysiology and treatment of this symptom domain.
The Diagnostic Interview for Psychoses (DIP) is a comprehensive interview schedule for psychotic disorders, linked to the OPCRIT diagnostic algorithm, bridging the gap between fully structured, lay-administered schedules and semistructured, psychiatrist-administered interviews. Here we describe the validity, reliability and applications of the Italian version of the DIP.
The interview was translated into Italian and its content validity tested by back translation. Sixty patients, drawn from among those who contacted the South-Verona Community Mental Health Service, were included in the study. Each patient was first assessed independently by two raters, one of whom conducted the interview, while the other assumed the role of observer. Subsequently (median: 89 days), 44 of these patients were re-interviewed by a third rater, who made an independent assessment. Diagnostic validity was assessed in 18 cases, interviewed with the DIP and using the SCAN as 'gold standard'.
The mean duration of the interview was 37 minutes for the inter-rater interviews and 39 minutes for the retest interviews. Good to excellent inter-rater reliability was demonstrated for both ICD-10 and DSM-IV diagnoses, while in the test-retest reliability pairwise agreement was high for half of the items. Diagnostic validity was good, with twelve out of the 18 DIP-OPCRIT diagnoses (67%) matching the SCAN diagnosis.
Overall, the results support the reliability and validity of the Italian translation of the DIP. The Italian version will be useful both in routine practice to establish standard reference diagnoses of psychosis and in the research field, where it can be used by academic researchers in clinical trials and epidemiological studies.
To examine the association between childhood abuse/neglect and central adiposity and obesity in a sample of 311 women (n = 106 black, 205 white) from the Pittsburgh site of the Study of Women's Health Across the Nation (SWAN).
SWAN included a baseline measurement of women in midlife (mean age = 45.7 years) and eight follow-up visits during which waist circumference (WC) and body mass index (BMI) were measured. The Childhood Trauma Questionnaire retrospectively assessed emotional, physical, and sexual abuse, and emotional and physical neglect in childhood.
Analyses of covariance showed that women with a history of any abuse/neglect, and specifically physical and sexual abuse, had significantly higher WC and BMI at baseline than women with no abuse history. A significant interaction between abuse and BMI showed that among women with BMI of <30, any abuse/neglect and certain subtypes of abuse predicted greater increases in WC over time. Additional analyses showed that Trait Anger scores and sex hormone-binding globulin (SHBG) attenuated cross-sectional relationships between abuse/neglect and WC and BMI.
This study suggests that abused/neglected women seem to have greater anger and lower levels of SHBG, which are associated with adiposity in midlife.
Dissertação de Mestrado em Psiquiatria apresentada à Faculdade de Medicina da Universidade do Porto Objectivos- As características clínicas dos doentes com perturbação de pânico nunca foram exaustivamente estudadas entre nós. Por outro lado a perturbação de pânico pode ser uma realidade clínica mais heterogénea do que geralmente é suposto. Partimos para esta investigação com o propósito, não só de avaliar dados de uma amostra do nosso meio sociocultural, como demonstrar que alguns subtipos sintomáticos da perturbação de pânico se relacionam com variáveis clínicas tais como depressão, suicidabilidade, ansiedade de base, gravidade da agorafobia e pânico, de um modo distinto.Métodos- Foi avaliada uma amostra de doentes com perturbação de pânico em relação a alguns dados clínico semiológicos fundamentais, desde logo as características sócio-demográficas, bem como o estudo das variáveis relacionadas com os ataques de pânico tais como as cognições de medo, a ansiedade antecipatória e a ansiedade de base, com a agorafobia, com o primeiro pedido de ajuda, com variáveis clínicas de frequente comorbilidade como seja a depressão ao longo da vida e actual, a ideação suicida e tentativa de suicídio. Foram utilizados os seguintes instrumentos de avaliação: a Entrevista Estruturada para as Perturbações Ansiosas-Revista (ADIS-R), o Inventário Depressivo de Beck (IDB), o Questionário de Medo, o SCL-90-R e o Questionário de Cognições Associadas aos Ataques de Pânico. Os 13 sintomas do ataque de pânico, segundo o DSM-IV, foram sujeitos a análise factorial. Os factores obtidos foram correlacionados com as cognições de medo, bem como com as variáveis clínicas em estudo. Resultados- As características clínico-semiológicas da amostra foram no geral concordantes com os resultados de trabalhos da mesma natureza. Após análise factorial dos sintomas dos ataques de pânico obtiveram-se quatro factores. Chamamos ao factor 1 cardiorespiratório, é composto pelos itens: dificuldade em respirar, sensação de sufocar, palpitações e desconforto ou dor no peito, bem como medo de morrer. O factor 2, ...
The World Health Organization-Composite International Diagnostic Interview (WHO-CIDI) is a highly structured interview for the assessment of mental disorders, based on the definitions and criteria of the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Over the past decade it has become evident that the CIDI does not sufficiently address the assessment needs of women. Women are affected by most mental disorders, particularly mood and anxiety disorders, approximately twice as frequently as men. Women-specific disorders, such as Premenstrual Syndrome (PMS), Premenstrual Dysphoric Disorder (PMDD), psychiatric disorders during pregnancy and postpartum as well as during the perimenopause, menopause and beyond are not addressed by the standard CIDI diagnostic modules. In addition, the CIDI in its current form does not address the potential effect that female reproductive milestones may have on diagnosis, treatment and prevention of mental disorders in women. Our aim was to develop a new women specific platform (CIDI-VENUS; CIDI-V) to be embedded in the existing CIDI that will address the above mentioned current deficiencies. Guided by a team of experts in the field of Women's Mental Health from Canada and Germany the following modules were developed: 1) A complete menstrual history and comprehensive contraceptive history with a link to the Premenstrual Symptoms Screening Tool (PSST). 2) A complete perinatal history of pregnancies, miscarriages, terminations, still births, death of a child, with details of current pregnancy including gestation and expected date of confinement, labour history and breastfeeding, history of tobacco, alcohol, and other substance use including prescription drugs during pregnancy and postpartum, a section on specific phobias and on recurrent obsessive/compulsive thoughts/behaviours (OCD) related to the baby with a link to the Perinatal Obsessive-Compulsive Scale (POCS), as well as a link to the Edinburgh Postnatal Depression Scale (EPDS). 3). A detailed history of use of hormone therapy (e.g. pills, patches, implants, etc.) with a focus on (peri-) menopausal women, differentiating between physical and psychological symptoms with a link to the Menopause Visual Analogue Scales (M-VAS) and to the Greene Climacteric Scale. 4) An iterative module concluding each CIDI section to specify the course of mental disorders during the reproductive stages and menopausal transition. While retaining core diagnostic sections and diagnostic algorithms, the CIDI-V is enriched by women-specific diagnostic modules, providing a wealth of clinically relevant information about women's mental health, not available anywhere else in our current psychiatric diagnostic instruments.
A test-retest reliability study of the Structured Clinical Interview for DSM-III-R was conducted on 592 subjects in four patient and two nonpatient sites in this country as well as one patient site in Germany. For most of the major categories, kappa s for current and lifetime diagnoses in the patient samples were above .60, with an overall weighted kappa of .61 for current and .68 for lifetime diagnoses. For the nonpatients, however, agreement was considerably lower, with a mean kappa of .37 for current and .51 for lifetime diagnoses. These values for the patient and nonpatient samples are roughly comparable to those obtained with other structured diagnostic instruments. Sources of diagnostic disagreement, such as inadequate training of interviewers, information variance, and low base rates for many disorders, are discussed.
Paranoia in the context of cocaine abuse is common and potentially dangerous. Several lines of evidence suggest that this phenomenon may be related to function of the dopamine transporter protein (DAT). DAT is the site of presynaptic reuptake of dopamine, an event that terminates its synaptic activity. The gene coding for dopamine transporter protein (DAT1) contains a variable number of tandem repeats (VNTR) polymorphism in the 3' untranslated region that can be typed by the polymerase chain reaction (PCR) (Vandenbergh et al. 1992). Although this is not a coding region polymorphism, it is close to the coding region and could plausibly be in linkage disequilibrium with a mutation in the gene. Cocaine blocks the dopamine transporter and increases synaptic availability of dopamine. We examined DAT alleles in 58 white and 45 black cocaine users in order to test only two hypotheses: (1) Is there an allelic association between DAT and cocaine dependence? and (2) Is there an allelic association between DAT and cocaine-induced paranoia? We did not demonstrate an allelic association with cocaine dependence. However, within the white sample, DAT genotype was associated with cocaine-induced paranoia (allele frequency for allele 9 = .16 for those without paranoid experiences versus .35 for those with, chi 2 = 3.9 [2 x 2 table], p < .05). There was no significant difference for the same measure in the black sample. Certain DAT genotypes may therefore predispose to paranoia in the context of cocaine use in white populations. We caution that these results require independent replication.
Open-label and placebo-controlled trials of fluvoxamine, a selective, serotonergic antidepressant, were conducted as an adjunct to relapse prevention psychotherapy in alcoholics. In the open trial, 16 inpatient alcoholics began a 12-week treatment program, with 10 patients dropping out during the first 4 weeks of treatment. In the controlled trial, 8 of 10 patients on fluvoxamine dropped out during the first 4 weeks of treatment, compared with only 1 of 9 patients on placebo. Baseline patient characteristics did not appear to explain the differential attrition in the controlled trial, although the placebo-treated patients were more alcohol dependent. In both trials, patients on fluvoxamine complained of a variety of adverse effects, which they often identified as the basis for early termination of treatment. These adverse effects appear to limit the usefulness of the medication for the treatment of alcoholism.
To observe and quantify white matter hyperintensities on MR images in adults with schizophrenialike symptoms who had had congenital rubella, in order to elucidate the neuropathologic sequelae of this perinatal viral infection and to explore the potential relationship of these lesions to schizophrenia.
Eleven deaf adult patients with documented prenatal rubella virus infection and schizophrenialike symptoms were compared with 19 age-matched patients with early-onset schizophrenia who did not have congenital rubella and with 18 age-matched control subjects. All MR images (obtained at 1.5 T) were evaluated by a neuroradiologist who was blinded to diagnosis and were rated for white matter lesions on a five-point scale: 0 = no lesions; 1 = 1 lesion less than 1 mm in diameter; 2 = 1 to 4 lesions 1 mm or greater; 3 = 5 to 10 lesions; 4 = more than 10 lesions or a single lesion more than 1 cm in diameter. In addition, the white matter hyperintensities were volumed objectively with a manual threshold technique.
Ratings of white matter lesions were significantly higher in the rubella patients than in the control subjects: 6 of the 11 patients had ratings greater than 1 compared with 1 of the 18 control subjects and none of the 19 schizophrenic patients. Also, MR images in five rubella patients received ratings at the highest end of the scale of abnormality (3 or 4). The white matter hyperintensities were characterized as bilateral T2 signal hyperintensities in periventricular and subcortical regions, punctate or linear in shape; they were observed predominantly in parietal lobes.
This quantitative MR study of adult rubella patients disclosed abnormal white matter lesions that may correspond to neurovascular lesions known neuropathologically. They do not appear to be directly related to schizophrenialike symptoms.
This study examined whether the degree of brain dysmorphology observable in adulthood was related to onset age of schizophrenic symptoms. Brain magnetic resonance imaging (MRI) scans were acquired in 57 men with schizophrenia, whose age at MRI was 19-53 years, and whose symptom onset ranged from age 7 to 29 years; all were inpatients in a state hospital. Volumes of intracranial space, cortical gray matter (GM) and white matter (WM), and cerebrospinal fluid (CSF) in lateral and third ventricles and cortical sulci were derived from MRI scans and corrected by regression analysis for variations attributable to age and head size, quantified in a control sample of healthy community volunteers. The schizophrenic patients had larger volumes of cortical and ventricular CSF and smaller volumes of cortical GM but not WM than age-matched controls, whether or not volumes were adjusted for head size and age norms. Age of onset did not correlate with any of the five age-adjusted brain measures. Neither current age, length of illness, nor symptom severity correlated with age-normalized volumes of cortical GM, sulcal CSF, or ventricular CSF. These observations are consistent with the theory that brain structure deficits 1) first develop prior to symptom onset (perhaps during the prenatal and/or early childhood process of GM development); 2) probably establish a vulnerability to subsequent dysfunctionality; but 3) are nonprogressive.
This study compared two measures of depression in a population with schizophrenia. Inpatients (n = 112) with schizophrenia, were assessed on the Hamilton (HDRS), and Calgary (CDSS) depression scales and the Positive and Negative Syndrome Scale (PANSS). Eighty-nine were reassessed 3 months later. A principal components factor analysis was applied to each depression scale. The relationship between measures of depression and positive and negative symptoms was explored using correlation, factor and regression analyses. There were no significant correlations between the total CDSS and positive or negative symptoms at either time. In contrast, the HDRS total score was correlated with both positive and negative syndromes at time 2. Moreover, a number of HDRS factors correlated significantly with the PANSS positive scale at both times and with the negative subscale score at time 2. Multiple regression analysis showed that the HDRS accounted for more of the variance in positive and negative symptoms scores than did the CDSS. The CDSS has fewer factors and less overlap with positive and negative symptoms than the HDRS. This suggests that it is a more specific measure of level of depression than the HDRS for individuals with schizophrenia.
This study compares the socio-demographic, physical and psychiatric profiles of representative samples of adults resident in communal establishments (n = 170) with those living in private households (n = 544) in a deprived multi-ethnic inner-city health district. Respondents were interviewed about their psychiatric and physical health as well as their early life experiences, close personal relationships, experiences of police contact and episodes of deliberate self-harm. Communal establishment residents were more likely to be single, white men and to be out of work than those in the private household sample. They typically left school at an earlier age, had a more disrupted upbringing, were less likely to have close personal relationships and reported more contact with the police. Both physical and psychiatric morbidity were substantially higher in the communal establishment residents than among those living in private households (especially for psychotic disorders). In contrast to these findings, comparisons between communal establishment residents with and without mental health problems revealed few differences. Our data highlight the extensive needs of those living in communal establishments and the need for a wide range of agencies to co-ordinate their efforts effectively if services to this population are to be effective.
Mental health registers contain diagnoses from serial contacts with mental health facilities over many years. This study examines the relationship between longitudinal diagnostic profiles and structured interview diagnoses. The aim is to improve the definition of diagnoses drawn from clinical case registers.
The Tasmanian Mental Health Case Register includes 1922 individuals, each with at least one diagnosis of schizophrenia between 1965 and 1990. A representative subsample of 29 individuals were assessed by the structured diagnostic interview for DSM-III-R (SCID). Diagnostic agreement between Register and SCID diagnoses was compared.
Twenty-four subjects (82.8%) received a lifetime diagnosis of schizophrenia on the SCID. For each subject, 'schizophrenia diagnostic dominance', the percentage of register entries with schizophrenia diagnoses over total entries, was calculated. Agreement between register and SCID correlated positively with schizophrenia diagnostic dominance and negatively with register mood diagnoses.
Longitudinal diagnostic profiles on databases may be superior to cross-sectional clinical diagnoses in predicting structured interview diagnoses, and may be useful in defining caseness in epidemiological studies using register diagnoses.
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