[Show abstract][Hide abstract] ABSTRACT: Having two systems of psychiatric diagnosis creates unnecessary confusion therefore it would be desirable to achieve increased consistency between ICD-11 and DSM-5. Unfortunately, however, DSM-5 has included many controversial suggestions that have weak scientific support and insufficient risk-benefit analysis. As a result ICD-11 should learn from the DSM-5 mistakes rather than repeating them.
Preview · Article · Jul 2013 · The British journal of psychiatry: the journal of mental science
[Show abstract][Hide abstract] ABSTRACT: Objective: Mental health in populations may be deteriorating, or it may be improving, but there is little direct evidence to support either possibility. Our objective was to examine secular trends in mental health indicators from national data sources. Methods: We used data (1994-2008) from the National Population Health Survey and from a series of cross-sectional studies (Canadian Community Health Survey) conducted in 2001, 2003, 2005, and 2007. We calculated population-weighted proportions and also generated sex-specific, age-standardized estimates of major depressive episode prevalence, distress, professionally diagnosed mood disorders, antidepressant use, self-rated perceived mental health, and self-rated stress. Results: Major depression prevalence did not change over time. No changes in the frequency of severe distress were seen. However, there were increases in reported diagnoses of mood disorders and an increasing proportion of the population reported that they were taking antidepressants. The proportion of the population reporting that their life was extremely stressful decreased, but the proportion reporting poor mental health did not change. Conclusions: Measures based on assessment of symptoms showed no evidence of change over time. However, the frequency of diagnosis and treatment appears to be increasing and perceptions of extreme stress are decreasing. These changes probably reflect changes in diagnostic practice, mental health literacy, or willingness to report mental health concerns. However, no direct evidence of changing mental health status was found.
No preview · Article · May 2012 · Canadian journal of psychiatry. Revue canadienne de psychiatrie
[Show abstract][Hide abstract] ABSTRACT: The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders provides the authoritative list of what are considered to be mental disorders. This list has a tremendous impact on research, funding, and treatment, as well as a variety of civil and forensic decisions. The development of this diagnostic manual is an enormous responsibility. Provided herein are lessons learned during the course of the development of the fourth edition. Noted in particular is the importance of obtaining and publishing critical reviews, restraining the unbridled creativity of experts, conducting field trials that address key issues and concerns, and conducting forthright risk-benefit analyses. It is suggested that future editions of the diagnostic manual be developed under the auspices of the Institute of Medicine. The goal would be broad representation, an evidence-based approach, disinterested recommendations, and a careful attention to the risks and benefits of each suggestion for change to the individual patient, to public policy, and to forensic applications.
No preview · Article · Apr 2011 · Annual Review of Clinical Psychology
[Show abstract][Hide abstract] ABSTRACT: Critical evaluation of DSM-V first draft This is an evaluation of the first DSM-V (Diagnostic and Statistical Manual of Mental Disorders-V) draft from the DSM-IV chairman. First, a brief history of DSM is reported. Then, major reasons for present controversies and the threat they raise to APA leadership in the field are discussed. Third point is careful recollection of the several conflicting aspects of the DSM-V draft, paying attention to drawbacks and their implications for future clinical practice, research and forensic activity. Comment is finally provided about APA (American Psychiatric Association) decisions aimed at reaching more consensus about this basic instrument of American psychiatry.
No preview · Article · Feb 2011 · Revue médicale suisse
[Show abstract][Hide abstract] ABSTRACT: This randomized clinical trial compared 16-week interventions with interpersonal psychotherapy, cognitive behavioral therapy, supportive psychotherapy, and supportive psychotherapy with imipramine for human immunodeficiency virus (HIV)-positive patients with depressive symptoms.
Subjects (N = 101; 85 male, 16 female) with known HIV seropositivity for at least 6 months were randomized to 16 weeks of treatment. Inclusion criteria were 24-item Hamilton Depression Rating Scale score of 15 or higher, clinical judgment of depression, and physical health sufficient to attend outpatient sessions. Therapists were trained in manualized therapies specific for HIV-positive patients. Treatment adherence was monitored.
Subjects randomized to interpersonal psychotherapy (n = 24) and supportive psychotherapy with imipramine (n = 26) had significantly greater improvement on depressive measures than those receiving supportive psychotherapy (n = 24) or cognitive behavioral therapy (n = 27). Similar results appeared in the completer subsample.
Depressive symptoms appear treatable in HIV-positive patients. Interpersonal psychotherapy may have particular advantages as a psychotherapy for patients who have experienced the significant life events of HIV infection.
No preview · Article · Jun 1998 · Archives of General Psychiatry
[Show abstract][Hide abstract] ABSTRACT: The authors present preliminary data from two treatment modalities of a randomized clinical trial in which they compared 16-week interventions of interpersonal psychotherapy to supportive psychotherapy.
HIV-positive patients who were not acutely medically ill and had scores of 15 or higher on the Hamilton Depression Rating Scale were randomly assigned to one of four treatment modalities. They were assessed by the Hamilton scale and Beck Depression Inventory at 8 and 16 weeks. Most subjects who underwent either interpersonal psychotherapy (N = 16) or supportive psychotherapy (N = 16) were male, gay or bisexual, white, and college educated.
Results of last-observation-carried-forward and completer analyses showed that scores on the Hamilton scale and Beck Depression Inventory decreased significantly for both treatments. Differential improvement for interpersonal psychotherapy appeared by midtreatment (week 8) and persisted at termination.
This is the first controlled study of individual psychotherapies for depressed HIV-positive patients. Results suggest that a specific antidepressant psychotherapy, interpersonal psychotherapy, has advantages over a supportive therapy.
Full-text · Article · Nov 1995 · American Journal of Psychiatry
[Show abstract][Hide abstract] ABSTRACT: We are now at an interesting crossroads in the history of psychiatric nosology. There have been many oscillations over time between etiologic and descriptive models, between lumping and splitting, and between categorical and dimensional systems. It is unfortunate, but inevitable, that most of the etiologic models of the past have been based on unproven and unprovable theories. Like its predecessors, DSM-IV is a descriptive system, and it too gradually will be replaced by an etiologic model--one, it is hoped, that is more scientifically valid than previous attempts at etiologic explanation. This will be an important step for the profession, for scientific understanding, and for the patient.
No preview · Article · Oct 1994 · Psychiatric Clinics of North America
[Show abstract][Hide abstract] ABSTRACT: This exploratory study sought demographic and clinical correlates of self-mutilation (self-injury without suicidal intent) in borderline personality disorder.
Among 124 consecutively admitted inpatients with borderline personality disorder, there were 62 who did not mutilate themselves, 23 who mutilated themselves infrequently (fewer than five lifetime events), and 39 who mutilated themselves frequently (five or more lifetime events); each received ratings on numerous measures of psychopathology.
Compared to nonmutilators, frequent mutilators were significantly more likely to be in outpatient treatment at the time of admission and had more weeks of prior outpatient and inpatient treatment; they were also more likely to receive comorbid diagnoses of current major depression, anorexia nervosa, and bulimia nervosa. Frequent mutilators had significantly higher group means on the Beck Scale for Suicidal Ideation, were more likely to have attempted suicide, and were more likely to have attempted suicide more often than both infrequent mutilators and nonmutilators. The adjusted odds ratios from logistic regression analyses demonstrated that major depression, bulimia nervosa, number of prior suicide attempts, and acute suicidal ideation were each associated with greater risk of frequent mutilation.
Borderline patients who frequently mutilate themselves may represent a subgroup of especially high utilizers of psychiatric treatment who are at particularly high risk for suicidal behavior and for comorbid major depression and eating disorders. Clinicians should consider aggressive treatment of comorbid axis I disorders and careful assessment of suicide risk in these patients.
No preview · Article · Oct 1994 · American Journal of Psychiatry
[Show abstract][Hide abstract] ABSTRACT: The authors report results of an 8-week, open trial of desipramine in 42 patients with DSM-III-R dysthymia with a concurrent diagnosis of major depression ("double" depression) and 33 patients with dysthymia who had no other depressive diagnosis ("pure" dysthymia). Either complete or partial remission was achieved by 70% of the patients with "pure" dysthymia. This compared favorably with but was not significantly different from results in the "double" depression group.
No preview · Article · Aug 1994 · American Journal of Psychiatry
[Show abstract][Hide abstract] ABSTRACT: The authors discuss some of the conceptual issues that must be considered in using and understanding psychiatric classification.
DSM-IV is a practical and common sense nosology of psychiatric disorders that is intended to improve communication in clinical
practice and in research studies. DSM-IV has no philosophic pretensions but does raise many philosphical questions. This paper
describes the development of DSM-IV and the way in which it addresses a number of philosophic issues: nominalism vs. realism,
epistemology in science, the mind/body dichotomy, the definition of mental disorders, and dimensional vs. categorical classification.
No preview · Article · Jul 1994 · Journal of Medicine and Philosophy
[Show abstract][Hide abstract] ABSTRACT: To characterize oculomotor components and diagnostic specificity of eye tracking abnormalities in schizophrenia, we examined a large consecutively admitted series of psychotic patients and matched controls. The most common abnormality in schizophrenic patients was low gain (slow) pursuit eye movements (47% of cases). Pursuit and saccadic eye movement abnormalities were no more severe in schizophrenic Ss than in those with affective psychoses, except that high rates of catch-up saccades were unique to schizophrenic Ss (17% of cases). These findings indicate that impaired pursuit eye movements are a major cause of eye tracking impairments in schizophrenia, that tracking dysfunctions commonly occur in affective psychoses, and that markedly high rates of catch-up saccades during eye tracking may be specific to schizophrenia.
Full-text · Article · Jun 1994 · Journal of Abnormal Psychology
[Show abstract][Hide abstract] ABSTRACT: This chapter reviews the conceptual and empirical support for a dimensional classification of personality disorders, focusing in particular on the five-factor model (FFM). The authors discuss the advantages and disadvantages of the categorical and dimensional models of classification. They then discuss the empirical data that are relevant to the respective validity of these two perspectives, focusing on empirical support for the five-factor dimensional model. Although the dimensional FFM may be limited by lack of familiarity, it provides a particularly compelling alternative to the Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) categorical diagnoses. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
[Show abstract][Hide abstract] ABSTRACT: This study compared rates of DSM-III-R personality disorders between patients with dysthymia and episodic major depression in order to clarify the relationship between chronic depression, episodic forms of mood disorders, and personality pathology. Fifty-one percent of the dysthymics and 42% of the episodic depressives had a personality disorder diagnosis. The most common personality disorders in the dysthymia group were avoidant and NOS (not otherwise specified) disorders. The most common personality disorders in the episodic major depression group were borderline and NOS. These data suggest that dysthymics and episodic depressives have comparable overall rates of personality disorders but qualitatively differ from each other on the distribution of personality pathology. The high rates of anxious cluster diagnosis in the dysthymic group may reflect diagnostic overlap between dysthymia and Cluster C personality disorders.
No preview · Article · Sep 1993 · Journal of Personality Disorders
[Show abstract][Hide abstract] ABSTRACT: The authors investigated gender differences in 137 inpatients with DSM-III borderline personality disorder. Male borderlines were more likely to be homosexual and to receive multiple DSM-III substance use diagnoses. especially of combinations of alcohol, cocaine, and stimulants.
No preview · Article · Jun 1993 · Journal of Personality Disorders