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Biomedical subjects

J E Mezzich

Publications and source records attributed to J E Mezzich.

At least 19 recordsLinked to original sources
PubMed1995

Impact of DSM-III axis III on the diagnosis of physical disorders in ambulatory psychiatric patients.

In the present study, the effectiveness and utility of DSM-III axis III in terms of adequate identification of physical disorders in psychiatric outpatients is appraised empirically. To this effect, the presence of physical disorders in diagnostic statements recorded in clinical charts is compared in a large medical center for two psychiatric outpatient samples, one from the nonmultiaxial DSM-II era and one after the implementation of the multiaxial DSM-III. In the earlier sample, 11% of the patients were diagnosed as having physical disorders. In the DSM-III sample, 42% of the patients were so diagnosed. The latter figure is consistent with the 40% average prevalence of physical disorders reported in careful studies of the physical condition of ambulatory psychiatric patients.

Adult↗
PubMed1995

Multiaxial diagnosis and psychotherapy planning: on the relevance of ICD-10, DSM-IV and complementary schemas.

This paper reviews, first, the historical development of multiaxial diagnostic schemas, with particular attention to those designed for the World Health Organisation's Tenth Revision of the International Classification of Diseases (ICD-10) and the American Psychiatric Association's DSM-IV. To complement standardized or nomographic multiaxial schemas, several personalized, or idiographic formulations are outlined, i.e. cultural, biographic, psychodynamic, group dynamic, and one dealing with quality of life. Contributions of comprehensive diagnosis (multiaxial and idiographic formulations) to psychotherapy planning and psychotherapy research are then discussed. The potential contributions of the psychotherapy process to diagnostic verification and clarifications are considered as well. Finally, the need for empirical validation research on the outlined relationships as well as the potential value of exploring further the synergism of nomographic and idiographic approaches are elaborated.

Culture↗
PubMed1994

Epidemiology and diagnostic systems in psychiatry.

Epidemiology and diagnosis are increasingly emerging as key topics in psychiatry. While each has particular roots, purposes and methods, a number of interesting points of contact can be elucidated. Bidirectional inter-relations between these fields are being perceived as growing and promising. Modern approaches to diagnostic description have made possible the design of potent tools for epidemiological surveys, and results from the latter are contributing to the refinement of diagnostic profiles. The new international diagnostic systems, including multiaxial formulations not only of illness but of the patient's whole clinical condition, offer challenging opportunities for further interaction and progress.

Cross-Sectional Studies↗
PubMed1994

Usefulness of DSM-III axis III in psychiatric inpatients: an actuarial comparison with the DSM-II period.

This study is a retrospective evaluation of the usefulness of DSM-III axis III (physical disorders) and its ability to enhance clinical case description in general psychiatric patients. The subjects of this study consisted of two samples of 75 inpatients; each was randomly selected and age-matched to represent DSM-II (1975-1979) and DSM-III (1981-1985) periods, respectively. The results indicated a substantial and statistically significant difference in the frequency of physical disorders recorded at intake before (9.3%) and after (46.7%) the implementation of DSM-III. DSM-III axis III may significantly enhance the recording of physical disorders in psychiatric inpatients.

Adult↗
PubMed1993

Do Caucasian and black adolescents differ at psychiatric intake?

A large sample of adolescents brought for psychiatric evaluation to a public University based facility are the subjects of the study. Material incorporated in a DSM-III multiaxial formulation plus symptoms constituted the dependent variables. Analyses concentrated on ethnic differences, with variation associated with gender and social class controlled statistically. Caucasians showed comparatively greater clinical morbidity: higher number of Axis I definite diagnoses and level of symptoms. Eating disorder diagnoses were more common in Caucasians. There were no significant differences pertaining to level of stress or social impairment. Blacks showed higher levels of symptoms scored as "social aggression" and diagnosed as conduct disorders. The pattern of results raised the question of a possible referral bias, with blacks shunted to the psychiatric facility with lower levels of standard clinical psychopathology, but higher levels of social oppositional behavior. Further research is needed to verify if such a bias does exist.

Adolescent↗
PubMed1993

Characteristics of repeat users of a psychiatric emergency service.

OBJECTIVE: Patients who visited a psychiatric emergency service were studied to determine whether repeat visitors, who consume a disproportionate share of services, could be identified by demographic and diagnostic characteristics. METHODS: Data were obtained from a semistructured diagnostic interview given to all 16,257 persons who made 29,214 visits to an urban psychiatric emergency service in Pittsburgh, Pennsylvania, from 1985 to 1989. Patients were categorized into four groups based on the number of visits in the five-year period. Patients in group 1 made a single visit, while those in group 2 averaged less than one visit per year; those in group 3 made one or two visits per year, and those in group 4, more than two visits per year. RESULTS: Groups 3 and 4 constituted 5.1 percent of the sample but made 27.1 percent of the total visits. Repeat users were significantly more likely to be male, younger, unmarried, unemployed, and nonwhite and to have diagnoses of schizophrenia, other psychotic disorders, and personality disorders. CONCLUSIONS: Repeat users of psychiatric emergency services appear to have demographic and diagnostic characteristics that may permit their early identification. For such patients, implementation of alternative management strategies, such as intensive case management, may reduce their use of services.

Adolescent↗
PubMed1992

On the descriptive validity of DSM III schizophrenia.

The study sample is drawn from patients seeking evaluation in a psychiatric intake facility. It concentrates on those who are assigned a diagnosis of psychosis as stipulated in DSM III. The aim is to elucidate the distinguishing characteristics of patients diagnosed as Schizophrenia Disorder. The descriptive validity of this disorder is pursued by systematically comparing clinical and demographic characteristics of patients with this disorder to those diagnosed as Paranoid Disorder, Atypical Psychosis, Brief Reactive Psychosis, Schizoaffective Disorder and Schizophreniform Disorder. These comparisons uncover special characteristics pertaining to the demography and impact of schizophrenia. The results obtained are explained using generalizations drawn from the epidemiology, natural history and clinical manifestations of schizophrenia and other psychoses.

Adult↗
PubMed1991

Architecture of clinical information and prediction of service utilization and cost.

The state of the art in predicting service utilization and cost in general medical care and psychiatry is reviewed. Diagnosis-related groups (DRGs) and measures of illness severity are specifically examined. Building on this experience and searching for other promising informational elements, key components of clinical information schemas are considered. The interface between patient and treatment domains is examined by using multiaxial classifications connected with the upcoming Tenth Revision of the International Classification of Diseases and the European International Classification of Mental Health Care. Within this framework, univariate and multivariate approaches to the prediction of service utilization and cost are outlined.

Cost Control↗
PubMed1990

DSM III as a systemic culture pattern: studying intracultural variation among psychiatrists.

DSM III is viewed as embodying a pool of information pertaining to a systemic culture pattern of psychiatry and attempts are made to describe how psychiatrists understand and apply it using ideas from cognitive anthropology. Each of seven psychiatrists evaluated a group of patients in an intake setting. Seven broad categories of Axis I diagnoses were formed and the frequencies with which psychiatrists used these categories were computed. In addition, twelve arithmetical measures pertaining to the five axes of DSM III and a current functioning axis and the decision regarding disposition were also computed. Using these dependent variables, the study analyzes the similarities and differences among psychiatrists in the way they formulate intake evaluations. Psychiatrists' selections of Axis I diagnoses were highly intercorrelated but they differed greatly among themselves in the way they coded many of the axes of DSM III. Group correlations among diagnostic measures indicated a patterning among diagnostic measures and the nature of this patterning is discussed. Each psychiatrists' set of correlations among the twelve diagnostic measures was itself correlated with that of others and this showed a very high level of interpsychiatrist agreement. Deductions drawn from the cultural consensus model suggest that psychiatrists share an underlying 'grammar' that references the pool of information pertaining to DSM III.

Cultural Characteristics↗
PubMed1990

Suicidal indicators in schizophrenia.

The clinical and sociodemographic profile of suicidal and nonsuicidal schizophrenia patients was investigated in 801 patients with this diagnosis seen at a comprehensive psychiatric facility between 1983 and 1987. Suicidal patients tended to exhibit depression, aggressiveness, substance abuse and a severe and progressive impairment in adaptive functioning.

Adolescent↗
PubMed1989

PROPOV-K: a FORTRAN program for computing a kappa coefficient using a proportional overlap procedure.

The computer program PROPOV-K allows the computation of an unweighted kappa coefficient for expressing interrater agreement in the general case in which multiple raters (not necessarily fixed in number) formulate a variable number of multiple diagnoses for each subject. PROPOV-K assesses agreement among lists of multiple diagnoses composed of nonordered categories. PROPOV-K calculates a kappa coefficient on the basis of estimating proportion of agreement between two diagnostic formulations as the ratio of the number of agreements between specific categories over the number of different specific categories mentioned in the two diagnostic lists. When multiple raters formulate a variable number of multiple diagnoses for each subject, the use of a kappa coefficient has been limited to researchers since there are no generally available computer programs. The purpose of this paper is to present a FORTRAN computer program allowing the computation of a kappa coefficient for the case mentioned above and to illustrate its use with examples respectively involving multiple psychiatric and multiple physical diagnoses.

Algorithms↗
PubMed1989

DSM-III disorders in a large sample of psychiatric patients: frequency and specificity of diagnoses.

This study examined certain nosological features of DSM-III axis I diagnostic categories and subcategories as applied to 11,292 general psychiatric patients presenting for care, using a semistructured assessment procedure. The most frequently used major categories were affective, substance use, childhood-onset, and adjustment disorders. Secondary diagnoses were given to 26% of the patients. Male patients predominated in the categories of impulse-control, psychosexual, and substance use disorders, and female patients predominated in the categories of anxiety, affective, and somatoform disorders. Of the 329 five-digit subcategories available in DSM-III, 296 (90%) were actually used. Sixteen percent of the patients were given unspecific primary diagnoses.

Adolescent↗
PubMed1988

Contemporary psychiatric interviewing: new directions for training.

THERE has been an unheralded evolution in psychiatric interviewing, an evolution that is, nonetheless, of a critical nature. Over the past three decades the basic psychiatric interview has evolved into a collection of different psychiatric interviews. Each style of interview is determined by the immediate patient care tasks facing the clinician, whether in an emergency room or a private practice office. The acquisition of new skills, such as structuring techniques and diagnostic examinations using the DSM-III, has become a vital and challenging aspect of the education of contemporary psychiatrists. In this paper the influences that have created these new developments in psychiatric interviewing will be outlined and their implications for training discussed. We will describe a specific training approach that has evolved as a method of helping psychiatric residents develop the skills and confidence needed to handle any one of the numerous types of psychiatric interviews required of a contemporary clinician, ranging from a traditional psychodynamic assessment to a standard diagnostic interview.

Countertransference↗