To understand how DSM-III and DSM-III-R are used and perceived by educators, researchers, practitioners, and trainees, in the spring of 1989 we surveyed all US psychiatric residency training directors (N = 197), 337 active psychiatrist researchers, a nationwide random sample of 952 practicing psychiatrists, and all PGY-3 and -4 residents. We describe the factors influencing the use of DSM-III and DSM-III-R and the perceptions of strengths and weaknesses of the DSMs from various perspectives (training, research, and practice). A modest increase in the acceptance of the DSM system was noted in comparing the results from the current survey and a similar 1984 survey about DSM-III. The implications of these findings for the development of DSM-IV are discussed.

Attitude of Health Personnel↗

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DSM-III and DSM-III-R: what are American psychiatrists using and why?

The purpose of this study was to determine whether American psychiatrists have switched from DSM-III to DSM-III-R as their primary diagnostic reference, and to examine what factors predicted the continued use of DSM-III. In 1989, we conducted a mail survey of practicing psychiatrists (N = 454), residency program directors (N = 128), residents (N = 1,331), and researchers (N = 196) regarding their training in, use of, and opinions about DSM-III and DSM-III-R. Approximately 30% of practitioners continued to use DSM-III as their primary diagnostic reference, although this was less frequently true of researchers and residents. In none of the four groups did a majority believe that DSM-III-R was needed, despite the fact that the majority of each group indicated that it was an improvement over DSM-III. The most commonly perceived reasons for publishing DSM-III-R were that it corrected problems with DSM-III and new research indicated changes were warranted. Compared with DSM-III-R users, DSM-III users more frequently believed that the 7-year interval between the two editions was too short, that DSM-III-R was not needed, and that the revised manual was little better than the original. Thus, 2 years after the publication of DSM-III-R 90% of psychiatrists were using DSM-III-R, at least in part, although a substantial minority continued to use DSM-III as their primary diagnostic manual. Even among DSM-III-R users, many believed that the revised manual was not needed. The perceived need for DSM-III-R was associated with the reasons ascribed to its publication; therefore, acceptance of DSM-IV may be partially a function of how its development is promoted and justified. That nearly one third of a random sample of practicing psychiatrists continued to use DSM-III supports concerns that the publication of DSM manuals every 6 or 7 years will divide the psychiatric community into subgroups using different diagnostic criteria.

Adult↗

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Brain damage and associated behavioral deficits following the administration of L-cysteine to infant rats.

L-cysteine in doses of 1.2-1.3 mg/g, was administered to 4-day-old rats which were tested throughout development and as adults on a variety of behavioral tasks. Lesions of the type previously described from L-cysteine treatment were confirmed in several cortical and limbic structures. No neurodegenerative changes were observed in NaCl (10 mmoles/kg) controls. Surviving L-cysteine treated animals displayed no obvious impairments in motor ability or growth rate, but did show behavioral deficits when tested as adults on 3 behavioral tasks: spontaneous alternation; Lashley III maze; and pattern discrimination. Activity in the open field was significantly higher in the L-cysteine group at 20 days of age. Amphetamine, administered in doses of 1.5 to 3.0 mg/kg, had no differential effects on open-field activity in the two groups. The behavioral changes observed in L-cysteine treated animals is similar to that which has been reported in adult rats with extensive hippocampal damage.

Amphetamine↗

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Four definitions of endogenous depression and the dexamethasone suppression test.

We examined the relationship between the DST and 4 definitions of endogenous depression: DSM-III, Feinberg and Carroll, Newcastle and RDC. Endogenous patients had a significantly higher rate of nonsuppression than nonendogenous patients according to the DSM-III and Newcastle definitions but not according to the RDC and Feinberg and Carroll criteria. Moreover, the relationship between the DST and the DSM-III and Newcastle definitions was significant even after individually controlling for age, psychosis and weight loss. We review the literature on the relationship between the DST and the RDC definition of endogenous depression and suggest that interstudy differences in criteria application may be partially responsible for the inconsistent results across studies.

Adult↗

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The relationship between age and post-dexamethasone cortisol: a test of three hypotheses.

Previous studies report that DST nonsuppressors are older than normal suppressors. Data are presented on 188 primary unipolar major depressive inpatients and 35 healthy controls. In males, age appeared to correlate positively with post-dexamethasone cortisols in depressed patients and normal controls, although mean levels were higher in depressives. Female controls showed no consistent relationship between age and post-dexamethasone cortisol. A positive relationship did exist for depressed women. However, the association disappeared when age-of-onset was entered into the model, suggesting that in females early onset may identify a subtype of depression with normal DST suppression.

Adult↗

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Validity of an operational definition for neurotic unipolar major depression.

After we reviewed the literature to identify the clinical and phenomenologic correlates of neurotic depression, we constructed a 6-item operational definition to distinguish neurotic unipolar major depressive disorder from non-neurotic major depression. The neurotic depressives were characterized by a low rate of abnormal dexamethasone suppression test (DST) results and a strong family history of alcoholism. Neurotic depressives improved less than non-neurotic depressives during the index hospitalization, and were more frequently rehospitalized during a 6-month prospective follow-up. Neurotic subtyping was significantly negatively associated with DSM-III melancholia. Neurotic classification remained significantly associated with the above validating variables after melancholic status was held constant, whereas melancholic subtyping did not predict DST results, familial alcoholism rates, or outcome when neurotic status was controlled.

Depressive Disorder↗

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Diagnosis and outcome in schizo-affective depression: a replication.

Forty-three inpatients with RDC schizo-affective depression were given structured interviews and then followed to 1 year using a design closely resembling that of another recent follow-up of schizo-affective patients. In replication of the earlier study, patients with either 'chronic' or 'mainly schizophrenic' schizo-affective disorder had significantly worse outcomes than did patients with nonchronic or 'mainly affective' schizo-affective depression and bipolar patients were significantly more likely to develop manic syndromes. The preceding duration of schizophrenia-like symptoms and a history of schizophrenia-like prodromes appeared to be the most important components of these two distinctions. In both studies, diagnostic subtype was the most robust of various potential outcome predictors. Also in both studies, 'mainly affective' and 'nonchronic' schizo-affective patients had outcomes no different from patients with psychotic depression.

Adult↗

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Past loss as a symptom formation factor in depression.

We examined the relationship between past loss and endogenous subtyping of depressed patients. In a sample of 124 female depressed inpatients there was no association between past loss and RDC endogenous or DSM-III melancholic subtyping. We thus failed to replicate Brown and colleagues' finding that past loss is a symptom formation factor.

Depressive Disorder↗

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Sensitizers, protectors and oncogenic transformation in vitro.

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Animals↗