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Biomedical subjects

R L Spitzer

Publications and source records attributed to R L Spitzer.

At least 55 records · Page 3Linked to original sources
PubMed1991

Results of a survey of forensic psychiatrists on the validity of the sadistic personality disorder diagnosis.

OBJECTIVE: The purpose of this study was to determine how often forensic psychiatrists evaluated individuals with sadistic personality disorder; their views about the usefulness of the diagnosis; the frequency of certain childhood factors; and the sensitivity and specificity of the individual diagnostic criteria. METHOD: A questionnaire to be answered anonymously was sent to all of the 1,390 members of the American Academy of Psychiatry and the Law. Two hundred seventy-nine usable questionnaires were returned for data analysis. RESULTS: Approximately 50% of the respondents had, at some time, evaluated in a forensic setting a subject who exhibited behavior that met the criteria for the disorder. Four percent of the cases seen in the preceding year by those respondents who had ever seen a case would have met the criteria for the disorder. Most of the forensic psychiatrists who had experience with the disorder believed that the diagnosis is useful for a variety of clinical and forensic purposes, but most also believed that the category has significant potential for being misused in legal settings. Almost all cases described by the respondents involved male patients, and there was frequently a history of childhood abuse and parental loss. The diagnostic criteria in these cases had high sensitivity and specificity. CONCLUSIONS: In forensic settings the diagnosis of sadistic personality disorder is probably not rare. The results of this study suggest that the diagnosis has both descriptive and construct validity and that further study of the disorder with the DSM-III-R diagnostic criteria is needed.

Antisocial Personality Disorder↗
PubMed1990

Using signal detection methodology to revise DSM-III-R: re-analysis of the DSM-III-R national field trials for autistic disorder.

Signal detection theory which takes into account the relative prevalence, sensitivity, and specificity of each of a set of criterion symptoms is used to determine an algorithm optimally predictive of a clinical diagnoses of autistic disorder using the data from the DSM-III-R national field trials. Findings support inclusion of one diagnostic criterion (marked lack of awareness of others) as mandatory, and four more (impaired imitation, abnormal social play, abnormal nonverbal communication, and abnormal speech) as alternate, associated criteria. Advantages of signal detection over other statistical methods for empirically deriving diagnostic standards are given, and implications for DSM-IV are discussed.

Algorithms↗
PubMed1990

The DSM-III-R field trial of disruptive behavior disorders.

The members of the DSM-III-R Advisory Committee responsible for the diagnostic criteria for the disruptive behavior disorders (attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder) were able to reach agreement on potential items to be included in the final diagnostic criteria. However, there was considerable disagreement about the relative utility of different items for the three disorders and no agreement on how many items should be required from a final list of discriminating items to establish each of the diagnoses. This article describes the method and results of a national field trial of the proposed criteria. Using as a standard the diagnosis of these disorders made by expert clinicians with experience with these disorders, the diagnostic criteria that were finally included in DSM-III-R demonstrated high sensitivity, specificity, and internal consistency.

Attention Deficit Disorder with Hyperactivity↗
PubMed1990

The DSM-III-R field trial of pervasive developmental disorders.

This article describes the method and results of a national field trial of the proposed criteria for the DSM-III-R diagnosis of autistic disorder at 11 sites which have experience in diagnosing pervasive developmental disorders. Using the diagnosis of autistic disorder made by expert clinicians as a standard, the diagnostic criteria that were finally included in DSM-III-R demonstrated high sensitivity and specificity across different age groups and in children with and without language.

Autistic Disorder↗
PubMed1990

The factor structure of self-report DSM-III axis II symptoms and their relationship to clinicians' ratings.

A factor analysis of the entire item set of the DSM-III criteria was conducted to determine the extent to which the factors that emerged corresponded to the 11 personality disorders and three clusters included in DSM-III. Data were obtained from 552 patients who completed a self-report personality questionnaire and from 287 psychiatrists who rated their patients. Eleven questionnaire factors emerged that had eigenvalues greater than one, and at least three items emerged with factor loadings greater than 0.40. A correlational and multiple regression analysis of the questionnaire factors and clinicians' ratings showed few strong relationships between the factors and the 11 personality disorders but good correspondence with the three clusters.

Adolescent↗
PubMed1990

Maladaptive denial of physical illness: a proposal for DSM-IV.

Denial of physical illness is a commonly encountered problem in consultation-liaison psychiatry. Although there is an extensive literature on denial, it has virtually ignored the diagnostic issues raised by the individual whose denial of physical illness is clearly maladaptive. The authors propose that DSM-IV include a subtype of adjustment disorder called "with maladaptive denial of physical disorder." They discuss this new category, its differential diagnosis, and the benefits to clinical practice of this proposed addition to diagnostic classification.

Adjustment Disorders↗
PubMed1989

Melancholia: from DSM-III to DSM-III-R.

On July 26, 1985, an ad hoc committee appointed by the APA Work Group to Revise DSM-III met and reviewed the research on the validity of the DSM-III criteria for melancholia. In this paper the proceedings of the meeting are related. After reviewing studies of the validity of the DSM-III melancholia criteria, the authors describe the committee's discussion of alternative proposals for DSM-III-R and the process of developing the new DSM-III-R criteria.

Depressive Disorder↗
PubMed1989

National field trial of the DSM-III-R diagnostic criteria for self-defeating personality disorder.

A national field trial of the criteria for self-defeating personality disorder was conducted in 1986. Among psychiatrists with a special interest in personality disorders there was a lack of consensus as to the need for the category in DSM-III-R. Although the diagnosis was more commonly made for female patients, the disorder was by no means rare in male patients. The diagnostic criteria for the disorder had high sensitivity and specificity. However, a series of analyses indicated that the category had limited descriptive validity and considerable overlap with borderline and dependent personality disorders.

Adult↗
PubMed1989

Late luteal phase dysphoric disorder and DSM-III-R.

Text and diagnostic criteria for a new category, late luteal phase dysphoric disorder, appear in appendix A of DSM-III-R: "Proposed Diagnostic Categories Needing Further Study." The inclusion of this category in the manual was perhaps the most controversial aspect of the revision of DSM-III. In this paper the authors describe the work of the advisory committee that first proposed the category, the rationale for the category's inclusion in the manual, and the many issues that were the focus of heated debates.

Attitude to Health↗
PubMed1989

Self-defeating personality disorder and DSM-III-R: development of the diagnostic criteria.

One of the major controversies during the development of DSM-III-R was the possible inclusion of self-defeating personality disorder. The authors review the clinical literature that serves as the conceptual basis for this diagnosis. The development of the diagnostic criteria is described, including the rationale for specific criteria and the objections raised by opponents of the category. The authors describe how some of these objections led to changes in the diagnostic criteria in an attempt to distinguish self-defeating personality disorder from normal reactions to victimization and abuse.

Female↗
PubMed1989

Psychotic disorders in DSM-III-R.

The authors review the important changes in the three sections of DSM-III-R that include only psychotic disorders (schizophrenia, delusional disorder, and psychotic disorders not elsewhere classified), outline the rationale for these changes, and, where available, review their empirical basis. In addition, they review two proposed changes that were not incorporated into DSM-III-R. They conclude by calling for an increasingly rigorous and data-based process of nosologic revision.

Adult↗
PubMed1988

Having a dream. A research strategy for DSM-IV.

Psychiatric research has had a major impact on both DSM-III and its revision (DSM-III-R). We propose a strategy to maximize the impact of psychiatric research on DSM-IV. This strategy is an elaboration of a study design that was particularly helpful in developing criteria for several of the problematic diagnostic categories of DSM-II-R. The strategy, called a "multiplex study design," employs (1) multiple collaborating centers, (2) multiple experts in the diagnoses being studied at each site, and (3) multiple diagnostic criteria sets so that alternative definitions of disorders can be compared in terms of (4) multiple external validity criteria, such as familial aggregation, course, and differential response to treatment. This strategy is a particularly efficient method for providing an empiric base for further revisions in our official classification of mental disorders.

Autistic Disorder↗