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PubMed1988

Divergence and convergence of diagnoses for depression between ICD-9 and DSM-III-R.

Contrasting the classification systems ICD-9 and DSM-III-R, a comparison of diagnoses for unipolar depressive disorders is presented from a sample of 168 psychiatric outpatients. A relatively clear correspondence existed between ICD-9 endogenous depression and DSM-III-R major depression. Neurotic depression (ICD-9) divided into either dysthymia or major depression in DSM-III-R. A generally greater variety of corresponding ICD-9 diagnoses was observed for DSM-III-R categories, since patients with eating disorders, alcohol or drug dependence, or with neuroses other than depressive type often received an additional specific DSM-III-R diagnosis for depression. For ICD-9 diagnostics, a decreased threshold was found for diagnosing depressive reaction, as compared with the equivalent DSM-III-R diagnosis of adjustment disorder with depressed mood. A new technique is introduced in order to adjust corresponding proportions according to base rate differences.

Adjustment Disorders↗
PubMed1992

Is the DSM-III-R category of mood disorders too broad? Personality findings.

In the DSM-III and DSM-III-R the affective or mood category has been widened and mood-incongruent psychotic affective illness (MICPAI) included. The present study was undertaken to determine whether this broad mood category is still homogeneous. Personality factors were used as parameters. Minnesota Multiphasic Personality Inventory findings of 54 patients with MICPAI were compared with those of 21 probands with a DSM-III typical affective disorder and with those of 15 DSM-III schizophrenics. It was shown that MICPAI differed significantly from typical affective disorder, but not from schizophrenia, in particular regarding the subscales "schizophrenia" and "psychopathic deviate". When MICPAI was subdivided into the depressed and manic type, the depressed type was found to be more closely related to schizophrenia (with respect to the subscales "paranoia" and "schizophrenia"), whereas the manic type hardly differed from affective disorder. Whether this result is due to diagnostic inaccuracies is discussed. Our finding that MICPAI differs from typical affective disorder with respect to personality is in accordance with heredity and outcome studies demonstrating that MICPAI is associated with a higher risk for schizophrenia in first-degree relatives and with worse outcomes when compared with typical affective disorder. It can thus be concluded that the decision to include MICPAI in the affective or mood category of the DSM-III or DSM-III-R has rendered this category more heterogeneous.

Depressive Disorder↗
PubMed1986

Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria.

Two hundred and eighty-three chronic pain patients, consecutive admissions to the Comprehensive Pain Center of the University of Miami School of Medicine, received an extensive psychiatric evaluation based upon the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria and flowsheets. All patients received the following type of diagnoses: DSM-III axis I; DSM-III axis II, and personality type. The distribution of assigned diagnoses for the entire patient sample was reviewed and a statistical comparison between male and female patients was performed with regards to the prevalence of each diagnosis. Anxiety syndromes and depression of various diagnostic types were the most frequently assigned axis I diagnoses with over half the patient sample receiving each of these diagnoses. Males were significantly overrepresented in the axis I diagnoses of intermittent explosive disorders, adjustment disorders with work inhibitions, and alcohol abuse and other drug dependence, while females were significantly overrepresented in disorders of current depression of various diagnostic types and somatization disorders. 58.4% of the patients fulfilled criteria for axis II personality disorder diagnoses. The most frequently personality disorders found in the patient group were dependent (17.4%), passive aggressive (14.9%), and histrionic (11.7%). Males were significantly overrepresented in paranoid and narcissistic disorders while females were overrepresented in histrionic disorder. The most frequent personality types found in the patient group were compulsive (24.5%) and dependent (10.6%). All personality types were similarly distributed between the sexes. The results of the present study were compared to a previous study of DSM-III diagnoses in chronic pain patients and are discussed in terms of the prevalence of DSM-III diagnoses in the general population. Questions are raised as to the applicability of certain DSM-III diagnoses in the chronic pain population.

Adjustment Disorders↗
PubMed1989

Scanning and transmission electron microscopy of biodegradable microspheres (DSM) in blood vessels.

A type of biodegradable microsphere (DSM), approximately 45 microns in diameter, made of polymerized potato starch (Pharmacia, Sweden) was intravenously injected into rats to observe the state of DSM in small blood vessels in the kidney and liver at the electron microscopic level. Prior to their digestion with amylase, individual DSM changed their round shape to an irregularly folded one to occupy almost the whole area of the lumen. At the transmission electron microscopic level, DSM were impregnated with colloidal iron and were easily identified. Interaction of the iron labelled DSM with the surface of endothelial cells was unexpectedly loose and no adherence or fusion of this surface was observed. The starch substance was not visible in the pinocytotic vesicles of the endothelium. These findings suggest the independent profile of DSM in situ.

Animals↗
PubMed2004

Biodistribution of 10B in a rat liver tumor model following intra-arterial administration of sodium borocaptate (BSH)/degradable starch microspheres (DSM) emulsion.

We reported that intra-arterial administration of borocaptate sodium (BSH)/lipiodol emulsion provided selectively high (10)B concentrations (approximately 200 ppm 6 h after administration) in experimental liver tumors. In the present study, we investigated the pharmacokinetics of BSH following intra-arterial administration of BSH with other embolizing agent, degradable starch microspheres (DSM). The (10)B concentration in the tumor at 1 h after administration of BSH with DSM was 231 ppm. At 6 h, the (10)B concentration in the tumor in BSH with DSM group was 81.5 ppm. The (10)B concentration in the liver at 1 h after administration of BSH with DSM was 184 ppm. At 6 h, the(10)B concentration in the liver in BSH with DSM group was 78 ppm. The tumor/liver (10)B concentration ratios (T/L ratio) in the "BSH+DSM" group were significantly smaller than those in the "BSH+lipiodol" group at 1 h (1.4 vs. 3.6) and 6h (1.1 vs. 14.9). BSH/DSM-boron neutron capture therapy (BNCT) was not suitable for treatment of multiple liver tumors due to the low T/L (10)B concentration ratio. However, the high (10)B accumulation in the liver tumors following intra-arterial administration of BSH/DSM emulsion suggests that BSH/DSM-BNCT has the potential for application to malignant tumors in other sites.

Animals↗
PubMed2006

Challenging DSM-IV criteria for hypomania: diagnosing based on number of no-priority symptoms.

BACKGROUND: DSM-IV definition of hypomania of bipolar-II disorder (BP-II), which includes elevated/irritable mood change as core feature (i.e., it must always be present), is not based on sound evidence. STUDY AIM: Following classic descriptions of hypomania, was to test if hypomania could be diagnosed on the basis of its number (9) of DSM-IV symptoms, setting no-priority symptom. METHODS: Consecutive 422 depression-remitted outpatients were re-interviewed by a mood specialist psychiatrist using the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version [a semi-structured interview modified by Benazzi and Akiskal (J Affect Disord, 2003; J Clin Psychiatry, 2005) to improve the probing for BP-II] in a private practice. History of episodes of subthreshold (i.e., 2 or more symptoms) and threshold (i.e., meeting DSM-IV criteria of elevated mood plus at least 3 symptoms, or irritable mood plus at least 4) hypomania, lasting at least 2 days, and which were the most common symptoms during the episodes, were systematically assessed. RESULTS: Bipolar-II disorder (BP-II) patients (according to DSM-IV criteria, apart from hypomania duration) were 260, and major depressive disorder (MDD) patients were 162. Mood change was present in all BP-II by definition. The most common symptoms were overactivity, which was present in almost all BP-II, followed by elevated mood and racing thoughts. ROC analysis of the number of hypomanic symptoms predicting BP-II found that a cut point of 5 or more symptoms over 9 had the best combination of sensitivity (90%) and specificity (84%), and the highest figure of correctly classified (87%) BP-II. History of episodes of 5 or more hypomanic symptoms was met by almost all BP-II. LIMITATIONS: Single interviewer. CONCLUSIONS: Following classic descriptions of hypomania, not setting any priority among the three basic domains of hypomania (mood, thinking, behavior), results suggest that a cutoff number of 5 symptoms over 9 (of those listed by DSM-IV) could be used to diagnose hypomania of BP-II. Diagnosing hypomania by counting a checklist of symptoms should make it easier to diagnose BP-II, and should reduce the current high misdiagnosis of BP-II as MDD, significantly impacting the treatment of depression.

Adult↗
PubMed2005

Identification of linear plasmid pAM1 in the flavonoid degrading strain Actinoplanes missouriensis(T) (DSM 43046).

By pulsed-field gel electrophoresis, a linear DNA element of about 100 kb was identified in Actinoplanes missouriensis(T) DSM 43046, which grows on the flavonoids hesperidin, rutin and quercetin, and which contains a CO forming quercetinase. Among six Actinoplanes species and strains tested, including A. globisporus(T) DSM 43857, A. philippinensis(T) DSM 43019, A. brasiliensis(T) DSM 43805, A. auranticolor(T) DSM 43031, and A. utahensis(T) DSM 43147, only the A. missouriensis strain exhibited such a genetic element. The linear plasmid, named pAM1, has proteins covalently attached to its 5'-ends like other linear replicons of actinomycetes. Attempts to cure pAM1 failed, however a mutant with reduced plasmid content was obtained, which showed reduced ability to degrade the flavonoid rutinosides rutin and hesperidin. Plasmid pAM1 is the first extrachromosomal genetic element identified in an Actinoplanes species and may be useful to develop genetic tools for biotechnologically important Actinoplanes strains.

Biodegradation, Environmental↗
PubMedDate not supplied

Patterns of covariation of DSM-IV personality disorders in a mixed psychiatric sample.

The covariation patterns of DSM-IV personality disorders (PDs) were studied in 431 consecutively admitted psychiatric patients. The co-occurrence rate was greater than 50% for all DSM-IV PDs. Both bivariate association tests and loglinear models showed distinct significant covariation patterns among PDs which were stable across confounder strata. DSM-IV PD clusters were not replicated, with the exception of cluster A. Principal-component analysis (PCA) showed the presence of 3 latent dimensions, thus explaining the DSM-IV PD covariation patterns. These results seem to stress the inadequacy of the DSM-IV categorical model of PD assessment. The need for a reduction of axis II categories and the inclusion of a dimensional model in the diagnostic assessment of DSM-IV PDs are discussed.

Adult↗
PubMedDate not supplied

Latent structure analysis of DSM-IV borderline personality disorder criteria.

The aim of this study was to evaluate the structure of DSM-IV borderline personality disorder (BPD) criteria. The study group consisted of 564 consecutively admitted inpatients and outpatients. BPD criteria discriminatory power was tested by using corrected item-to-total and item-to-diagnosis correlations. Weighted least-squares (WLS) confirmatory factor analysis (CFA) was used to assess the fit of DSM-IV BPD unidimensional model. The categorical model of BPD was tested by exploratory latent class analysis (LCA). Item analysis suggested a hierarchy in BPD criteria discriminatory power, even if with different rank order with respect to the DSM-IV model. CFA showed a unifactorial structure with congeneric items as the best fitting model for DSM-IV BPD criteria (chi2 = 18.89, df= 27, P > .87). LCA showed evidence for three latent classes; heterogeneity was observed only among subjects falling below DSM-IV diagnostic threshold for BPD. These results support the categorical model of BPD, even if with several differences with respect to DSM-IV.

Adult↗
PubMed2006

Gender differences in the prevalence of DSM-IV and ICD-10 PTSD.

BACKGROUND: Gender differences in the prevalence of post-traumatic stress disorder were examined by analysing discrepancies between the DSM-IV and ICD-10 diagnostic systems. METHOD: Data from the Australian National Survey of Mental Health and Well-Being (n=10641) were analysed at the diagnostic, criterion and symptom level for DSM-IV and ICD-10 PTSD for males versus females. RESULTS: While there was a significant gender difference in the prevalence of PTSD for ICD-10, no such difference was found for DSM-IV. The pattern of gender difference at the diagnostic level was mirrored in the pattern of gender differences at the criterion level for both DSM-IV and ICD-10. Females only endorsed three symptoms at a significantly higher rate than males. For all other symptoms, endorsement was equal. This apparently small gender difference at the symptom level was sufficient to cause the gender difference at the diagnostic level for ICD-10, but not DSM-IV because of the different manner in which symptoms are configured into criteria in each of the diagnostic systems. CONCLUSIONS: Gender differences in ICD-10 PTSD but not in DSM PTSD diagnoses are attributable in this study to different patterns of endorsement of symptoms by males and females. Possible reasons for the differential endorsement of symptoms and implications for the use of epidemiological instruments are discussed.

Adult↗
PubMed1996

A short DSM-III-R-based diagnostic instrument for screening mental disorders in geriatric institutions.

A screening instrument based on the DSM-III-R was developed in order to differentiate aged persons with or without a DSM-III-R mental disorder. The usefulness of this instrument was investigated in six geriatric institutions with 171 residents aged 65 to 93 years in Finland. The nursing staff independently rated the mental status of residents; researchers (a psychiatrist and general practitioner) made a diagnosis based on DSM-III-R criteria. The majority of the residents (mean 69%, varying from 33% to 84% in different institutions) had a DSM-III-R mental disorder. This screening instrument functioned well in differentiating residents without a mental disorder from those with DSM-III-R mental disorder: The nursing staff's agreement was 90%, kappa.71, sensitivity .90, and specificity .88. However, only half the cases of depression were diagnosed correctly: Sensitivity was .50 and specificity .95. With a more specific 9-class diagnostic instrument based mainly on DSM-III-R categories, agreement was only moderate (68%) and kappa .59. The instrument developed in this study seemed to be a useful screening method when applied by the staff, but accurate diagnostics require psychiatric knowledge, especially of depression.

Aged↗
PubMed2001

Does DSM-IV Asperger's disorder exist?

DSM-IV criteria for autistic and Asperger's disorders were applied to 157 children with clinical diagnoses of autism or Asperger's disorder. All children met the DSM-IV criteria for autistic disorder and none met criteria for Asperger's disorder, including those with normal intelligence and absence of early speech delay. The reason for this was that all children had social impairment and restricted and repetitive behavior and interests (required DSM-IV symptoms for both autistic and Asperger's disorders) and all had a DSM-IV communication impairment (which then qualified them for a diagnosis of autistic disorder and not Asperger's disorder). Communication problems exhibited by all children were impaired conversational speech or repetitive, stereotyped, or idiosyncratic speech (or both), which are DSM-IV criteria for autism. These findings are consistent with those of 5 other studies and indicate that a DSM-IV diagnosis of Asperger's disorder is unlikely or impossible.

Adolescent↗
PubMed2000

Persistence of Lactobacillus plantarum DSM 9843 on human tonsillar surface after oral administration in fermented oatmeal gruel. A pilot study.

The occurrence of Lactobacillus plantarum DSM 9843 on tonsillar scrapings was studied after single-dose administration. Six healthy volunteers gargled 100 ml of fermented oatmeal gruel containing 2 x 10(11) colony forming units (cfu) of Lb. plantarum DSM 9843 for 2 min and then swallowed it. Two healthy volunteers drank 50 ml fermented oatmeal gruel (containing 1 x 10(11) cfu of Lb. plantarum DSM 9843) mixed with 50 ml fruit juice, and in another experiment, 5 ml fermented oatmeal gruel (containing 1 x 10(10) cfu of Lb. plantarum DSM 9843) mixed with 95 ml fruit juice. Lb. plantarum DSM 9843 were found in tonsillar scrapings 4-8 h after intake of 2 x 10(11) cfu, for 5-8 h after intake of 1 x 10(11) cfu, and finally up to 4 h after intake of 1 x 10(10) cfu. On electron microscopy micrographs, short rod-shaped bacteria were visible 1 h after intake of the fermented oatmeal gruel, but not 2 h after intake. The results suggest that Lb. plantarum DSM 9843 possess an ability to adhere to tonsillar cells.

Administration, Oral↗
PubMedDate not supplied

Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note.

Over the years, the DSM diagnosis of gender identity disorder (and its predecessors gender identity disorder of childhood [GIDC] and transsexualism) has attracted controversy as a mental disorder, for its diagnostic criteria, as a target of therapeutic intervention, and for its relationship to a homosexual sexual orientation. Another point of controversy is the claim that the diagnosis of GIDC was introduced into the DSM-III in 1980 as a kind of "backdoor maneuver" to replace homosexuality, which was deleted from the DSM-II in 1973. In this article, we challenge this historical interpretation and provide an alternative account of how the GIDC diagnosis (and transsexualism) became part of psychiatric nosology in the DSM-III. We argue that GIDC was included as a psychiatric diagnosis because it met the generally accepted criteria used by the framers of DSM-IIIfor inclusion (for example, clinical utility, acceptability to clinicians of various theoretical persuasions, and an empirical database to propose explicit diagnostic criteria that could be tested for reliability and validity). In this respect, the entry of GIDC into the psychiatric nomenclature was guided by the reliance on "expert consensus" (research clinicians)--the same mechanism that led to the introduction of many new psychiatric diagnoses, including those for which systematic field trials were not available when the DSM-III was published.

Child↗
PubMed2002

DSM-IV mania symptoms in a prepubertal and early adolescent bipolar disorder phenotype compared to attention-deficit hyperactive and normal controls.

OBJECTIVE: To compare the prevalence of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) mania symptoms in a prepubertal and early adolescent bipolar disorder phenotype (PEA-BP) to those with attention deficit hyperactivity disorder (ADHD) and normal community controls (CC). METHODS: To optimize generalizeability, subjects with PEA-BP and ADHD were consecutively ascertained from outpatient pediatric and psychiatric sites, and CC subjects were obtained from a random survey. All 268 subjects (93 with PEA-BP, 81 with ADHD, and 94 CC) received comprehensive, blind, baseline research assessments of mothers about their children and of children about themselves. PEA-BP was defined by DSM-IV mania with elation and/or grandiosity as one criterion to ensure that subjects had one of the two cardinal symptoms of mania and to avoid diagnosing mania only by criteria that overlapped with those for ADHD. RESULTS: Five symptoms (i.e., elation, grandiosity, flight of ideas/racing thoughts, decreased need for sleep, and hypersexuality) provided the best discrimination of PEA-BP subjects from ADHD and CC controls. These five symptoms are also mania-specific in DSM-IV (i.e., they do not overlap with DSM-IV symptoms for ADHD). Irritability, hyperactivity, accelerated speech, and distractibility were very frequent in both PEA-BP and ADHD groups and therefore were not useful for differential diagnosis. Concurrent elation and irritability occurred in 87.1% of subjects with PEA-BP. Data on suicidality, psychosis, mixed mania, and continuous rapid cycling were also provided. CONCLUSION: Unlike late teenage/adult onset bipolar disorder, even subjects with PEA-BP selected for DSM-IV mania with cardinal symptoms have high rates of comorbid DSM-IV ADHD. High rates of concurrent elation and irritability were similar to those in adult mania.

Adolescent↗
PubMed2005

The craving withdrawal model for alcoholism: towards the DSM-V. Improving the discriminant validity of alcohol use disorder diagnosis.

AIMS: To compare the discriminant validity of the DSM-IV and the ICD-10 classification of alcohol use disorders (AUD) with an alternative classification, the craving withdrawal model (CWM). CWM requires craving and withdrawal for the diagnosis of alcohol dependence and raises the alcohol abuse threshold to two DSM-IV AUD criteria. METHODS: Data were derived from The Netherlands Mental Health Survey and Incidence Study, a large representative sample of the general Dutch population. In the present study, only non-abstinent subjects were included (n=6041). Three diagnostic systems (DSM-IV, ICD-10, and CWM) were compared using the following discriminant variables: alcohol intake, psychiatric comorbidity, functional status, familial alcohol problems, and treatment sought. RESULTS: The year prevalence of CWM alcohol dependence was lower than the prevalence of ICD-10 and DSM-IV dependence (0.3% vs 1.4% and 1.4%). The year prevalence of abuse was similar for CWM and DSM-IV (4.7 and 4.9%), but lower for ICD-10 harmful use (1.7%). DSM-IV resulted in a poor distinction between normality and abuse and ICD-10 resulted in a poor distinction between harmful use and dependence. In contrast, the CWM distinctions between normality and abuse, and between abuse, and dependence were significant for most of the discriminant variables. CONCLUSION: This study indicates that CWM improves the discriminant validity of AUD diagnoses. The predictive validity of the CWM for alcohol and other substance use disorders remain to be studied.

Adult↗
PubMed1990

Using DSM-III criteria to diagnose delirium in elderly general medical patients.

Studies of delirium in general medical populations have used criteria for delirium different from current DSM-III or DSM-IIIR criteria of the American Psychiatric Association, or have used DSM-III or DSM-IIIR criteria without operationalizing the components of these criteria. Therefore this prospective study was conducted to establish an approach to operationalizing DSM-III criteria and to determine the incidence and prevalence of delirium. Two hundred thirty-five consecutive subjects age 70 and over admitted to general medicine underwent daily standardized screening. Patients with low scores on screening tests or clinical evidence suggestive of any psychiatric disorder and controls were seen by a psychiatrist, who determined whether delirium was present by applying explicit operational definitions to each component of the DSM-III criteria for delirium. We conclude that the syndrome of delirium as defined by the American Psychiatric Association is prevalent on admission among elderly on general medical services, but the number of cases developing in the hospital is much less than often stated in the literature.

Aged↗
PubMed1992

A sex caused inconsistency in DSM-III-R: the definition of mental disorder and the definition of paraphilias.

The DSM-III-R definition of mental disorder is inconsistent with the DSM-III-R definition of paraphilias. The former requires the suffering or increased risk of suffering some harm while the latter allows that deviance, by itself, is sufficient to classify a behavioral syndrome as a paraphilia. This inconsistency is particularly clear when examining the DSM-III-R account of a specific paraphilia, Transvestic Fetishism. The author defends the DSM-III-R definition of mental disorder and argues that the DSM-III-R definition of paraphilias should be changed. He recommends that the diagnostic criteria for specific paraphilias, particularly that for Transvestic Fetishism, be changed to make them consistent with the DSM-III-R definition of mental disorder.

Female↗