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PubMed1999

[Prevalence of alcohol abuse and alcohol dependence according to DSM-IV criteria in first year university students].

OBJECTIVE: To determine the prevalence of alcohol problems in first-year college students. DESIGN: Cross-sectional. METHOD: Data on the prevalence of alcohol abuse or dependence according to DSM-IV criteria were collected in the period November 1995-April 1996 among college freshmen at the Catholic University of Louvain (Belgium). 3564 consecutive students completed a questionnaire which assessed drinking behaviour (Composite International Diagnostic Interview CIDI, Section J) and identified students at risk as defined by DSM-IV criteria. Our study included a large number of college freshmen, so we were able to perform our analyses with a large statistical power. All students had the opportunity to refuse their co-operation, but there were no non-responders, so selection bias was absent. The medical ethical committee of the KU Leuven approved this study. RESULTS: Of all 3564 consecutive students 501 (14.1%; 95% confidence interval (95% CI): 12.9-15.3) met DSM-IV criteria of alcohol abuse (n = 373; 10.5%; 9.5-11.5) or of alcohol dependence (n = 128; 3.6%; 3.0-4.2). Of the male students 301 (18.5%; 16.7-20.5) met the criteria of alcohol abuse and 96 (5.9%; 4.8-7.1) of alcohol dependence, of the female students 72 (3.7%; 2.9-4.6) and 32 (1.6%; 1.2-2.3) respectively. More than 10% (12.2%; 11.1-13.3) of these freshmen operated a vehicle under influence. This contributed in a major way to the DSM-IV conclusion. CONCLUSION: In this, one of the first studies among college freshmen using DSM-IV criteria the prevalence of alcohol abuse was in excess of 10%. In addition a substantial proportion of college freshman appeared to be alcohol dependent according to DSM-IV criteria.

Adolescent↗
PubMed2003

[A version of DSM-IV criteria adapted for adolescents and applied to young smokers].

OBJECTIVES: To evaluate nicotine dependence in adolescent smokers using a version of DSM-IV criteria for nicotine dependence adapted for adolescents (DSM-IVa). To establish its usefulness and the most relevant items for diagnosing adolescent smokers. POPULATION AND METHODS: Two thousand six hundred forty-seven schoolchildren between 10 and 17 years old were surveyed. A sample size was calculated for each year of age, using the finite population equation with the addition of 10% so that the absolute error would not increase at the end of the study if questionnaires were withdrawn. The sample was stratified by sex and type of school for each age group, with allocation to each stratum proportional to the number of individuals. Schools and students were selected using random number tables. The questionnaire collected the most significant personal data and information related to DSM-IVa criteria. RESULTS: Smokers made up 23.1% of the sample, and 63.5% of them smoked daily. According to the DSM-IVa criteria, 70.7% of the smokers were nicotine dependent. The DSM-IVa had a kappa value of 1 and internal consistency was good (Cronbach's alpha: 0.5598). CONCLUSIONS: The DSM-IVa is useful in the studied population, although not perfect. According to the criteria, 70.7% of those interviewed were already nicotine dependent. The key questions were those that referred to the presence of nicotine withdrawal syndrome symptoms and the need to spend a large amount of free time obtaining or smoking cigarettes.

Adolescent↗
PubMed2003

[Correlation between carbon-monoxide levels in exhaled air and nicotine-dependence measurements systems (DSM-IV, Fagerström test and ARU-SMQ-9) in adolescent smokers].

BACKGROUND AND OBJECTIVE: If we are capable of 1) determining the correlation, in young smokers, between carbon-monoxide levels in exhaled air (CO) and carboxihemoblobine (COHb) (cooximetrically determined) and 2) adapting the versions of the nosologic criteria DSM-IV for nicotine-depencence (DSM-IVa), Fagerström Test (FTNDa), and ARU-SMQ-9a Test to adolescents, then we may be able to establish how useful such tests are to measure nicotine-ependences in adolescents. SUBJECTS AND MEHTOD: Cross-sectional, observation-based study carried out in 41 schools. 2,647 students aged 10 to 17 years were surveyed. The size of the sample was calculated for eacha nd using the equation of finite population. For each age, the sample was stratified according to sex and type of school. Schools and students were chosen by using the table of random numbers. Teenagers filled up a questionnaire which included DSM-IVa, FTNDa, and ARU-SMQ-9a and were subsequently given a cooximery. RESULTS: 23.1% were smokers. The correlation between the levels of CO and the nicotine-dependence tests was: DSM-IVa rho o = 0.3390 (p = 0.0000); FTNDa rho o = 0.5853 (p 0 0.000); ARU-SMQ-9a rho o = 0.4670 (p = 0.000). The correlation with the levels of carboxihemoglobine was: DSM-IVa rho o = 0.3369 (p = 0.000); FTNDa *o = 0.5498 (p = 0-000); ARU-SMQ-9a rho o = 0.4460 (p 0 0-000). The study was based on 583 smoking scholars who underwent the cooximetry. CONCLUSIONS: The correlation between DSM-IVa, FTNDa, and ARU-SMQ-9a and the levels of CO and COHb in young smokers is low but meaninful. In our opinion, research to find new, simple, cheap, and easily-accessible tools allowing the correct diagnosis and follow-up of young smokers must continue.

Adolescent↗
PubMedDate not supplied

Diagnostics discrepancies between ICD-10 and DSM-IV in personality disorders.

INTRODUCTION: 50 % of the patients seen in the mental health clinics have personality disorders and their diagnosis is very important to establish the patient's prognosis and treatment. The clinician usually only uses one nosology, the ICD-10 or the DSM-IV and is aware of the differences between them. However, he/she gives preference to his/her favorite nosology. MATERIAL AND METHOD: A total of 248 patients seen in a mental health clinic were included in the study. They were diagnosed of anxiety (n = 121) and depressive (n = 127) disorders, with a mean age of 32.3 years for anxiety disorders and 32.4 years depressive disorders. The International Personality Disorders Examination (IPDE) Screening Questionnaire in its DSM-IV and ICD-10 versions was administered to observe the degree of concordance between the two nosologies. RESULTS AND DISCUSSION: The female population predominated in our sample, these being 35.5 % men with anxiety disorders and 65,5 % women, and 29.10 % men and 70.9 % women with depressive disorders. An observational study was performed by studying the percentage with 3 or more positive items and also percentage with 6 or more positive items. It was observed that the DSM-IV version produced more positive diagnoses and more comorbidity. Thus, it is necessary to consider whether the ICD-10 version subdiagnoses personality disorders or the DSM-IV version gives false positives. The qualitative differences between the ICD-10 and the DSM-IV must also be considered. The ICD-10 does not include narcissistic and schizotypal personality disorders and subdivides the borderline personality disorder into two subcategories, so that a given patient can receive different diagnoses according to the nosology used. CONCLUSIONS: In the patient sample studied, diagnostic discrepancies in personality disorders between DSM-IV and ICD-10 are so important that the World Health Organization and the American Psychiatry Association should consider unifying categories and diagnostic criteria of personality disorders in the next nosologies.

Adult↗
PubMed1989

Two kinds of borderline concepts. Conceptual and empirical agreement between DSM-III, DIB, and Kernberg.

The definitional criteria of the 3 systems (DSM-III, DIB and Kernberg) have been compared. While there is rather weak agreement between the criteria of DIB and those of DSM-III, there is no agreement at all between Kernberg's criteria and those of the other 2 systems. When the 3 systems are compared in terms of empirical diagnosis, the agreement between DSM-III and DIB is moderate and clearly stronger than that between Kernberg and either DSM-III or DIB. In terms of sensitivity, the Kernberg borderline comprises the DSM-III and DIB borderlines as subsets. The findings are consistent with the idea that Kernberg's borderline concept is an instance of a severity or maturity level construct, while DSM-III and DIB are characterological constructs, orthogonally related to the level construct.

Borderline Personality Disorder↗
PubMed1989

[Experimental study of normal liver regeneration in hepatic arterial infusion with degradable starch microspheres (DSM)].

Influence of hepatic arterial infusion with degradable starch microspheres (DSM) or with anti-cancer drug or with both for normal liver regeneration in rat was determined by histological and microautoradiographical examination and liquid scintilation before or after 70% hepatectomy. DSM was seen in interlobular artery in early phase after hepatic arterial infusion, but disappeared into the central vein by degrees for 2 hours later. Adriamycin (ADM) in serum was detected for a long time after hepatic arterial infusion with DSM + ADM. In the heart muscle, a significantly lower concentration of ADM was seen in the DSM + ADM group than in the ADM only group. In the case of hepatic arterial infusion with DSM only after hepatectomy, there was no influence on normal liver regeneration. No significant difference was seen between hepatic arterial infusion and intravenous infusion with ADM only. However, in the case of hepatic arterial infusion with DSM + ADM after hepatectomy, a significant difference was seen in the inhibition of liver regeneration from any other groups.

Animals↗
PubMedDate not supplied

[Psychopathological profile of acute schizophrenic syndromes diagnosed according to ICD-10 and DSM-IV criteria].

Diagnostic and symptomatological profiles of schizophrenic syndromes diagnosed according to ICD-10 and DSM-IV were compared. For this reason a group of patients fulfilling at least one of these sets of criteria was created and then diagnostic and symptomatological profile was compared between those who fulfilled the ICD-10 and those who fulfilled DSM-IV criteria. 105 inpatients hospitalized in acute phase of their first or one of consecutive episodes were included--102 of them had fulfilled ICD-10, and 90 DSM-IV criteria of schizophrenia. Diagnostic concordance between the two systems of criteria was high (83%). Differentiation of diagnostic profile (i.e. difference between frequency of fulfilling the specific requirements of ICD-10 or DSM-IV criteria) of the symptoms in these two groups was not significant, expert of 6-month criterion of duration of illness, which was significantly less frequently valid in ICD-10 syndromes group. A comparison of symptomatological profiles (i.e. frequency and intensity of symptoms) of schizophrenic syndromes diagnosed by ICD-10 or DSM-IV criteria and described by several rating scales (PANSS, SAPS/SANS, KOSS-S) did not show any significant differences. Results suggested that despite of different ways of defining the schizophrenic syndromes in both diagnostic systems, disorders manifested in the groups of patients created by means of them are very similar in psychopathological picture. This seems to be a significant change in comparison to more prominent differences contrasting the previous versions of the diagnostic systems (i.e. ICD-9 and DSM-III-R).

Acute Disease↗
PubMed1984

Exclusion criteria of DSM-III. A study of co-occurrence of hierarchy-free syndromes.

The diagnostic criteria of the third edition of the DSM-III often state that one diagnosis cannot be made if it is "due to" another disorder. Using data from the National Institute of Mental Health Diagnostic Interview Schedule, with a sample of 11,519 subjects from a community population, we found that if two disorders were related to each other according to the DSM-III exclusion criteria, then the presence of a dominant disorder greatly increased the odds of having the excluded disorder. We also found that disorders, which DSM-III says are related to each other, were more strongly associated than disorders, which DSM-III says are unrelated. However, we also found there was a general tendency toward co-occurrence, so that the presence of any disorder increased the odds of having almost any other disorder, even if DSM-III does not list it as a related disorder. We concluded that empirical studies are needed to study the assumptions underlying the use of a diagnostic hierarchy.

Adult↗
PubMed1985

Treatment outcome validation of DSM-III depressive subtypes. Clinical usefulness in outpatients with mild to moderate depression.

An algorithm for transcribing Research Diagnostic Criteria diagnoses for depressive disorders to similar categories in the DSM-III was applied to 103 depressed outpatients previously diagnosed by Research Diagnostic Criteria. All had Hamilton Depression Rating Scale scores of 18 or less. Among 64 patients completing a six-week, double-blind study comparing desipramine hydrochloride with placebo, desipramine was significantly more effective than placebo in patients with DSM-III major depression but not in those with dysthymic disorder. Among patients with major depression, a significant drug-placebo response difference was demonstrated even in those without melancholia. These findings support the clinical usefulness of the DSM-III in the treatment of depressed outpatients. Independent of DSM-III diagnosis, however, evidence of panic attacks seemed to identify patients who benefited from desipramine therapy. This suggests that the DSM-III hierarchy, which excludes consideration of panic in patients with major depression, may require revision.

Anxiety Disorders↗
PubMed2003

Mild disorders should not be eliminated from the DSM-V.

BACKGROUND: High prevalence estimates in epidemiological surveys have led to concerns that the DSM system is overly inclusive and that mild cases should be excluded from future DSM editions. OBJECTIVE: To demonstrate that the DSM-III-R disorders in the baseline National Comorbidity Survey (NCS) can be placed on a severity gradient that has a dose-response relationship with outcomes assessed a decade later in the NCS follow-up survey (NCS-2) and that no inflection point exists at the mild severity level. METHODS: The NCS was a nationally representative household survey of DSM-III-R disorders in the 3-year time span 1990-1992. The NCS-2 is a follow-up survey of 4375 NCS respondents (76.6% conditional response rate) reinterviewed in 2000 through 2002. The NCS-2 outcomes include hospitalization for mental health or substance disorders, work disability due to these disorders, suicide attempts, and serious mental illness. RESULTS: Twelve-month NCS/DSM-III-R disorders were disaggregated into 3.2% severe, 3.2% serious, 8.7% moderate, and 16.0% mild case categories. All 4 case categories were associated with statistically significantly (P<.05, 2-sided tests) elevated risk of the NCS-2 outcomes compared with baseline noncases, with odds ratios of any outcome ranging monotonically from 2.4 (95% confidence interval, 1.6-3.4) to 15.1 (95% confidence interval, 10.0-22.9) for mild to severe cases. Odds ratios comparing mild to moderate cases were generally nonsignificant. CONCLUSIONS: There is a graded relationship between mental illness severity and later clinical outcomes. Retention of mild cases in the DSM is important to represent the fact that mental disorders (like physical disorders) vary in severity. Decisions about treating mild cases should be based on cost-effectiveness not current severity. Cost-effectiveness analysis should include recognition that treatment of mild cases might prevent a substantial proportion of future serious cases.

Adolescent↗
PubMed2006

The prevalence and correlates of DSM-IV intermittent explosive disorder in the National Comorbidity Survey Replication.

CONTEXT: Little is known about the epidemiology of intermittent explosive disorder (IED). OBJECTIVE: To present nationally representative data on the prevalence and correlates of DSM-IV IED. DESIGN: The World Health Organization Composite International Diagnostic Interview was used to assess DSM-IV anxiety disorders, mood disorders, substance use disorders, and impulse control disorders. SETTING: The National Comorbidity Survey Replication, a face-to-face household survey carried out in 2001-2003. PARTICIPANTS: A nationally representative sample of 9282 people 18 years and older. MAIN OUTCOME MEASURE: Diagnoses of DSM-IV IED. RESULTS: Lifetime and 12-month prevalence estimates of DSM-IV IED were 7.3% and 3.9%, with a mean 43 lifetime attacks resulting in 1359 dollars in property damage. Intermittent explosive disorder-related injuries occurred 180 times per 100 lifetime cases. Mean age at onset was 14 years. Sociodemographic correlates were uniformly weak. Intermittent explosive disorder was significantly comorbid with most DSM-IV mood, anxiety, and substance disorders. Although the majority of people with IED (60.3%) obtained professional treatment for emotional or substance problems at some time in their life, only 28.8% ever received treatment for their anger, while only 11.7% of 12-month cases received treatment for their anger in the 12 months before interview. CONCLUSIONS: Intermittent explosive disorder is a much more common condition than previously recognized. The early age at onset, significant associations with comorbid mental disorders that have later ages at onset, and low proportion of cases in treatment all make IED a promising target for early detection, outreach, and treatment.

Adolescent↗
PubMed1989

Alcohol dependence in ICD-9 and DSM-III-R: a comparative polydiagnostic study.

Diagnoses of alcohol dependence, using the classification systems ICD-9 and DSM-III-R, were compared in a sample of 215 psychiatric outpatients. A lower diagnostic threshold was obtained for DSM-III-R. This category tended to be more inclusive for relatively mild forms of inadequate alcohol use. Of those patients with ICD-9 alcohol dependence, 79% also met criteria for the corresponding DSM-III-R category, whereas 61% of subjects diagnosed as dependent according to DSM-III-R received the equivalent diagnosis in ICD-9. These results were obtained assuming equal base rates (sample frequencies) for dependence and abuse. Diagnoses were further compared with independently derived scores of the Munich Alcoholism Test (MALT), and the validity of DSM-III-R was found to be superior. Checklist-guided interviews had a positive impact upon accuracy and validity of diagnoses.

Adolescent↗
PubMed2002

Should mood reactivity be included in the DSM-IV atypical features specifier?

BACKGROUND: The definition of atypical depression is still an unsolved issue. DSM-IV atypical features specifier criteria always require mood reactivity, but why mood reactivity should be included is unclear. The study aim was to test whether mood reactivity should be included in DSM-IV atypical features specifier. METHODS: Consecutively, 164 unipolar and 241 "soft" bipolar II major depressive episode (MDE) outpatients were interviewed with the Structured Clinical Interview for DSM-IV. The DSM-IV criteria for atypical features specifier were strictly followed. Associations were tested by univariate logistic regression. RESULTS: MDE with atypical features was present in 41.4 % of patients. Bipolar II disorder was significantly more common in patients with atypical features. MDE with atypical features was significantly associated with bipolar II, female gender, lower age of onset, more axis I comorbidity, fewer psychotic features, and more depressive mixed states. In the whole sample, mood reactivity was significantly associated with all the atypical symptoms, apart from leaden paralysis, and all the other atypical symptoms were significantly associated with each other. In the bipolar II sub-sample, mood reactivity was associated with many, but not all, atypical symptoms, while in the unipolar sub-sample it was associated with no atypical symptom. Atypical symptoms were significantly more common in mood reactive than in non-mood reactive patients, apart from leaden paralysis. Bipolar II disorder and mood reactivity were strongly associated. CONCLUSIONS: Results may support the inclusion of mood reactivity in the DSM-IV atypical features specifier for bipolar II disorder, but not for unipolar depression.

Adult↗
PubMed2006

A psychometric evaluation of the DSM-IV pathological gambling diagnostic criteria.

Specific diagnostic criteria for pathological gambling (PG) have been available for 25 years, since the publication of DSM-III. Little research has examined the psychometric performance of the diagnostic criteria. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to examine the sensitivity, specificity and predictive values of the DSM-IV PG criteria for psychiatric outpatients who screened positive for a gambling problem. A total of 1709 psychiatric outpatients were evaluated with a semistructured diagnostic interview for PG. Of all patients 88 screened positive for PG, 40 of whom met DSM-IV diagnostic criteria for a lifetime history of PG. All ten DSM-IV criteria were significantly more frequent in the PG group. The sensitivity of the criteria ranged from 25.0% to 90.0% (mean = 67.8%), whereas specificity ranged from 62.5% to 100% (mean = 81.9%). Positive predictive values ranged from 64.1% to 100% (mean = 78.9%), and negative predictive values ranged from 61.5% to 90.7% (mean = 77.1%). Guidelines are recommended for determining whether a diagnostic criterion should be retained as part of the set of diagnostic criteria, and our results suggested that two of the DSM-IV PG criteria are candidates for elimination (criterion 8--commitment of illegal acts; criterion 10--reliance on others for financial assistance to relieve a desperate financial problem).

Adult↗
PubMed1993

The classification of panic disorders: from Freud to DSM-IV.

The authors trace the history of the classification of anxiety disorders, beginning with a detailed discussion of Freud's work on anxiety-neurosis as a basis for subsequent work. They discuss how anxiety disorders were described in DSM-I and DSM-II where Freud's concept of the anxiety neurosis was used as a major organizing principle. The revolutionary change in DSM-III is described in which the term and organizing principle of neurosis was dropped. The controversies that have arisen as a result of changes in DSM-III-R are discussed, particularly as they relate to compatibility with the International Classification of Diseases-10 (ICD-10) and especially with respect to the relationship and priority of panic and agoraphobia. Finally the authors discuss the process by which decisions will be made in DSM-IV where changes will be based on systematic reviews of empirical evidence whenever possible.

Anxiety Disorders↗
PubMedDate not supplied

Reliability and clinical validity of UM-CIDI DSM-III-R generalized anxiety disorder.

This is the first in a series of reports on the long-term test-retest reliability and procedural validity of the UM-CIDI, a modified version of the Composite International Diagnostic Interview used in the US National Comorbidity Survey (NCS). This report focuses on DSM-III-R Generalized Anxiety Disorder (GAD). The NCS administered the UM-CIDI to a nationally representative sample of 8098 respondents in the age range 15-54. A subsample of 36 respondents was subsequently selected for clinical reappraisal of GAD, consisting of reinterviewing by a clinical reappraisal interviewer who blindly readministered the GAD section of the UM-CIDI followed by an expanded version of the GAD section of the Structured Clinical Interview for DSM-III-R (SCID). The test-retest reliability of UM-CIDI/DSM-III-R lifetime GAD is Kappa = .53. When the requirement that the worries be excessive or unrealistic (A2) is removed, as in ICD-10 and partially in DSM-IV, reliability increases to Kappa = .78. The concordance between the baseline UM-CIDI diagnosis and the SCID diagnosis is Kappa = .35, while the cross-sectional concordance is Kappa = .47 (.66 when the Criterion A2 requirement is removed). Item-level analysis shows that lack of concordance between the UM-CIDI and the SCID is due largely to Criteria A2 and D. The A2 problem could be addressed either by deemphasizing the cognitive-evaluative component of GAD as in ICD-10, or by removing consideration of the term "unrealistic" from the criterion as in DSM-IV and more clearly specifying the meaning of the term "excessive". These options require further research on similarities and differences in risk factors, course, family history, and treatment response of more narrowly and broadly defined GAD. The Criterion D problem is due to lack of clarity in what constitutes a symptom occurring "often". This is clarified in DSM-IV. It is likely that this clarification will make it possible to develop more precisely structured questions to evaluate Criterion D in subsequent revisions of the UM-CIDI, resulting in improved reliability and validity.

Adolescent↗
PubMed1984

Mania and DSM-III schizophreniform disorder.

The investigations applied DSM-III schizophreniform criteria to 111 patients satisfying Feighner criteria for mania. Thirteen manics (12%) who met the DSM-III criteria were compared to the remaining manics. Manics satisfying DSM-III schizophreniform criteria had more depressive symptoms, but the two groups did not differ significantly on a number of demographic, clinical, and laboratory variables previously found to discriminate schizophrenics from affectives. The morbid risk for affective disorder in first-degree relatives of manics satisfying DSM-III schizophreniform criteria, although not significantly different, was one-third that of the remaining manics. However, the morbid risk for alcoholism in the relatives of the schizophreniform sample was twice that of the other group. The relative groups did not differ in combined morbid risk for alcoholism and affective disorder. The validity for psychiatric research of the DSM-III schizophreniform category is discussed in light of these findings.

Adult↗
PubMedDate not supplied

DSM-III melancholia: do the criteria accurately and reliably distinguish endogenous pattern depression?

The Structured Clinical Interview for DSM-III (SCID), Newcastle Endogenous/Reactive Index, Feinberg-Carroll Discriminant Index, and Hamilton Depression Scale were used to assess 70 depressed patients in order to determine similarities and differences in symptom structure and severity in those patients with and without endogenous/melancholic depression. All patients with melancholia according to DSM-III had definite endogenous major depression by the Research Diagnostic Criteria (RDC), but only 20 out of 35 patients with RDC definite endogenous depression were DSM-III melancholic. There was a greater difference in symptom pattern between those patients with definite endogenous depression and those with probable or non-endogenous depression than there was between the melancholic and non-melancholic definite endogenous depressives. A prerequisite for the valid delineation of a nosological category is the establishment of good reliability for diagnostic criteria. Using SCID ratings of audiotaped interviews of 9 patients (5 with major depression), the 8 raters in this study achieved a kappa coefficient of 0.79, suggesting that the use of a structured interview can improve the reliability of DSM-III diagnoses. Interrater reliabilities for most of the individual DSM-III major depressive episode and melancholia items were reasonable, but some were low. The low reliabilities could be improved by redefinition of the items to reduce ambiguity and by development of a SCID glossary.

Adult↗