Current DSM-IV Axis Research Articles

Predictors of Retention and Drug Use Among Patients With Opioid Use Disorder Transferred to a Specialty "Second Chance" Methadone Program.

Many patients in methadone treatment have difficulty achieving or maintaining drug abstinence, and many clinics have policies that lead to discharging these patients. We designed a pilot "Second Chance" (SC) program for patients scheduled to be discharged from other local methadone clinics to be transferred to our clinic. Determine whether SC patients' retention and opioid use is related to physical or mental health conditions, non-opioid substance use, or treatment features. From December 2012 to December 2014, this program enrolled 70 patients who were discharged from other clinics in the area; we were their last remaining option for methadone treatment. Unlike the clinic's standard policies, the treatment focus for SC patients was retention rather than abstinence. This program focused on connection to care (eg, psychiatric services) and enabled patients to continue receiving services despite ongoing substance use. Each patient was assessed at treatment entry and followed until June 2016 to evaluate outcomes. SC patients receiving disability benefits (n = 37) vs. non-disabled (n = 33) had significantly (P < .05) higher rates of current DSM-IV Axis I psychiatric diagnosis (97% vs 70%), prescriptions for opioids (84% vs 55%) and benzodiazepines (65% vs 27%), and higher methadone doses at admission (58 vs 46 mg) but did not differ significantly in rates of 6-month or 1-year retention (77% and 56%, respectively) or all-drug use (39% positive urine drug screens). Methadone doses >65 mg predicted significantly longer retention and less opioid use, but these effects were not moderated by baseline characteristics. Patients in methadone treatment struggling to achieve abstinence may benefit from retention-oriented harm-reduction programs. Higher methadone doses can improve retention and opioid abstinence despite psychiatric comorbidities. Further work is needed to improve program implementation and outcomes in this complex population.

P.1.k.018 Prevalence of nonmedical prescription drug misuse in a sample of Greek medical students

of education, marital status, current DSM-IV Axis I diagnosis, psychiatric and medical history, family history, medications taken on a regular basis, smoking status), including data on current treatment with psychotropic drugs, were recorded. Additional rating instruments were administered, including MINI-Plus 5.0 Structured Interview, Conners’ Adult ADHD Rating Scale (CAARS), SCID II-Personality Questionnaire, quality of life measures (EUROQOL EQ-5D), drug use test Drug Use Disorders Identification Test (DUDIT), Barratt Impulsiveness Scale (BIS). Preliminary results are based on a total sample of 105 subjects (49 males, 56 females). ASRS positive were 51 subjects that represents 49% of the total sample. The most frequent primary diagnoses were anxiety disorders (N = 68), followed by mood disorders (N = 22), personality disorders (N = 11) and others (N = 4). The patients were treated with a variety of psychotropic drugs; however, none of them were receiving specific pharmacotherapy for attention deficit hyperactivity disorder, i.e., stimulants or atomoxetine. The complete results report definite aADHD diagnosis as confirmed by CAARS, psychiatric comorbidity including personality disorders and impulsivity signs, illicit substance use, and socioeconomic status, including quality of life. Our results are the first data on the prevalence and drug treatment of adult attention deficit hyperactivity disorder in the Czech Republic. The findings confirmed earlier reports indicating high rates of comorbidity of aADHD with other psychiatric conditions. Our data suggest that attention deficit hyperactivity disorder in adults is in general poorly recognized and not treated adequately.

Borderline Personality Disorder, Exposure to Interpersonal Trauma, and Psychiatric Comorbidity in Urban Primary Care Patients

Objective: Few data are available on interpersonal trauma as a risk factor for borderline personality disorder (BPD) and its psychiatric comorbidity in ethnic minority primary care populations. This study aimed to examine the relation between trauma exposure and BPD in low-income, predominantly Hispanic primary care patients. Method: Logistic regression was used to analyze data from structured clinical interviews and self-report measures (n = 474). BPD was assessed with the McLean screening scale. Trauma exposure was assessed with the Life Events Checklist (LEC); posttraumatic stress disorder (PTSD) was assessed with the Lifetime Composite International Diagnostic Interview, other psychiatric disorders with the SCID-I, and functional impairment with items from the Sheehan Disability Scale and Social Adjustment Scale Self-Report (SAS-SR). Results: Of the 57 (14%) patients screening positive for BPD, 83% reported a history of interpersonally traumatic events such as sexual and physical assault or abuse. While interpersonal trauma experienced during adulthood was as strongly associated with BPD as interpersonal trauma experienced during childhood, noninterpersonal trauma was associated with BPD only if it had occurred during childhood. The majority (91%) of patients screening positive for BPD met criteria for at least one current DSM-IV Axis I diagnosis and exhibited significant levels of functional impairment. Conclusion: Increased awareness of BPD in minority patients attending primary care clinics, high rates of exposure to interpersonal trauma, and elevated risk for psychiatric comorbidity in this population may enhance physicians' understanding, treatment, and referral of BPD patients.

COMPLICATED GRIEF SYMPTOMS IN ANXIETY DISORDERS: PREVALENCE AND ASSOCIATED IMPAIRMENT

Previous research has identified high rates of comorbid anxiety disorders among individuals presenting with primary CG. In the present study, we examined the prevalence of comorbid CG in bereaved primary anxiety disorder (AD) patients compared to bereaved healthy controls. We also examined the impairment associated with comorbid CG in AD. Participants were 242 bereaved adults (mean (SD) age = 41.5 (13.1), 44.2% women) with a primary AD diagnosis, including generalized anxiety disorder (GAD; n = 57), panic disorder (PD; n = 49), posttraumatic stress disorder (PTSD; n = 29), and generalized social anxiety disorder (GSAD; n = 107), as well as 155 bereaved healthy controls with no current DSM-IV Axis I diagnosis (mean (SD) age = 43.0 (13.6), 51.0% women). CG symptoms were measured using the 19-item inventory of complicated grief (ICG), with threshold CG defined as an ICG score of ≥30. Quality of life and functional impairment were assessed with the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Range of Impaired Functioning Tool (LIFE-RIFT), respectively. Participants with primary ADs had significantly higher rates of threshold CG symptoms than bereaved controls (12.0% vs. 0.65%; Fisher's Exact P < 0.001). Rates of threshold CG were significantly elevated for each AD when compared to bereaved controls. After adjustment for age, sex, education, and comorbid major depressive disorder, threshold CG was associated with lower quality of life (β = -0.140, P = 0.023) and greater impairment (β = 0.141, P = 0.035) among individuals with AD. Our findings suggest that threshold CG is of clinical relevance in bereaved individuals with a primary anxiety disorder. Screening for CG in patients with ADs may be warranted.

1872 – Comorbidity between panic disorder with and without co-occurring depression and personality disorders: a systematic review

Panic disorder is an anxiety disorder characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms. The diagnosis frequently is associated to other comorbid axis-I psychiatric disorders, especially depressive disorders. Moreover panic disorder can also be comorbid with axis-II diagnosis of Personality Disorder 1 (PDs). The aim of this study was to evaluate the existing comorbidity between current DSM-IV axis I panic disorder with and without co-occurring depression and current DSM-IV axis II PDs. We review all database from 1987 until January 2012 of all relevant cross-sectional and case-control studies which evaluate the comorbidity between panic disorders and PDs. We found 97 possible papers, 20 entered in the review. Among patients with a current DSM-IV panic disorder 44.3% [34.6, 54.2] had any PDs; 6.3% [3.1, 10.4] had any cluster A-PDs; 17.9% [12.2, 24.2] any cluster B-PDs, and 34.9% [25.6, 44.7] had any cluster C-PDs. Among patients with a current DSM-IV panic disorder and co-occurring depression 61.8% [44.6, 77.7] had any personality disorder 7.2% [4.4, 10.5] had any cluster A-PDs; 24.0% [17.6, 30.9] any cluster B-PDs, and 38.6% [25.7, 52.2] had any cluster C-PDs. The comorbidity between Panic disorder and Personality disorders is common. Cluster C-PDs was the most frequent PDs subtype related to panic disorder. Personality disorders were more prevalent among individuals with panic disorder and co-occurring depression. Further evaluations including dimensional and characterial dimensions are needed.Goodwin RD, Brook JS, Cohen P. Panic attacks and the risk of personality disorder. Psychol Med. 2005;35:227-35.

The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief

Background Complicated grief (CG), variously called pathological or traumatic grief, is a debilitating syndrome that is not currently included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, ( DSM-IV) nomenclature. One issue that remains under debate is whether this condition can be clearly distinguished from other psychiatric disorders, such as major depression and posttraumatic stress disorder, with which CG frequently coexists. Methods Using a structured clinical interview for CG and the Structured Clinical Interview for DSM-IV, trained experienced raters conducted careful diagnostic assessments of individuals seeking treatment of bereavement-related distress. All study participants met criteria for a current CG syndrome. Liberal criteria were used to diagnose DSM-IV disorders, making no attempt to decide if symptoms could be explained by grief. Results Of 206 who met the criteria for CG, 25% had no evidence of a current DSM-IV Axis I disorder. When present, psychiatric comorbidity was associated with significantly greater severity of grief; however, even after adjustment for the presence of comorbidity, severity of CG symptoms was associated with greater work and social impairment. Limitations It is likely that our study underestimated the rate of CG without comorbidity because fewer DSM diagnoses would have been made if a judgment about grief had been taken into consideration. Conclusions Our data provide further support for the need to identify CG as a psychiatric disorder.

Psychiatric characteristics of 100 nonviolent suicide attempters in Hungary

Background: Previous international and Hungarian studies have shown that around 90% of persons making suicide attempts had at least one current mental disorder. The aim of this study was to investigate the current prevalence of DSM-IV Axis I psychiatric diagnoses among nonviolent suicide attempters in Budapest, Hungary. Methods: Using a structured interview (Mini International Neuropsychiatric Interview) determining DSM-IV Axis I diagnoses, the authors examined 100 consecutively contacted nonviolent suicide attempters (68 females and 32 males), aged between 14 and 66 (mean: 36.3 years). Results: A total of 64% of the subjects were repeated attempters, and the most common method was drug overdose (96%), in 21% of cases in combination with alcohol ingestion. A total of 92% of the attempters had at least one current DSM-IV Axis I psychiatric diagnosis. In 87% it was depressive disorder (59% unipolar major depression, 14% bipolar II depression and 12% bipolar I depression, 2% dysthymic disorder), in 46% anxiety disorders, in 27% substance-use disorder and in 2% psychotic disorder. Sixty percent of the attempters received two or more current Axis I diagnoses (35% depressive + anxiety disorder only, 15% depressive + substance-related disorder only, and 10% depressive + anxiety + substance-related disorder). Limitations: Nonviolent suicide attempters are not representative of all persons with attempted suicide and subthreshold Axis I diagnoses were not investigated. Conclusion: This study supports previous international and Hungarian findings on the high prevalence and comorbidity of Axis I mental disorders among persons with recent nonviolent suicide attempt.

Latent structure of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition personality disorder criteria

Aims This study investigated the internal construct validity of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV) personality disorders and explored alternative models to characterize the personality disorder traits. The relationship between the obtained personality disorder dimensions and measures of functioning and disability was examined. Methods The subjects in the study were 742 community-residing individuals who participated in the Hopkins Epidemiology of Personality Disorders Study. The presence of DSM-IV personality disorder traits was assessed by psychologists using the International Personality Disorder Examination (IPDE). Confirmatory factor analysis was performed on all the IPDE criteria for each of the 10 personality disorders using the Mplus program. Exploratory factor analysis of all personality disorder traits was completed using the same program. Factor scores were correlated with subjects' GAF ratings and number of missed days from work for physical and psychological reasons. Results A single underlying factor was found for the IPDE item criteria of avoidant and dependent personality disorder, with less evidence for the other 8 personality disorders. Five factors were retained as the dimensional accounting for the personality disorder criteria. These factors were named compulsive, neurotic avoidant, aloof, impulsive callous, and egocentric. Of the five factors, 4 were associated with evidence of diminished functioning. Conclusions The IPDE pathological personality traits did not empirically cluster according to the current DSM-IV axis II diagnostic system but instead defined 5 relatively independent PD symptom dimensions that were related to functional impairments.

Co-occurrence of 12-month mood and anxiety disorders and personality disorders in the US: results from the national epidemiologic survey on alcohol and related conditions

The objective of this study was to determine the prevalence and co-occurrence of DSM-IV personality disorders (PDs) among individuals with current DSM-IV mood and anxiety disorders in the US population and among individuals who sought treatment for such mood or anxiety disorders. Face-to-face interviews were conducted with 43,093 individuals, 18 years and older, in the National Institute on alcohol abuse and alcoholism's 2001–2002 National epidemiologic survey on alcohol and related conditions (NESARC). Odds ratios (ORs) were calculated to determine the prevalence and associations between current DSM-IV axis I and axis II disorders. Associations between mood, anxiety and PDs were all positive and statistically significant. Avoidant and dependent PDs were more strongly related to mood and anxiety disorders than other PDs. Associations between obsessive–compulsive PD and mood and anxiety disorders were significant, but much weaker. Paranoid and schizoid PDs were most strongly related to dysthymia, mania, panic disorder with agoraphobia, social phobia and generalized anxiety disorder, while histrionic and antisocial PDs were most strongly related to mania and panic disorder with agoraphobia. Results of this study highlight the need for further research on overlapping symptomatology, factors giving rise to the associations and the treatment implications of these disorders when comorbid.

Volumes of the caudate nuclei in women with somatization disorder and healthy women

Very little is known about the pathophysiology of somatization disorder. This study was designed to analyze the volumes of some brain structures possibly involved in somatization based on the observation of glucose metabolism of the brain in these patients. We studied 10 female patients with a diagnosis of somatization disorder or undifferentiated somatoform disorder with no comorbid current DSM-IV Axis I disorder and compared them to 16 healthy female volunteers using brain MRI (1.5T instrument). The patients had bilateral enlargement of caudate nuclei volumes compared with healthy volunteers. These volume differences in the caudate nuclei could be associated with the pathophysiology of somatization.

Abstracts

While many studies have demonstrated positive outcomes from psychotherapy when it is practiced in a controlled research environment with carefully selected (or excluded) patient groups and rigid manualised therapy sessions there is a paucity of research regarding effective outcomes from psychotherapy as it is practiced in actual clinical conditions. The aim of this series of studies was to investigate outcomes, using an effectiveness approach, from psychodynamic psychotherapy as it is practiced by private psychiatrists. Three studies were planned. The aim of Study 1 was to provide standardized baseline measures on the following dimensions • Personal Demographic Information (PDI), • Target Symptoms and Disorders (TSD) including a neuropsychological profile • Inter and Intra Personal (IIP) factors, and, • General Functioning and Quality of Life (GFQoL) factors. Study 2 aimed to examine changes in patient characteristics during the course of treatment. Thus, baseline assessments were repeated at sixmonthly intervals to determine if therapy had been effective for individual patients. A third study was planned to assess the extent to which the results of significant outcome predictors could be replicated in different patient samples. Twenty-nine psychiatrists consented to refer patients with 20 patients having completed pre therapy assessments and six and 18-month follow-up questionnaires. The presentation of this research will focus on the interesting research methodology utilized, patient demographic characteristics and on the patient changes occurring over time on the dimensions of Defence Style (DSQ), Quality of Life (WHOQOL- Bref) and the severity of depression (BDI). The patient sample included 10 male and 10 female patients, whose ages ranged from 19 years to 66 years (mean = 43 years). While seven of the patients did not meet SCID-IV criteria for a current DSM-IV Axis 1 disorder, six patients met criteria for a current mood disorder, three for panic disorder, one patient each for PTSD, alcohol abuse and dependence, and 2 patients met current criteria for multiple Axis 1 disorders. The research is ongoing.

Anger and aggression in psychiatric outpatients.

This study sought to evaluate the degree of anger and aggression experienced by psychiatric outpatients and to determine whether anger is as prominent an emotional state in these patients as are depression and anxiety. We also sought to determine which Axis I and Axis II disorders were associated with increased rates of subjective anger and aggressive behavior. 1300 individuals presenting to a psychiatric outpatient practice underwent semistructured interviews to evaluate current DSM-IV Axis I (N = 1300) and Axis II disorders (N = 687). Levels of subjective anger and aggression during the preceding week were assessed in each patient, and the odds ratios were calculated for each disorder. A multiple regression analysis was performed to determine which psychiatric disorders independently contributed to the presence of subjective anger and aggressive behavior. Approximately one half of our sample reported currently experiencing moderate-to-severe levels of subjective anger, and about one quarter had demonstrated aggressive behavior in the preceding week. This level of anger was found to be comparable to the levels of depressed mood and psychic anxiety reported by our sample. Major depressive disorder, bipolar I disorder, intermittent explosive disorder, and cluster B personality disorders independently contributed to the presence of both anger and aggression. Anger and aggression are prominent in psychiatric outpatients to a degree that may rival that of depression and anxiety; it is therefore important that clinicians routinely screen for these symptoms.

Increased incidence of anxiety and depressive disorders in persons with organic solvent exposure.

The purpose of this study was to determine whether the prevalence of current and past DSM-IV axis I psychiatric disorders is higher among persons with a history of exposure to organic solvents than among a demographically similar group of nonexposed control subjects. Thirty-eight solvent-exposed subjects and 39 nonexposed healthy control subjects were evaluated for axis I disorder with the Structured Clinical Interview for DSM-IV. A significantly higher number of solvent-exposed subjects (71%) met criteria for current DSM-IV axis I disorder in comparison with control subjects (10%). The most prevalent diagnosis in exposed subjects was within the anxiety and mood clusters, with a high percentage (36%) of exposed subjects meeting criteria for a dual diagnosis of mood and anxiety disorder. There were no differences between the groups in past psychiatric disorders or current or past substance abuse or dependence. The rates of past psychiatric disorders among solvent-exposed subjects are similar to those among normal control subjects, but the prevalence of current DSM-IV axis I psychiatric disorders is significantly higher among exposed subjects than among control subjects.