Diagnostic And Statistical Manual Of Mental Disorders , Third Edition Research Articles

Association of level of adherence to Mediterranean diet with cognitive and dementia status in subjects with chronic diseases: a cross-sectional study

ABSTRACT Background: The Mediterranean diet has been linked to brain neuroprotection. Evidence from meta-analyses showed reduced risk of dementia with greater intake of vegetables and fruits, fish, and the Mediterranean diet. The current study raises important questions about the association between low risk dementia and Mediterranean diet. Objective: The objective was to evaluate the association between levels of adherence to the Mediterranean diet and dementia and cognitive status in subjects 50 years of age and older. Method: The Mediterranean Diet Adherence Screener (MEDAS), the modified 30-item ‘Diagnostic and Statistical Manual of Mental Disorders Third Edition (DSM-III) risk of dementia, and the Standard Mini-Mental Status Examination (SMMSE) cognitive status scores were used to assess the levels of adherence to the Mediterranean diet’. Results: A total of 150 subjects were enrolled in the study. Forty-one (27.3%) had ‘suspected or confirmed dementia, while 48 individuals (32%) were categorized as having moderate to severe cognitive decline. Subjects who reported moderate to high adherence to the Mediterranean diet (55, 36.7%) had significantly lower dementia scores (7.0 3.8 versus 17.6 5.1) and higher cognitive (25.4 3.8 versus 8.6 7.2) scores compared to those (38, 25.3%) who reported low adherence to the Mediterranean diet. Conclusion: Subjects who were highly or moderately adherent to the Mediterranean diet had significantly lower dementia scores and better cognitive status than those with low adherence.

Reconceptualization of borderline conditions through the lens of the alternative model of personality disorders.

Borderline (BPD) and schizotypal personality disorder (SPD) were introduced in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). However, the clinical differentiation of the 2 diagnoses (e.g., psychotic-like features) was challenging for diagnostic classification and clinical management. With the introduction of the alternative model for personality disorders (AMPD) in DSM-5 Section III, a dimensional approach was proposed, which potentially holds promise for better future differentiation between BPD and SPD. The present study sought to examine the psychopathology using the AMPD model. A total of 105 patients were interviewed, 25 were excluded according to exclusion criteria, and the final sample comprised 80 patients who fulfilled the DSM-5 criteria for BPD (n = 35), SPD (n = 25), and comorbid BPD + SPD (n = 20), respectively. All patients were administered The Structured Clinical Interview for DSM-5 alternative model for personality disorders Modules I and II. One-way analysis of variance tests with planned contrasts were used. Results showed that for AMPD Criterion A, the BPD + SPD group had the most severe impairment of personality functioning, except for Identity, where the SPD group showed the most severe impairment. For AMPD Criterion B, the domain of Detachment and the facet of Eccentricity from the Psychoticism domain were most prominent for the SPD group relative to the 2 other groups. The differentiating between BPD and SPD manifestations of cognitive/perceptual disturbances does not seem resolved by the Psychoticism domain, which covers broader aspects of psychopathology. Future research should further investigate the construct of Psychoticism, especially to differentiate nonpsychotic symptoms (e.g., dissociation) and address thought disorder. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Measuring Trauma Symptoms in Paramedicine

Background The trauma experienced as a paramedic can have a devastating psychological impact on both professionals and students in training, and increases the risk of developing post-traumatic stress disorder (PTSD). Paramedics are often placed in high-risk situations involving multiple or sustained trauma and also experience high levels of occupational stress, which can produce adverse psychological and physiological responses. Despite these risks, understanding trauma and its various manifestations in paramedicine has not been well documented. Methods This narrative review describes the history and changes in diagnostic criteria, and contrasts the methods of measuring PTSD symptomology with the current criteria. Results PTSD was first defined in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) in 1980, however the diagnostic criteria and associated measurement tools failed to reflect the repeated and vicarious traumatic events experienced by paramedics. Currently, the majority of the measurement tools used to assess post-traumatic stress are still aligned with superseded diagnostic criteria and many only classify the symptoms of PTSD as present or absent with little consideration given to symptom severity. Consequently, these existing measurements of PTSD are out dated and inefficient in their ability to identify and measure PTSD using the revised criteria. Conclusion The development of a more specific measurement tool, which reflects the DSM-5 diagnostic criteria of trauma-related stressors within this population, will allow for a more comprehensive measurement of symptoms. Future research undertaken in this specific field will also help to inform education and training programs to assist with the negative impacts of trauma and aid in management and treatment of PTSD in paramedics.

The New Crisis in Confidence in Psychiatric Diagnosis

The New Crisis in Confidence in Psychiatric Diagnosis

A Resolution for Physicians: Time to Focus on the Public Health Threat of Gun Violence

The Editors discuss how physicians, who have long been powerful voices in discussions of issues that threaten public health, should draw on similar motivations and strategies to promote sensible, e...

Disease versus Dimension in Diagnosis

Edward Shorter, PhD, FRSC1; Herman M van Praag, MD, PhD2 Can J Psychiatry. 2010;55(2):59-64. The Argument for Disease It is chimerical to think that psychiatric illness can be collapsed into couple of smooth dimensions. This is conceit that comes to us from psychoanalysis, which was uninterested in specificity of treatment. In reality, just as there are discrete diseases of the kidney, there are discrete diseases of the brain that produce behavioural symptoms. These can no more be scaled than renal tuberculosis and renal carcinoma can be arrayed onto single dimension. Let us consider the view, articulated by Samuel Guze1 in 1992, that psychiatry is branch of medicine. If we are to regard psychiatric diagnoses as medical diagnoses, how might they be constructed? Building on Guze,1 Max Fink and Michael Alan Taylor2 have proposed 3-fold basis for carving out discrete psychiatric illnesses: describing an illness entity in well-circumscribed Psychopathologie terms; verifying its existence with laboratory measures; and, validating it with distinctive response to treatment. Based on this triune measure of what one might call disease-ness, what solid disease diagnoses does psychiatry possess? Melancholia Out of the soup of depression, it is possible to fish several solid diagnoses that fulfill the above criteria. The major depression of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) is nondisease and should be divided into melancholia and nonmelancholia.3 Nonmelancholia is anything but discrete disease entity, while melancholia is probably the most solid disease that psychiatry possesses, characterized, in psychopathological terms, by psychomotor change and profound neurovegetative disturbances, and verified by such biological markers as positive response to the dexamethasone suppression test (in contrast to nonmelancholia), by REM latency, and by blunted thyroid-stimulating hormone response to exogenous thyrotropin-releasing hormone.4 Finally, melancholia is validated by distinctive response to tricyclic antidepressants (TCAs) and to electroconvulsive therapy (ECT). Not all patients with purported melancholia will display these biological markers, but it is profoundly interesting that within the melancholia diagnosis there is psychopathological core of patients possessing this biological homogeneity. (Atypical depression neither shows the typical neurovegetative signs of melancholia nor responds well to ECT.) These cases of melancholia cannot be arrayed on dimensional scale, except in the trivial sense that the disease waxes and wanes. Catatonia Formerly, catatonia was considered subtype of schizophrenia. DSM-IV conceded that features5' p 417 might characterize mood disorder as well. Seldom has catatonia been seen as an independent illness entity worthy of a home of its own, as Fink and Taylor6 put it (in the title of their article). Nevertheless, clearly it belongs on the list of genuine psychiatric diseases because its psychopathology is well specified and has rating scale of its own. To be sure, it does not possess biological marker (verification), but in intravenous lorazepam, catatonia possesses differential treatment response (validation). (No other psychotic illness responds to lorazepam; symptoms of catatonia are also relieved with ECT.) Catatonia has no dimensional features: the diagnosis is made with the presence of 2 or more signs, and the score on the catatonia rating scale does not influence the response to treatment. It would be incorrect to say, as the dimensional argument might put it, that all of us possess embryonic catatonic symptoms that then aggravate under stress. Atypical Depression Atypical depression is less clearly delineated than melancholia and catatonia, in psychopathological terms, but nonetheless displays some underlying biological unity. …

P01-327 - New dimensionsin assessing and treating traumatic stress: a meta-analysis of historical and recent contributions to the field

ObjectivesNew dimensions of traumatic stress have surfaced since the inclusion of the PTSD classification in The Diagnostic and Statistical Manual of Mental Disorders-Third Edition (DSM-III) with its main focus on Vietnam Veterans. New Dimensions of traumatic stress entered the clinical/cultural equation with new populations, both military and civilian, subjected to massive disasters (hurricanes, floods, terrorist's attacks…) as well as those exposed to the potential of violence. The nearly four-year siege of Sarajevo and the constant fear of improvised explosive devices and suicide bombers among troops in Iraq and Afghanistan add another dimenstion of traumatic stress that falls outside the usually accepted “combat exposure” measure for a PTSD diagnosis. Our objective was to evaluate the scientific and clinical literature to see what assessment and treatment modalities are being employed to address this broader definition of traumatic stress.MethodsWe conducted a comprehensive review of journal articles and books published in English and the Slavic languages, the vast majority published within the past decade.ResultsThe search comprised of over 300 hits, mostly journal articles.ConclusionsAssessment tools have been expanded to include co-morbid clinical and health diagnoses as well as pre-morbid factors. Related clinical diagnoses include major depression and panic attacks while health concerns run the range of immune deficiency disorders as those associated with traumatic brain injuries. Psychopharmacology inroads seem to focus on Serotonin agonists while cognitive-behavioral approaches dominate the psychotherapies. Targeted populations include coalition troops (male & female) and those involved in the Bosnian and Kosovo conflicts.

Obituary: Yutaka Honda, MD, PhD (1929–2009)

Dr. Yutaka Honda, the former Editor-in-Chief of Psychiatry and Clinical Neurosciences (PCN) from 1995 to 1999 passed away on September 1, 2009 at the age of 79. Dr. Honda, circa 1999, courtesy of his son, Dr. Makoto Honda He was born in 1929 and graduated from the Faculty of Medicine of the University of Tokyo in 1954 and received his PhD degree from the university in 1959. He served as a lecturer in the Department of Psychiatry, Faculty of Medicine of the University of Tokyo during the tumultuous period of the historical student revolt in the early 1970s and its aftermath until the middle of the 1980s, during which activities of the department were seriously hindered. Despite such difficulty, he tirelessly taught and inspired many young psychiatrists, who dared to join the department hoping to normalize the situation; fortunately I was one of them, in clinical and research activities. In 1985, he was appointed as the director of the Seiwa Hospital affiliated with the Neuropsychiatric Research Institute, a prestigious private neuropsychiatric institution in Tokyo. Later he assumed the directorship of the institute and was the emeritus director of the Neuropsychiatric Research Institute at the time of his demise. He was an excellent researcher, educator, and clinician in psychiatry and his contributions to psychiatry are enormous as introduced below. Dr. Honda is well-known world-wide as a leading researcher of sleep disorders, especially narcolepsy. He actively continued research on those topics until recently. He published more than 50 original articles on sleep disorders, the vast majority of which are on narcolepsy, in international journals and numerous articles in Japanese. His latest original work, ‘Absence of ubiquitinated inclusions in hypocretin neurons of patients with narcolepsy. Neurology, 2009; 73(7): 511–517’ was first-authored by his son, Dr. Makoto Honda at the Tokyo Institute of Psychiatry and was published on 18 August 2009. He was a caring clinician and eager for advocacy activity of patients, especially those with narcolepsy. He helped patients with narcolepsy organize the Narco-kai (an association of patients with narcolepsy) in 1967, now the Japan Narcolepsy Association, and has supported its activity since then. He published many Japanese books to promote the understanding of narcolepsy in Japan. Dr. Honda was enthusiastic about standardizing psychiatric diagnoses in Japan, where no standard psychiatric diagnostic system existed before 1980. He contributed to establishing the Japanese Society for International Psychiatric Diagnostic Criteria in 1981, currently the Japanese Society for Psychiatric Diagnosis, and to introducing the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) of the American Psychiatric Association (APA) into Japan. Also in 1981, he and his colleagues invited Prof. Robert L. Spitzer, the then chairperson of the APA Task Force on Nomenclature and Statistics, to Japan and organized a series of conferences on DSM-III. This had a profound impact on Japanese psychiatrists to adopt DSM-III and it successors and ICD-10 as standard diagnostic systems in Japan. He served as the Editor-in-Chief of the Japanese Journal of Psychiatry and Neurology, a forerunner of PCN, in 1994 and then of PCN from 1995 to 1999, which became an official journal of the Japanese Society of Psychiatry and Neurology in 2008. Thanks to his excellent guidance during his five- year tenure as Editor-in-Chief, PCN gained the status of an international psychiatric journal. And PCN obtained the impact factor of 1.394 in 2008, which is expected to increase further. He also was a founding editorial board member of the Japanese Journal of Clinical Psychiatry, a prestigious Japanese psychiatric journal, first published in 1972. We will miss a great psychiatrist, but his teachings and works in psychiatry will long live in the minds of professionals who have ever been acquainted with him to encourage them to contribute to the advancement of psychiatry.

P01-37 Personality and addiction: Psychological assessment of personality traits in addicted and nonaddicted people

Introduction & aim:Since the introduction of Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) in 1980, there has been a growing interest in the study of patients with substance use disorders (SUD). The driving force behind this field has been, and still is, the high clinical pessimism about the prognosis, and the difficulties in the clinical management of the characteristics of diagnosed patients. In this way the important matter to study is the evaluation of co-occurring personality problems and substance abuse. So the study investigated the personality traits of addicted and nonadicted people.Method:101 addicted people and 101 nonaddicted people were randomly selected and Mc Care & Costa's NEO PI-R inventory was administered on them. Mean scores were compared with T independent tests.Results:Findings indicated that there are differences among means of personality traits in two groups. Addicted people are more neurotic and open to experience than nonaddicted people and nonaddicted people are more extroverted, agreeable and conscientiousness than addicted people.Conclusion:Findings showed addicted people are more neurotic and open to experience than nonaddicted people and nonaddicted people are more extroverted, agreeable and conscientiousness than addicted people.It indicates that evaluating with reliable measures and with more attentions to personality traits can help the psychiatrists and psychologists to diagnose the cause of tendency to addiction and also reduce the psychological problems that is related with addiction before and in during drug treatment and can reduce duration of treatment and enhance efficacy of treatment methods.

Treatment of PTSD and substance abuse comorbidity.

Approximately 50% of individuals in inpatient substance abuse treatment centers will also meet criteria for comorbid PTSD (Brown et al., 1999). This combination of disorders has severe consequences for the individual in terms of course, symptom severity, and effectiveness of treatment. When working with a PTSD-SA population, there are several forms of substances which are more likely to be abused when compared to substance users that do not meet criteria for PTSD. Furthermore, these substances appear to be related to the specific symptoms pattern exhibited by the individual (Stewart, Conrod, Pihl, & Dongier, 1999). Research also indicates that some symptoms of PTSD are more likely than others to elicit substance use in general (Sharkansky, Brief, Peirce, Meehan, & Mannix, 1999). Additionally, the negative impact that substance use relapse risk situations have on an individual may further interfere with the individual's ability to cope effectively with the symptoms of PTSD, which would lead to an increase in both PTSD and SA symptoms/behaviors (Sharkansky et al., 1999). The combination of PTSD-SA also poses several barriers to effective treatment. Some of these barriers are based on clinical lore, and have not undergone the rigorous empirical testing pivotal in the field of psychology. Other barriers have been supported in the empirical field, and these must be addressed in order for treatment to be effective. Post-traumatic Stress Disorder Post-traumatic Stress Disorder (PTSD) was first recognized by the American Psychiatric Association as a diagnosable condition in 1980 when it was introduced into the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DMS-III) (American Psychiatric Association, 1980). Since that time, PTSD etiology, symptomology, and treatment have been extensively studied. PTSD is defined as the development of three categories of symptoms following exposure to a traumatic event in which the individual both (1) came into contact with an event that involved actual or threatened death or serious injury to self or others, and (2) responded to this event with intense fear, helplessness, or horror (American Psychiatric Association, 2000). In essence, exposure to a traumatic event is not sufficient to warrant a diagnosis of PTSD. The subjective, emotional experience of the individual in the aftermath of the trauma must also be taken into account (APA, 2000). The three clusters of symptoms that classify PTSD are reexperiencing, avoidance and numbing, and hyperarousal. Each of these symptom clusters is distinct and affects different areas of psychological functioning. Additionally, disturbances in each category can give rise to comorbid diagnoses associated with that cluster of symptoms that will further disrupt the individual's level of functioning (Taylor, 2006). Lastly, the DSM-IV-TR (2000) states that the symptoms must occur for a minimum of one month and cause clinically significant distress and impairment in several areas of functioning. The first cluster of symptoms, reexperiencing, refers to the persistent emergence of thoughts and feelings associated with the traumatic event. This can occur in several modalities. These include intrusive images, distressing nightmares, acting and feeling as if the event were occurring again, and psychological distress and/or physiological reactivity when confronted with reminders of the traumatic event (American Psychiatric Association, 2000). The second cluster of symptoms, avoidance and numbing, involves both the persistent avoidance of stimuli associated with the trauma and the numbing of general responsiveness that was not characteristic of the individual prior to the trauma (American Psychiatric Association, 2000). Examples of avoidance include all efforts to keep oneself from coming into contact with thoughts, feelings, conversations, activities, places, or people that remind the individual of the trauma. …

DSM and the Death of Phenomenology in America: An Example of Unintended Consequences

During the 19th century and early 20th century, American psychiatry shared many intellectual traditions and values with Great Britain and Europe. These include principles derived from the Enlightenment concerning the dignity of the individual and the value of careful observation. During the 20th century, however, American psychiatry began to diverge, initially due to a much stronger emphasis on psychoanalytic principles, particularly in comparison with Great Britain. By the 1960s and 1970s, studies such as the US-UK study and the International Pilot Study of Schizophrenia demonstrated that the psychodynamic emphasis had gone too far, leading to diagnostic imprecision and inadequate evaluation of traditional evaluations of signs and symptoms of psychopathology. Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) was developed in this context, under the leadership of representatives from institutions that had retained the more traditional British-European approaches (eg, Washington University, Iowa). The goal of DSM-III was to create a comprehensive system for diagnosing and evaluating psychiatric patients that would be more reliable, more valid, and more consistent with international approaches. This goal was realized in many respects, but unfortunately it also had many unintended consequences. Although the original creators realized that DSM represented a "best effort" rather than a definitive "ground truth," DSM began to be given total authority in training programs and health care delivery systems. Since the publication of DSM-III in 1980, there has been a steady decline in the teaching of careful clinical evaluation that is targeted to the individual person's problems and social context and that is enriched by a good general knowledge of psychopathology. Students are taught to memorize DSM rather than to learn complexities from the great psychopathologists of the past. By 2005, the decline has become so severe that it could be referred to as "the death of phenomenology in the United States."

Depression in Older Age Is a Risk Factor for First Ischemic Cardiac Events

Depressive disorders have been shown to be associated with cardiac diseases and death, but the underlying disease mechanism is unclear. The authors hypothesized that the cardiac morbidity and mortality after depression in late life is mediated by subclinical atherosclerosis and is thus confined to ischemic heart diseases. Using the population-based cohort of the Longitudinal Aging Study Amsterdam, 2,403 men and women aged 55 and over without cardiac disease were followed to assess the onset of cardiac disease or cardiac death. Ischemic heart diseases (angina pectoris, [non]fatal myocardial infarction) were distinguished from other cardiac diseases (congestive heart failure, arrhythmia). Major depressive disorder (MDD) was defined according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) criteria. Subthreshold depression was defined as clinically relevant depressive symptoms not fulfilling DSM criteria. After a mean follow up of 7.2 years, 444 first cardiac events occurred, of which 252 were primary ischemic events and 192 other cardiac events. Cox regression analysis adjusted for physical health variables showed that, when compared with nondepressed respondents, those with MDD had a relative risk (RR) of 2.09 (95% confidence interval: 1.13-3.85) for any cardiac event. Considering only ischemic events, the RR conferred by MDD increased to 3.00 (1.51-5.93), whereas the RR declined to 0.96 (0.24-3.89) for all other cardiac events. Subthreshold depression did not increase the risk of future cardiac events. Major depression in older age predicts first cardiac events. The excess cardiac morbidity and cardiac mortality after major depression could entirely be attributed to ischemic heart diseases.

Tobacco industry influence on the definition of tobacco related disorders by the American Psychiatric Association

Objective: The Diagnostic and statistical manual of mental disorders, third edition (DSM-III), published by the American Psychiatric Association (APA) in 1980, included the first official definitions by the APA of...

Generalized anxiety disorder

The diagnosis of generalized anxiety disorder (GAD) was first introduced in 1980 with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) of the American Psychiatric Association. Prior to this, the diagnosis of “anxiety neurosis” was given to patients with symptoms similar to those now incorporated within the GAD category. Originally, GAD was created as a residual category within the anxiety disorders as a rubric for patients with serious anxiety problems but without panic attacks. Panic disorder therefore received far more research attention, and GAD was seen as a diagnosis of exclusion once panic disorder had been ruled out. It is now clear, however, that GAD is a serious psychiatric disorder that is more common than panic disorder and frequently encountered in primary care practice. Indeed, the primary care physician is more likely to see patients with pure GAD than is the psychiatrist. While the treatment of GAD is relatively straightforward, the diagnosis can be difficult. Hence, careful attention to several key symptomatic presentations is important.

Abstracts of literature

Abstracts of literature

How complex interactions of ischemic brain infarcts, white matter lesions, and atrophy relate to poststroke dementia.

Cerebrovascular disease is a major factor related to cognitive impairment. However, behavioral correlates of ischemic brain lesions are insufficiently characterized. To examine magnetic resonance imaging correlates of dementia in a large, well-defined series of patients with ischemic stroke. Detailed medical, neurological, and neuropsychological examinations were conducted 3 months after ischemic stroke for 337 of 486 consecutive patients aged 55 to 85 years. Infarcts (type, site, side, number, and volume), extent of white matter lesions (WMLs), and degree of atrophy were categorized according to magnetic resonance images of the head. The definition for dementia of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) was used. Dementia was diagnosed in 107 (31.8%) of the patients and stroke-related dementia in 87 (25.8%). Volumes, numbers, distinct sites of infarcts, extent of WMLs, and degree of atrophy were different for the demented and nondemented subjects. Particularly, volumes of infarcts in any (right- or left-sided) superior middle cerebral artery territory (27.3 vs 13.7 cm(3), P =. 002) and left thalamocortical connection (14.8 vs 4.0 cm(3), P =. 002) differentiated the 2 groups. Logistic regression analysis showed that the correlates of any dementia included the combination of infarct features (volume of infarcts in any superior middle cerebral artery: odds ratio [OR], 1.11; frequency of left-sided infarcts: OR, 1.21), extent of WMLs (OR, 1.3), medial temporal lobe atrophy (OR, 2.1), and host factors (education; OR, 0.91). In the patients with stroke-related dementia, the main correlate was volume of infarcts in the left anterior corona radiata (OR, 1.68). Correlates of poststroke dementia do not include merely 1 feature but a combination of infarct features, extent of WMLs, medial temporal lobe atrophy, and host features.

Follow up study of longstanding depression as predictor of mortality in elderly people living in the community

Longstanding and recurrent depressive disorders are quite common in elderly people. 1 2 Not much is known, however, of their clinical course and prognosis, including mortality. The need for treatment...

Cross-National Epidemiology of Obsessive-Compulsive Disorder

Our knowledge of the prevalence and demographic and clinical characteristics of obsessive-compulsive disorder (OCD) has, until recently, been based almost exclusively on patient samples. The epidemiology of OCD was first described in a large United States household sample from the Epidemiologic Catchment Area (ECA) study. Since these original observations, the rates of OCD in household populations determined from diagnostic procedures similar to those used in the United States have been published from different parts of the world. Detailed comparisons of rates, sex ratios, age at onset, and demographic and clinical characteristics of OCD in these samples are now available.This article reports on the cross-national epidemiology of OCD from seven international epidemiologic surveys, including the United States ECA study. Each survey used the Diagnostic Interview Schedule (DIS), a highly structured interview, developed for use in epidemiologic surveys, that yields Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) psychiatric diagnoses. All investigators provided the data from their study to be pooled at Columbia University, and the prevalence rates were standardized to the age and sex distribution of the five-site ECA household population so that more precise estimates and comparisons could be made.

Comparison of major epidemiological surveys using the diagnostic interview schedule

The National Institutes of Mental Health Diagnostic Interview Schedule (DIS) was developed to assess members of the general public for presence of psychiatric symptoms in the landmark Epidemiological Catchment Area (ECA) study in the United States. The success of this undertaking combined with the acceptance by researchers throughout the world of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) led to the replication of the ECA in various countries. This report summarizes the comparative results of six of these studies conducted in: Edmonton, Canada; Seoul and rural Korea; Christchurch, New Zealand; Puerto Rico; Taiwan; and the United States. The data presented includes comparison of: (1) rates of psychiatric disorders in selected urban areas from all six studies; (2) rates of psychiatric disorders in rural populations of the four studies with rural samples; (3) intra-cultural rates of psychiatric disorders in Chinese, Hispanic and American settings; (4) rates of psychiat...

The Detection of Depression and the Financing of Medical Care

To the Editor.— The report by Wells and colleagues 1 highlighted the problem of underdiagnosing depressive disorder in general medical practice. The purpose of this letter is to bring to the readers' attention the availability of a self-administered paper-and-pencil questionnaire for diagnosing major depressive disorder (MDD) that my colleagues and I have developed and validated during the past few years. 2-4 The Inventory to Diagnose Depression (IDD) is a self-administered scale specifically designed to diagnose MDD in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) and the revised DSM-III . The scale takes approximately 10 minutes to complete and less than a minute to hand score to determine whether the MDD criteria are met. The IDD assesses depression with 22 groups of five statements. One symptom of depression is assessed by each group and the statements are arranged in order of increasing symptom severity. The IDD differs from other