Diagnostic Checklist Research Articles

Consultation–Liaison Psychiatry in General Hospitals: Improvement in Physicians’ Detection Rates of Alcohol Use Disorders

In the general hospital setting, alcohol-use disorders very commonly remain undetected.The authors hypothesized that including a consultation-liaison (C-L) psychiatrist in primary-care rounds would improve detection rates of alcohol-use-disorders.Patients (N=165) on two medical wards were screened by means of the Alcohol Use Disorders Identification Test. Diagnoses were confirmed with the International Diagnostic Checklists and compared with physicians' detection rates. C-L intervention included demonstrations of standardized diagnostic procedures in order to change primary-care physicians' behavior.Primary-care-physicians' detection rates of alcohol-use disorders increased significantly after implementation of the C-L service, whereas no significant differences were observed on the control ward.Tentative data thus underscore the efficacy of C-L psychiatry for detection and intervention in alcohol-use disorders.

Consultation-Liaison Psychiatry in General Hospitals: Improvement in Physicians' Detection Rates of Alcohol Use Disorders

In the general hospital setting, alcohol-use disorders very commonly remain undetected. The authors hypothesized that including a consultation-liaison (C-L) psychiatrist in primary-care rounds would improve detection rates of alcohol-use-disorders. Patients (N=165) on two medical wards were screened by means of the Alcohol Use Disorders Identification Test. Diagnoses were confirmed with the International Diagnostic Checklists and compared with physicians' detection rates. C-L intervention included demonstrations of standardized diagnostic procedures in order to change primary-care physicians' behavior. Primary-care-physicians' detection rates of alcohol-use disorders increased significantly after implementation of the C-L service, whereas no significant differences were observed on the control ward. Tentative data thus underscore the efficacy of C-L psychiatry for detection and intervention in alcohol-use disorders.

Attention Deficit/Hyperactivity Disorder in Children and Adolescents With Autism Spectrum Disorder

Objective: This study aims to evaluate ADHD-like symptoms in children with autism spectrum disorder (ASD) based on single-item analysis, as well as the comparison of two ASD subsamples of children with ADHD (ASD+) and without ADHD (ASD-). Methods: Participants are 83 children with ASD. Dimensional and categorical aspects of ADHD are evaluated using a diagnostic symptom checklist according to DSM-IV. Results: Of the sample, 53% fulfill DSM-IV criteria for ADHD. The comparison of the ASD+ and the ASD- samples reveals differences in age and IQ. Correlations of ADHD and PDD show significant results for symptoms of hyperactivity with impairment in communication and for inattention with stereotyped behavior. Item profiles of ADHD symptoms in the ASD+ sample are similar to those in a pure ADHD sample. Conclusion: The results of our study reveal a high phenotypical overlap between ASD and ADHD. The two identified subtypes, inattentive-stereotyped and hyperactive-communication impaired, reflect the DSM classification and may theoretically be a sign of two different neurochemical pathways, a dopaminergic and a serotonergic. (J. of Att. Dis. 2009; 13(2) 117-126)

S49-03 Posttraumatic disorders in patients with substance use disorders: A German multi-center study

Aims:This multi-center study examined the prevalence of posttraumatic stress disorder (PTSD) and the level of dissociative symptoms in a German population of patients with different substance use disorders (SUD).Method:A total of 459 participants (59.7% male) were recruited in 14 study centers. Of these, 182 (39.7%) were alcohol dependent (A), 154 (33.6%) were drug-dependent (D), and 123 (26.8%) were dependent on both, alcohol and drugs (AD). Diagnostic measures included the Addiction Severity Index (ASI), the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Scale (DES), and the Posttraumatic diagnostic scale (PDS). The International Diagnostic Checklists (IDCL) were used to confirm DSM-IV diagnoses of PTSD and SUD.Results:25.3% of the subjects had PTSD confirmed by both IDCL and PDS. Higher rates were found in the AD (34.1%) and D (29.9%) groups as compared to group A (15.4%, p < .001). Similarly, rates of dissociative symptoms as measured by the DES differed significantly between the different subgroups (AD: M=15.1±11.3; D: M=12.9±11.7; A: M=9.9±8.8; p < .001). In a stepwise linear regression model, childhood trauma severity was associated with dissociation independent from current PTSD. The relationships between SUD group and dissociation ceased to be statistically significant when age and gender were included in the model.Conclusion:The findings support significant rates of PTSD and dissociative symptoms in patients with SUD and marked differences between the different SUD subgroups. The complex relationship between childhood trauma, dissociation, and PTSD in patients with SUD requires more research.

Role of PET in the Initial Staging of Cutaneous Malignant Melanoma: Systematic Review

To calculate summary estimates of the diagnostic performance of fluorine 18 fluorodeoxyglucose (FDG) positron emission tomographic (PET) imaging in the initial staging of cutaneous malignant melanoma (CMM), following the new American Joint Committee on Cancer (AJCC) staging classification on per-patient and per-lesion bases. MEDLINE, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews databases, and reference lists of reviews and included papers were searched, without any language restrictions, for relevant articles published before March 2007. Two reviewers independently assessed study eligibility and methodologic quality by using the quality assessment of diagnostic accuracy studies checklist. A pooled random effect was estimated and a fixed coefficient regression model was used to explore the existing heterogeneity. Twenty-eight studies involving 2905 patients met the inclusion criteria. The pooled estimates of FDG PET for the detection of metastasis in the initial staging of CMM were sensitivity, 83% (95% confidence interval [CI]: 81%, 84%); specificity, 85% (95% CI: 83%, 87%); positive likelihood ratio (LR), 4.56 (95% CI: 3.12, 6.64); negative LR, 0.27 (95% CI: 0.18, 0.40); and diagnostic odds ratio, 19.8 (95% CI: 10.8, 36.4). Results from eight studies suggested that FDG PET was associated with 33% disease management changes (range, 15%-64%). There is good preliminary evidence that FDG PET is useful for the initial staging of patients with CMM, especially as adjunctive role in AJCC stages III and IV, to help detect deep soft-tissue, lymph node, and visceral metastases. FDG PET-computed tomographic imaging seemed to be more precise than PET alone, as suggested by four eligible studies. Further evaluation by using a well-designed prospective study, with clinical outcome-focused measures and cost effectiveness analysis, is needed to clarify the appropriate role of FDG PET in CMM staging. http://radiology.rsnajnls.org/cgi/content/full/249/3/836/DC1.

Mental disorders and quality of life in COPD patients and their spouses

In the current study, the prevalence of the most common psychological disorders in COPD patients and their spouses was assessed cross-sectionally. The influence of COPD patients' and their spouses' psychopathology on patient health-related quality of life was also examined. The following measurements were employed: Forced expiratory volume in 1 second expressed in percentage predicted (FEV1%), Shuttle-Walking-Test (SWT), International Diagnostic Checklists for ICD-10 (IDCL), questionnaires on generic and disease-specific health-related quality of life (St. George's Respiratory Questionnaire (SGRQ), European Quality of Life Questionnaire (EuroQol), a modified version of a Disability-Index (CDI)), and a screening questionnaire for a broad range of psychological problems and symptoms of psychopathology (Symptom-Checklist-90-R (SCL-90-R)). One hundred and forty-three stable COPD outpatients with a severity grade between 2 and 4 (according to the GOLD criteria) as well as 105 spouses took part in the study. The prevalence of anxiety and depression diagnoses was increased both in COPD patients and their spouses. In contrast, substance-related disorders were explicitly more frequent in COPD patients. Multiple linear regression analyses indicated that depression (SCL-90-R), walking distance (SWT), somatization (SCL-90-R), male gender, FEV1%, and heart disease were independent predictors of COPD patients' health-related quality of life. After including anxiousness of the spouses in the regression, medical variables (FEV1% and heart disease) no longer explained disability, thus highlighting the relevance of spouses' well-being. The results underline the importance of depression and anxiousness for health-related quality of life in COPD patients and their spouses. Of special interest is the fact that the relation between emotional distress and quality of life is interactive within a couple.

Toward a New Paradigm for Psychiatric Diagnoses and Clinical Research in Sexology

The growing acceptance of a biopsychiatric model for women's sexual health issues and the dramatic increase of pharmaceutical industry research funding over the last decade have both contributed to ethical and professional crises in sexology and psychiatry. Although conflict of interest (COI) policies deal with some of these issues, public trust is compromised in such an industry-dominated climate. This article describes why the lack of transparency in diagnostic and clinical guidelines is an important public health issue for women, presents data about financial associations between expert members of diagnostic guidelines panels and `Big Pharma', and relates the discussion to concepts of biopower and biopolitics. One element in these developments — the overuse of diagnostic checklists — undermines an appreciation for the diversity of women's sexualities, reinforces the authority of only certain kinds of research, and privileges biomedical interventions. The authors emphasize the need for a paradigm shift, analogous to that advanced by the New View Campaign, that promotes diagnostic instruments and treatment interventions more fully supportive of consumer, rather than corporate, interests.

Trauma and PTSD in Patients With Alcohol, Drug, or Dual Dependence: A Multi‐Center Study

We investigated (1) the prevalence of posttraumatic stress disorder (PTSD) in treatment-seeking subjects with substance use dependence (SUD), (2) the association between comorbid PTSD and the severity and course of addiction and psychopathology, and (3) this association in patients with subsyndromal PTSD, and in trauma exposure without PTSD. In this cross-sectional study, 459 subjects in 14 German addiction treatment centers participated with alcohol-dependence (A) in 39.7%, drug-dependence (D) in 33.6%, or both (AD) 26.8%. The diagnostic measures included the International Diagnostic Checklists (IDCL), Posttraumatic Diagnostic Scale (PDS), Addiction Severity Index (ASI), and the Brief Psychiatric Rating Scale (BPRS). Associations between independent characteristics and outcomes were analysed by univariate and multivariate statistics. 25.3% of the subjects had PTSD confirmed by both IDCL and PDS with higher rates in the AD (34.1%) and D (29.9%) groups compared with group A (15.4%, p < 0.001). In 22.8%, PTSD was subsyndromal (either IDCL or PDS positive) without significant differences between SUD groups, and 18.3% met PTSD trauma criteria A without PTSD (exposure). After controlling for SUD and gender, trauma subgroups significantly differed regarding the onset of alcohol-related symptoms (p < 0.02), numbers of previous admissions (p < 0.03), severity of SUD (p < 0.001), current craving (p < 0.02), and psychopathology (p < 0.001). We observed the worst outcome in PTSD, while trauma exposure had no effects. The prevalence of PTSD is higher in drug than in alcohol dependence. The more strictly PTSD is diagnosed (by interviewer and questionnaire) the more clearly are associations with characteristics of SUD. PTSD seems to be an independent risk factor for an unfavorable outcome of SUD.

Systematic review of accuracy of screening instruments for predicting fall risk among independently living older adults.

The objective of this study was to summarize the evidence on the accuracy of screening tools for predicting falling risk in community-living older adults. This study was designed as a systematic review. Prospective studies of clinical fall risk prediction tools that provided data on the number of participants who sustained falls during follow-up were included. We searched six electronic databases and reference lists of studies and review articles. Data were extracted by two reviewers independently, and methodological quality assessment was performed with a modified version of the Quality Assessment of Diagnostic Accuracy Studies checklist. Twenty-five studies were included. These studies evaluated 29 different screening tools, but only 6 of the tools were evaluated by more than one study. Methodological quality was variable, and many studies were small. No meta-analyses were performed because of heterogeneity. Most tools discriminated poorly between fallers and nonfallers. We found that existing studies are methodologically variable and the results are inconsistent. Insufficient evidence exists that any screening instrument is adequate for predicting falls.

Keeping an Uphill Edge

Several behaviors in a ski shop were identified as being deficient using Austin's Performance Diagnostic Checklist (2000) and Daniels and Daniels' PIC/NIC Analysis (2004). During a 4-week baseline, 7 cleaning behaviors were monitored and 5 were subsequently targeted in an intervention package using an ABC design. The intervention included: a task clarification session, a posted behavioral checklist, graphic feedback of the group's performance for the previous week, and daily task-specific feedback. Immediately after the checklist was posted, the frequency of employee cleaning behaviors increased 52%. Cleaning behaviors increased an additional 12% after the implementation of daily task-specific feedback. Results suggest the interventions generalized to the 2 cleaning behaviors not mentioned in the task-clarification session.

FDG-PET improves accuracy in distinguishing frontotemporal dementia and Alzheimer's disease

Distinguishing Alzheimer's disease (AD) and frontotemporal dementia (FTD) currently relies on a clinical history and examination, but positron emission tomography with [(18)F] fluorodeoxyglucose (FDG-PET) shows different patterns of hypometabolism in these disorders that might aid differential diagnosis. Six dementia experts with variable FDG-PET experience made independent, forced choice, diagnostic decisions in 45 patients with pathologically confirmed AD (n = 31) or FTD (n = 14) using five separate methods: (1) review of clinical summaries, (2) a diagnostic checklist alone, (3) summary and checklist, (4) transaxial FDG-PET scans and (5) FDG-PET stereotactic surface projection (SSP) metabolic and statistical maps. In addition, we evaluated the effect of the sequential review of a clinical summary followed by SSP. Visual interpretation of SSP images was superior to clinical assessment and had the best inter-rater reliability (mean kappa = 0.78) and diagnostic accuracy (89.6%). It also had the highest specificity (97.6%) and sensitivity (86%), and positive likelihood ratio for FTD (36.5). The addition of FDG-PET to clinical summaries increased diagnostic accuracy and confidence for both AD and FTD. It was particularly helpful when raters were uncertain in their clinical diagnosis. Visual interpretation of FDG-PET after brief training is more reliable and accurate in distinguishing FTD from AD than clinical methods alone. FDG-PET adds important information that appropriately increases diagnostic confidence, even among experienced dementia specialists.

Recommendations for the reporting of prostate carcinoma

It has been evident for decades that pathology reports are very variable even within a single institution. Standardization of reporting is the optimal way to insure that information necessary for patient management, prognostic and predictive factor assessment, grading, staging, analysis of outcomes, and tumor registries are included in pathology reports. The ADASP has chosen a pathologist expert in each field to assemble a group from within the pathology community (with clinician input if desired) to write specific cancer protocols. These were then approved by the ADASP council and subsequently by the membership. The American College of Surgery Commission on Cancer (COC) accredits cancer centers in the United States. Recently, the COC decided to require elements, deemed as essential by the CAP, to be described in all pathology reports in their accredited cancer centers as of January 2004. Importantly, they do not require that the specific College of Pathologists (CAP) protocols or synoptic reports be used. ADASP has updated all of its protocols to comply with the COC requirements in the form of uniform checklists. The checklists use the staging criteria cited in the American Joint Committee on Cancer 2002 staging manual (sixth edition) but include a variety of other references listed in each of the checklists. Moreover, the checklists are formatted for ease of use. They may be used as templates for uniform reporting and are designed to be compatible with voice-activated transcription. The different elements in these revised ADASP diagnostic checklists have been divided into Required and Optional. The term Required in this context only signifies compliance with the COC guidelines. ADASP realizes that specimens and practices vary, and it will not be possible to report these elements in every case. However, ADASP hopes that pathologists will find these checklists useful in daily clinical practice while facilitating compliance with the new COC requirements.

Recommendations for the reporting of pleural mesothelioma

It has been evident for decades that pathology reports are very variable even within a single institution. Standardization of reporting is the optimal way to ensure that information necessary for patient management, prognostic and predictive factor assessment, grading, staging, analysis of outcomes, and tumor registries is included in pathology reports. In recent years, 2 societies (first the Association of Directors of Anatomic and Surgical Pathology [ADASP] and then the College of American Pathologists [CAP]) have undertaken to publish guidelines for the reporting of common cancers. The CAP assigned multidisciplinary groups of pathologists, surgeons, radiation, and medical oncologists to develop the protocols. Other pathologists and clinicians then reviewed them. After those reviews the protocols were reviewed by multiple CAP committees and finally approved by the Board of Governors. The ADASP, in contrast, chose a pathologist expert in each filed to assemble a group from within the pathology community (with clinician input if desired) to write specific cancer protocols. These were then approved by the ADASP council and subsequently by the membership. Although both societies began the process at approximately the same time, the streamlined approach adopted by the ADASP enabled them to publish years earlier in pathology journals frequented by anatomic pathologists. Although the formats are somewhat different, the contents are essentially the same. The American College of Surgery Commission on Cancer (COC) accredits cancer centers in the United States. Recently, the COC decided to require elements, deemed as essential by the CAP, to be described in all pathology reports in their accredited cancer centers as of January 2004. Importantly, they do not require that the specific CAP protocols or synoptic reports be used. The ADASP has updated all of its protocols to comply with the COC requirements in the form of 37 uniform checklists. The checklists use the staging criteria sited in the American Joint Committee on Cancer 2002 Staging Manual (sixth edition) but include a variety of other references listed in each of the checklists. Moreover, the checklists are formatted for ease of use. They may be used as templates for uniform reporting and are designed to be compatible with voice-activated transcription. The different elements in these revised ADASP diagnostic checklists have been divided into required and optional. The term required in this context only signifies compliance with the COC guidelines. The ADASP realizes that specimens and practices vary, and it will not be possible to report these elements in every case. However, the ADASP hopes that pathologists will find these checklists to be useful in daily clinical practice, while facilitating compliance with the new COC requirements.

Das Zwangsinventar OCI-R - die deutsche Version des Obsessive-Compulsive Inventory-Revised

The English original version of the OCI-R is a brief, psychometrically sound scale measuring the major symptoms of patients with obsessive-compulsive disorder (OCD) on six dimensions: checking, washing, ordering, hoarding, obsessing and neutralizing. It has good convergent and discriminant validity and is sensitive to treatment effects. A German OCI-R version has not been examined until now. Reliability and validity of an authorized German version of the OCI-R were examined in a sample of 175 patients with OCD. The patients were diagnosed by experienced psychotherapists via an interview that utilized the International Diagnostic Checklists. Other measures for anxiety, worry, depression and perfectionism were used to determine convergent and discriminant validity. The full scale and five of six subscales had excellent internal consistency and "Neutralizing" had satisfactory internal consistency. A confirmatory factor analysis (SEM) replicated the original factor structure. All global fit indices suggested a good fit for the model. The local fit indices showed an excellent fit for 5 subscales and an acceptable fit for "neutralizing". The German version has good to excellent convergent validity and good divergent validity for the full scale and the subscales. The good results of the Foa et al.-study have been replicated in a German sample of patients with OCD. The German version of the OCI-R proved to be a reliable and valid self-report measure of obsessive-compulsive symptoms and appears to measure OCD quite independently from anxiety, worry, depression and perfectionism.

Hereditary spastic paraparesis and psychosis

Hereditary spastic paraparesis (HSP) is characterized by progressive spasticity and weakness of the legs with or without additional abnormalities. Reports of psychiatric disorders in patients with HSP are limited to mood disturbances rather than to psychosis. We had noted significant psychotic illness in several patients recruited to a survey of HSP in Ireland and therefore set about examining the frequency and nature of psychosis in our patients with HSP. Cases with HSP and psychotic illness were identified from a nationwide epidemiological and clinical study. Psychiatric case notes were reviewed and Operational Diagnostic Criteria Checklist (OPCRIT) applied. Six patients from four families with HSP had evidence of psychosis in addition to paraparesis. OPCRIT diagnoses were 'narrow schizophrenia' (n = 2), 'broad schizophrenia' (n = 2) and 'schizo-affective/manic disorder' (n = 2). Patients were from families with Kjellin's syndrome and SPG4-HSP but not other kindreds and psychosis was not evident in family members without HSP. We found a higher than expected rate of psychosis in the Irish HSP population. Two groups of HSP patients may have increased risk of developing psychosis: those with Kjellin's syndrome and those with SPG4-HSP.

Does microalbuminuria predict illness severity in critically ill patients on the intensive care unit? A systematic review*

Studies assessing the accuracy of microalbuminuria to predict illness severity on the intensive care unit have produced inconsistent results. To determine the diagnostic accuracy of microalbuminuria to predict illness severity in critically ill patients on the intensive care unit. MEDLINE (1951 to September 2004) and EMBASE (1980 to September 2004) electronic databases were searched for relevant studies. Reference lists of all abstracts were manually searched to identify studies not included in the electronic database. Studies that prospectively evaluated the accuracy of microalbuminuria to predict illness severity and/or mortality probability in adult patients on the intensive care unit were selected. We included nine studies in the review. Data to evaluate methodological quality and results were abstracted. The methodological quality of a number of studies was poor. Significant heterogeneity in the design and conduct of the studies circumvented the data being subjected to meta-analysis. Studies also differed in the timing of the index test, in the methods of quantifying microalbuminuria, and in the cutoff values used. This descriptive analysis reveals that microalbuminuria may hold promise as a predictor of illness severity and mortality on the intensive care unit. However, future epidemiologic studies need to be conducted to determine the optimal timing as well as the threshold reference value for the urine albumin creatinine ratio in the adult intensive care unit population. Thereafter, multiple-center prospective epidemiologic studies must be conducted to confirm and validate the findings of these preliminary studies. Future studies should conform to the Standards for Reporting of Diagnostic Accuracy checklist in terms of study design, conduct, and reporting. Presently there is no evidence to warrant the use of this tool on the intensive care unit.

Personality Disorder and Chronicity of Addiction as Independent OutcomePredictors in Alcoholism Treatment

A prospective four-year study examined which components of addiction severity predicted time to relapse among 112 adults with chronic alcoholism who participated in a comprehensive outpatient treatment program. Recruited from emergency, inpatient, and outpatient facilities, patients were admitted into the program consecutively between March 1998 and June 2002. Alcohol abstinence was carefully monitored for four years from admission by regular contacts and urine and blood analyses. Alcoholism characteristics and personality disorders were assessed with structured interviews and the International Diagnostic Checklists for Personality Disorders. Among a variety of potential variables, only presence of a personality disorder and chronicity of addiction were independently associated with a decrease of cumulative four-year abstinence probability. Their high predictive values suggest that chronicity and personality disorder rank among the most important characteristics of addiction severity.

Personality Disorder and Chronicity of Addiction as Independent OutcomePredictors in Alcoholism Treatment

Personality Disorder and Chronicity of Addiction as Independent OutcomePredictors in Alcoholism Treatment

Use of the Performance Diagnostic Checklist to Select an Intervention Designed to Increase the Offering of Promotional Stamps at Two Sites of a Restaurant Franchise

The performance diagnostic checklist (PDC) was administered to examine the variables influencing the offering of promotional stamps by employees at two sites of a restaurant franchise. PDC results suggested that a lack of appropriate antecedents, equipment and processes, and consequences were responsible for the deficits. Based on these results, an intervention consisting of task clarification, self-monitoring, equipment modification, goal setting, and graphic feedback was implemented and evaluated with a multiple baseline design across settings. The results for restaurant 1 yielded baseline and intervention means of 25% and 72%, respectively. The results for restaurant 2 yielded baseline and intervention means of 11% and 80%, respectively. Overall, these results suggest that the PDC is a useful tool for guiding intervention selection for performance deficits which occur across more than one site.

Megestrol attenuates the hormonal response to CCK-4–induced panic attacks

Progestational hormones may have anxiolytic properties. CCK-4 (cholecystokinin tetrapeptide) can be used pharmacologically to induce panic attacks both in normal controls and patients suffering from panic disorder. In this study we compared the effects of pretreatment with the progestational hormone megestrol and placebo on CCK-4-induced panic attacks and stress hormone release in healthy male controls. Using a double-blind balanced design, we pretreated 10 medically and psychiatrically healthy male controls with placebo or megestrol 160 mg at 11 p.m. and 8 a.m. (sigma=320 mg) prior to the experiment. Following 1 h of rest, 12 blood samples were drawn between 1,000 h and 1,300 h and analyzed for ACTH and cortisol levels. At 1,100 h, subjects received an intravenous injection of 50 microg CCK-4. Clinical ratings were performed at 1,045 h and 1,110 h, and included the Acute Panic Inventory (API), International Diagnostic Checklist (IDCL), as well as a visual analog scale (VAS) for anxiety and tension. CCK-4 significantly increased anxiety and tension. Pretreatment with megestrol showed no significant effect on clinical ratings. Baseline ACTH and cortisol levels, as well as ACTH and cortisol levels after administration of CCK-4, were significantly reduced after pretreatment with megestrol. In a sample of healthy male controls, pretreatment with megestrol had a profound effect on the hypothalamic-pituitary-adrenal (HPA) axis, whereas the clinical effects on panic attacks were weak. Further studies in a larger sample of subjects, including both females and patients suffering from panic disorder, seem warranted.