Different Sets Of Diagnostic Criteria Research Articles

Simplified Diagnosis of Critical Illness Polyneuropathy in Patients with Prolonged Mechanical Ventilation: A Prospective Observational Cohort Study.

Background: Although early identification of critical illness polyneuropathy (CIP) is necessary, the established diagnostic criteria have several limitations in the intensive care unit (ICU) setting. The purpose of this study was to define simplified diagnostic criteria of CIP that best predict clinical outcomes. Methods: This prospective, single-center study included 41 ICU patients with prolonged mechanical ventilation (≥21 days). We applied three different sets of diagnostic criteria (combining the results of the Medical Research Council (MRC) sum score and nerve conduction studies (NCS)) for CIP in order to identify the criteria with the best predictive power for clinical outcomes. Results: The simplified diagnosis of CIP meeting the criteria, i.e., that the MRC sum score < 48 and amplitudes of the tibial and sural nerve < 80% of the lower limit of normal, showed the strongest association with 0 ventilator-free days at day 60 (odds ratio, 6.222; p = 0.029). Conclusions: The diagnostic criteria combining the MRC sum score and the tibial and the sural NCS were identified as the simplified criteria of CIP that best predicted the clinical outcomes. The implementation of these simplified criteria may allow for early identification of CIP in the ICU, thereby contributing to prompt interventions for patients with a poor prognosis.

Forensic Assessment of PTSD Via DSM-5 Versus ICD-11 Criteria: Implications for Current Practice and Future Research

Recognition of the high prevalence of trauma exposure and posttraumatic stress symptoms among adult and youth offenders has inspired calls for justice systems to engage in trauma-informed practices, particularly with regard to the assessment of trauma histories and posttraumatic reactions in legal contexts. Accordingly, skills in trauma assessment have become essential professional competencies for those conducting psychological evaluations in the justice system. However, there are a number of challenges to effective practice, including the existence of two distinctly different sets of diagnostic criteria for posttraumatic stress disorder (PTSD) in the DSM-5 versus ICD-11; controversies over whether separate diagnostic entities comprising complex PTSD and developmental trauma disorder are valid; limitations of the existing measures for assessing and diagnosing the disorder(s); difficulties with differential diagnosis of overlapping disorders and detection of malingering; and limited attention to cultural, ethnic, and racial diversity in the idioms and expressions of posttraumatic stress reactions. The present article reviews these challenges and offers recommendations for future research and clinical practice.

Large-scale genome-wide meta-analysis of polycystic ovary syndrome suggests shared genetic architecture for different diagnosis criteria.

Polycystic ovary syndrome (PCOS) is a disorder characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology. Affected women frequently have metabolic disturbances including insulin resistance and dysregulation of glucose homeostasis. PCOS is diagnosed with two different sets of diagnostic criteria, resulting in a phenotypic spectrum of PCOS cases. The genetic similarities between cases diagnosed based on the two criteria have been largely unknown. Previous studies in Chinese and European subjects have identified 16 loci associated with risk of PCOS. We report a fixed-effect, inverse-weighted-variance meta-analysis from 10,074 PCOS cases and 103,164 controls of European ancestry and characterisation of PCOS related traits. We identified 3 novel loci (near PLGRKT, ZBTB16 and MAPRE1), and provide replication of 11 previously reported loci. Only one locus differed significantly in its association by diagnostic criteria; otherwise the genetic architecture was similar between PCOS diagnosed by self-report and PCOS diagnosed by NIH or non-NIH Rotterdam criteria across common variants at 13 loci. Identified variants were associated with hyperandrogenism, gonadotropin regulation and testosterone levels in affected women. Linkage disequilibrium score regression analysis revealed genetic correlations with obesity, fasting insulin, type 2 diabetes, lipid levels and coronary artery disease, indicating shared genetic architecture between metabolic traits and PCOS. Mendelian randomization analyses suggested variants associated with body mass index, fasting insulin, menopause timing, depression and male-pattern balding play a causal role in PCOS. The data thus demonstrate 3 novel loci associated with PCOS and similar genetic architecture for all diagnostic criteria. The data also provide the first genetic evidence for a male phenotype for PCOS and a causal link to depression, a previously hypothesized comorbid disease. Thus, the genetics provide a comprehensive view of PCOS that encompasses multiple diagnostic criteria, gender, reproductive potential and mental health.

Challenges in pediatric chronic inflammatory demyelinating polyneuropathy

Chronic inflammatory demyelinating neuropathy, a treatable immune-mediated disease of the peripheral nervous system is less common in childhood compared to adults. Despite different sets of diagnostic criteria, lack of a reliable biologic marker leads to challenges in diagnosis, follow-up and treatment. Our first aim was to review clinical presentation, course, response to treatment, and prognosis in our childhood patients. We also aimed to document diagnostic and therapeutic pitfalls and challenges at the bedside. Our original cohort consisted of 23 pediatric patients who were referred to us with a clinical diagnosis of chronic inflammatory demyelinating neuropathy. Seven patients reaching to an alternative diagnosis were excluded. In the remaining patients, diagnostic, treatment and follow-up data were compared in typical patients who satisfied both clinical and electrodiagnostic criteria and atypical patients who failed to meet minimal research chronic inflammatory demyelinating neuropathy electrodiagnostic requirements. Eight of 16 patients (50%) met the minimal chronic inflammatory demyelinating neuropathy research diagnostic requirements. There was only a statistically significant difference (p = 0.010) in terms of European Neuromuscular Centre childhood chronic inflammatory diagnostic mandatory clinical criteria between the two groups. Misdiagnosis due to errors in electrophysiological interpretation (100%, n = 8), cerebrospinal fluid cytoalbuminologic dissociation (100%, n = 4 and/or subjective improvement on any immunotherapy modality (80 ± 19.27%)) was frequent. Pediatric CIDP is challenging in terms of diagnostic and therapeutic pitfalls at the bedside. Diagnostic errors due to electrophysiological interpretation, cerebrospinal fluid cytoalbuminologic dissociation, and/or subjective improvement on immunotherapy should be considered.

Nosology and inheritance pattern(s) of joint hypermobility syndrome and Ehlers-Danlos syndrome, hypermobility type: a study of intrafamilial and interfamilial variability in 23 Italian pedigrees.

Joint hypermobility syndrome (JHS) and Ehlers-Danlos syndrome, hypermobility type (EDS-HT) are two markedly overlapping heritable connective tissue disorders. The cumulative frequency of JHS and EDS-HT seems high, but their recognition remains an exclusion diagnosis based on different sets of diagnostic criteria. Although proposed by a panel of experts, clinical identity between JHS and EDS-HT is still a matter of debate due to unknown molecular basis. We present 23 families with three or more individuals with a diagnosis of JHS and/or EDS-HT. Rough data from the 82 individuals were used to assess the frequency of major and minor criteria, as well as selected additional features. A series of statistical tools were applied to assess intrafamilial and interfamilial variability, emphasizing intergenerational, and intersex differences. This study demonstrates marked heterogeneity within and between families in terms of agreement of available diagnostic criteria. In 21 pedigrees affected individuals belong to two or three phenotypic sub-categories among JHS, EDS-HT, and JHS + EDS-HT overlap. Intergenerational analysis depicts a progressive shifting, also within the same pedigree, from EDS-HT in childhood, to JHS + EDS-HT in early adulthood and JHS later in life. Female-male ratio is 2.1:1, which results lower than previously observed in unselected patients' cohorts. In these pedigrees, JHS, EDS-HT, and JHS + EDS-HT segregate as a single dominant trait with complete penetrance, variable expressivity, and a markedly evolving phenotype. This study represents a formal demonstration that EDS-HT and JHS contitute the same clinical entity, and likely share the same genetic background, at least, in familial cases.

Using Different Criteria to Diagnose (Central) Auditory Processing Disorder: How Big a Difference Does It Make?

To quantify how 9 different diagnostic criteria affected potential (central) auditory processing disorder ([C]APD) diagnoses in a large sample of children referred for (central) auditory processing ([C]AP) assessment. A file review was conducted on 150 children (94 boys and 56 girls; ages 7.0-15.6 years) with normal peripheral hearing who had completed a (C)AP assessment involving low-pass filtered speech, competing sentences, 2-pair dichotic digits, and frequency patterns with linguistic and nonlinguistic report. Each child was classified as having or not having (C)APD based on 9 different sets of diagnostic criteria drawn from published technical reports, position statements, and selected research. The rates of potential (C)APD diagnosis ranged from 7.3% for the strictest criteria to 96.0% for the most lenient criteria. Until greater consensus is reached, any diagnosis of (C)APD should be qualified by an explicit statement of the criteria used. Calls to abandon the use of (C)APD as a global label should also be supported.

A rational approach to the diagnosis of polycystic ovarian syndrome during adolescence

Polycystic ovarian syndrome (PCOS) is a lifelong disorder characterized by hyperandrogenism and ovulatory dysfunction, with a wide spectrum of clinical symptoms and signs. Three different sets of diagnostic criteria have been established in order to define this disease in adult women, but there is controversy regarding the use of these criteria in adolescence. During puberty, the adult criteria for ovulatory dysfunction does not seem applicable, because an irregular menstrual pattern and a decreased ovulatory rate is a physiologic event during this period of life. Also, a higher prevalence of polycystic ovarian morphology (PCOM) may be observed during this period, so PCOM is not a useful criterion to define PCOS in young women. These findings suggest that a key factor to diagnose to PCOS during adolescence is hyperandrogenism. In addition, since PCOM is not clearly associated with hyperandrogenism during this period of life, the term "polycystic ovarian syndrome" during adolescence creates confusion and may be misleading.

Revised NIA-AA criteria for the diagnosis of Alzheimer's disease: a step forward but not yet ready for widespread clinical use

In clinical medicine, diagnostic criteria are not only useful everyday tools for the practicing physician, but also represent a conceptual concentrate of the understanding of the etiology and pathophysiology of diseases at a given point in time. Although different sets of diagnostic criteria for Alzheimer's disease (AD) have been developed, the most widely used and best validated by clinico-pathological study to date are the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke – Alzheimer's Disease and Related Disorders Association) criteria which were published in 1984 (McKhann et al., 1984). These criteria are largely based on the exclusion of other conditions that may cause dementia and can be succinctly but fairly summarized as defining AD as an “acquired progressive cognitive, behavioral, and functional impairment with no other obvious cause”. Clearly, the NINCDS-ADRDA criteria were etiology- and pathophysiology-agnostic in that they failed to point at any specific etiology, not even a degenerative one. They were also developed before other important causes of dementia, such as dementia with Lewy bodies, fronto-temporal dementia and subcortical vascular dementia had been fully described and characterized. The recent publication of a substantially revised version of these criteria (Sperling et al. 2011; Albert et al., 2011; McKhann et al., 2011), heralded by a largely European initiative four years ago (Dubois et al., 2007) has been greeted with great interest by the field. The newly proposed criteria reflect the substantial insights on disease pathophysiology gained over the last decades, especially regarding the molecular pathology of AD and the time course of such pathology in relation to clinical symptoms and disease.

Current diagnosis of CIDP: the need for biomarkers

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a chronic neuropathy characterized by symmetrical proximal and distal weakness, with large-fiber sensory loss, impaired balance, and areflexia. This condition is often underdiagnosed due to the frequent absence of these classical clinical features as well as abnormalities that arise during confirmatory tests. Current diagnostic tests involve the measurement of cerebrospinal fluid protein levels, nerve biopsy, electrodiagnostic testing, and treatment response. Due to the clinical heterogeneity of the condition and a lack of a consistent confirmatory test, a variety of diagnostic criteria were developed. At least 14 different sets of diagnostic criteria have been proposed that each have varying diagnostic sensitivities. Although the diagnostic tests used within these criteria are useful, they individually offer evidence to support, rather than definitively confirm, the diagnosis of CIDP. Currently, there is no biomarker that can reliably identify all patients with CIDP, but it is evident that such a biomarker is urgently needed to ensure effective disease management.

A semi-structured clinical interview for psychosis sub-groups (SCIPS): development and psychometric properties

Clinical sub-groups of schizophrenia, namely drug related, traumatic, anxiety and stress sensitivity sub-types, have been proposed for use in research, training and practice. They were developed on the basis of clinical observation but have not yet been used in research or clinical practice to any great extent. To develop a semi-structured clinical interview for psychosis sub-groups (SCIPS) and determine the best diagnostic criteria with the highest inter-rater reliability, test-retest reliability and concurrent validity for sub-grouping patients with schizophrenia according to a newly developed classification scheme. The SCIPS was developed based upon discussion with the clinician researchers who had developed and were using the sub-groups. Kappa coefficients were calculated between two independent diagnostic assessments with the SCIPS (for inter-rater reliability and test-retest reliability, n=20) and between the SCIPS diagnosis and the sub-groupings as determined independently with highest achievable validity (for concurrent validity, n=21) for patients with schizophrenia. These inter-rater reliability and concurrent validity were compared among five different sets of diagnostic criteria to determine which was most reliable and valid. A set of diagnostic criteria with the highest inter-rater reliability and concurrent validity was determined. Kappa coefficients (95% confidence interval) for the inter-rater reliability and concurrent validity were 0.93 (0.66-1.20) and 0.73 (0.47-1.00), respectively, with these diagnostic criteria. The SCIPS is a promising tool with which to sub-group patients with schizophrenia according to this recently developed classification scheme. The semi-structured interview achieves acceptable inter-rater and test-retest reliability and concurrent validity.

Depression in the elderly community: I. Prevalence by different diagnostic criteria and clinical profile

- Background and Objectives: Depression is one of the most intriguing disorders in the elderly. We conjecture that prevalence of depression in the community vary according to the diagnostic criteria used. Furthermore, we anticipate that important proportions of depression go untreated or inadequately treated in a Southern European city. Metodology: This report is part of the Zaragoza Study (or ZARADEMP 0), an epidemiological project to document psychiatric morbidity in a representative sample of the elderly. A two - phase design was completed in a sample of n= 1080 elderly (65+ years). Standardized instruments were used, and the Geratric Mental State (GMS) was the main instrument. Cases of depression were diagnosed with three different sets of diagnostic criteria: AGECAT syndrome, AGECAT diagnosis and DSM - IV criteria. Descriptive statistics were used. Results: In support of the working hypothesis, the prevalence of depression tended to be lower when stringent diagnostic criteria were used. It was 7.0 % with AGECAT syndrome, 5.7% with AGECAT diagnosis among the cases, 4.8% with DSM - IV criteria. Anxiety, co - morbid syndromes were frequent among the cases (45.5%) and 18.2% of them had co - morbid AGECAT syndromes. Differential psychopathological profiles are observed between cases of major and minor depression. Undertreament or inadequate treatment was very frequent, and only 54.5% of major depression cases were on antidepressants. Conclusions: The prevalence of depression in the elderly vanes according to diagnostic criteria used, and does not increase with age. Co-morbid anxiety and organic syndromes are common, and only half the major depressive cases were on antidepressants.

Liquordiagnostik der Multiplen Sklerose – Diagnose und Differenzialdiagnose

Bei der Multiplen Sklerose handelt es sich um eine chronisch–entzündliche Erkrankung des zentralen Nervensystems mit funktionellen Defiziten vorwiegend aufgrund multipler demyelinisierender Läsionen unterschiedlichen Alters. Grundkonzept der Diagnosestellung ist der Nachweis einer Dissemination des Krankheitsprozesses in Bezug auf Ort und Zeit. Die diagnostischen Kriterien der Multiplen Sklerose wurden wiederholt revidiert. Der Artikel gibt einen Überblick über verschiedene Kriteriensysteme und diskutiert die derzeit verwendeten McDonald–Kriterien in ihrer revidierten Fassung von 2005. Die Diagnosestellung der Multiplen Sklerose beruht auf dem Ausschluss anderer entzündlicher, infektiöser, granulomatöser und hereditärer Erkrankungen, die nachfolgend skizziert werden. Ein klinischer Abklärungsalgorithmus bei Verdacht auf Multiple Sklerose wird vorgestellt. Im Rahmen der Diagnosestellung ist die Liquoranalyse essenziell, charakteristische Liquorbefunde und ihre Bedeutung werden diskutiert.

Diagnostic Criteria of Vascular Dementia in CADASIL

Subcortical ischemic vascular dementia (SIVD) is a major subtype of vascular dementia (VaD). Recently, the diagnostic criteria of VaD have been modified to encompass this entity. Application of these criteria in CADASIL, a genetic model of SIVD, may help to better assess their significance. The aim of this study was to compare different sets of diagnostic criteria of VaD in a population of CADASIL patients. Different sets of diagnostic criteria of VaD (DSMIV, ICD10, standard NINDS-AIREN, modified NINDS-AIREN for SIVD) were applied to 115 CADASIL patients. Diagnosis of VaD was made through 2 steps: (1) diagnosis of dementia and (2) association of dementia to lesions of vascular origin. The percentage of patients satisfying the different sets and the concordance between these criteria was analyzed. At least 1 set of criteria was satisfied for diagnosis in 29 subjects with dementia. In this group of patients, the sensitivity of the DSM IV, ICD 10, and standard NINDS-AIREN criteria for VaD was, respectively, 79%, 72%, and 45%. In contrast, the sensitivity of the NINDS-AIREN criteria for SIVD was 90%. The incomplete sensitivity of these last criteria was related to the absence of focal signs in some patients. The neuroimaging criteria were satisfied in all patients with dementia. The modified NINDS-AIREN criteria of SIVD are the most sensitive VaD criteria in CADASIL. Among these criteria, the neuroimaging criteria, although poorly specific to dementia, have a complete sensitivity. In contrast, focal signs were inconstant in CADASIL patients with dementia.

Changes in diagnostic criteria for PTSD: Implications from two prospective longitudinal studies.

This study assesses differences in PTSD rates according to different sets of diagnostic criteria. Two samples have been studied: one comprised of 286 combat stress reaction (CSR) casualties and 218 non-CSR veterans from the Lebanon war (Study 1); the other of 95 ex-POWs and 101 non-POWs from the Yom Kipur war (Study 2). Participants were administered two versions of the PTSD inventory based on different Diagnostic and Statistical Manual of Mental Disorders (DSM) editions: DSM-III and DSM-IV in Study 1 and DSM-III-R and DSM-IV in Study 2. PTSD rates declined when criteria of more recent DSM editions were applied. In addition, findings clearly demonstrate the importance of the dysfunction criterion (F) in PTSD. The highly complex nature of the PTSD diagnosis is discussed, as well as the important role of dysfunction and distress.

Clinical benefits of the new definitions of the metabolic syndrome

The metabolic syndrome can most simply be defined as an inter-related cluster of risk factors for diabetes and cardiovascular disease. Over the last decade, several different sets of diagnostic criteria have been generated. This has caused confusion, although all include a measure of obesity, dysglycemia, raised triglycerides and low high-density lipoprotein-cholesterol (HDL-C) raised blood pressure and, implicitly, insulin resistance. Most recently, the International Diabetes Federation (IDF) and the American Heart Association (AHA)/National Heart, Lung and Blood Institute (NHLBI) have produced similar criteria, although differing in waist measurement, which is lower, ethnically adjusted and obligatory in the IDF recommendations. There has been arguments as to both the etiology and clinical utility of the syndrome. In general, it provides a useful tool for use in primary care to screen people for increased relative risk of both cardiovascular disease and diabetes. There has been an explosion of interest in the metabolic syndrome over the past two decades. However, there have been a plethora of diagnostic criteria, dissenting views on pathogenesis, arguments about clinical usefulness and differences of opinion regarding the predictive power of the syndrome. In the following editorial we shall discuss the historical development of the syndrome and attempts to generate diagnostic sets, and argue that, with the most recent criteria produced by the IDF and the AHA/NHLBL, we now have a valuable and easy-to-use clinical tool of great potential benefit to patients.

Diagnosis of arrhythmogenic right ventricular cardiomyopathy by 3 different sets of criteria

Introduction: Diagnosis of arrhythmogenic right ventricular dysplasia / cardiomyopathy (ARVD/C) has major implications for the management of patients and their first-degree relatives. Diagnosis may be difficult and is based on a set of criteria proposed by the International Task Force (TF) for Cardiomyopathies in 1994. More recently, diagnostic criteria based on MRI or ECG only have been suggested in the literature. We evaluated the consistency in outcome between 3 different sets of diagnostic criteria.

Gestational diabetes mellitus in Chinese women

Objective: To determine whether foreign diagnostic criteria for the diagnosis of gestational diabetes mellitus (GDM) are suitable for Chinese pregnant women. Methods: The study participants were 340 pregnant women receiving obstetric care at the Shanghai Jiaotong University–Affiliated Sixth People's Hospital in Shanghai, China. The normal-pregnancy group comprised 190 women with no risk factor for GDM and the high-risk pregnancy group comprised 150 women who had at least one high-risk factor for GDM. All women took the diagnostic 100-g, 3-h oral glucose tolerance test (100-g 3-h OGTT) between 24 and 28 weeks of pregnancy. The results of the 100-g 3-h OGTT were classified according to three different sets of diagnostic criteria: (1) new, “Chinese” diagnostic criteria based on the results from the 100-g 3-h OGTT performed in the 190 healthy participating women; (2) the Carpenter and Coustan criteria; and (3) the National Diabetes Data Group (NDDG) criteria. Venous plasma glucose (VPG) was measured by the glucose oxidase method. A consistency check was used for analysis. Obstetric and neonatal outcomes were recorded. Results: With 97.5% as the statistical cutoff value for the 100-g 3-h OGTT, the new diagnostic criteria for this study, based on data obtained from the 100-g 3-h OGTT performed on the 190 participating healthy pregnant women, were 5.2, 10.3, 8.9, and 7.7 mmol/L at 0, 60, 120, and 180 min. The ê value was 0.83 for the new criteria vs. the Carpenter and Coustan criteria ( P<0.001) and 0.70 for the new criteria vs. the NDDG criteria ( P<0.001). In women with GDM and gestational-impaired glucose tolerance (GIGT), the incidence rates of macrosomia by the new criteria and the Carpenter and Coustan criteria were similar, but higher than the rates calculated with the NDDG criteria ( P<0.05). Conclusion: With venous plasma glucose level measured by the glucose oxidase method, the Carpenter and Coustan criteria are applicable to Chinese pregnant women for diagnosis of GDM.

Controversies in vascular dementia

The main controversies in the field of vascular dementia (VaD) include the nosological classification of this disorder, the definition of dementia, the differences between the different sets of diagnostic criteria, the concept of Binswanger disease, the role of vascular lesions in Alzheimer disease, and the results of cholinesterase trials in VaD. Vascular Cognitive Disorder (VCD) is the most current nosological classification for the global diagnostic category of cognitive impairment of vascular origin, ranging from mild cognitive impairment (MCI) to vascular dementia. It includes specific disease entities such as poststroke VaD, CADASIL, Binswanger disease, and AD plus CVD. Vascular cognitive impairment (VCI) is limited to cases of vascular MCI without dementia, by analogy with the concept of amnesic MCI, currently considered the earliest clinically diagnosable stage of Alzheimer disease (AD). The main problem of VaD stems from the currently accepted definition of dementia that requires memory loss as the sine qua non for the diagnosis. This may result in over-sampling of patients with AD worsened by stroke (AD+CVD). We have proposed an operational definition of dementia in VaD based on the presence of abnormal executive control function, severe enough to interfere with social or occupational functioning. This may increase the sensitivity and specificity of the NINDS-AIREIN criteria. In donepezil trials in VaD that excluded prestroke MCI, the placebo groups were different from those in AD without CVD, and in AD+CVD trials.

Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome following allogeneic HPC transplantation: a diagnostic dilemma.

Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) has been described as a specific sequela of allogeneic HPC transplantation (HPCT). Nevertheless, because multiple transplant-related sequela can cause the characteristic clinical features of TTP-HUS, the diagnosis is difficult. All English-language articles describing patients with TTP-HUS following HPCT were identified. Articles reporting five or more total patients, including at least one patient diagnosed with TTP-HUS following allogeneic HPCT, were reviewed. All articles describing autopsies of patients diagnosed with TTP-HUS following allogeneic HPCT were also reviewed. Thirty-five articles reporting 5 or more total patients described 447 patients diagnosed with TTP-HUS following allogeneic HPCT. The frequency of diagnosis of TTP-HUS following allogeneic HPCT varied by 125-fold (0.5%-63.6%). Twenty-eight different sets of diagnostic criteria were described in the 35 articles; 25 articles included both RBC fragmentation and increased serum LDH. Many risk factors described as correlating with the diagnosis of TTP-HUS also predict greater risk for multiple transplant-related complications. Benefit of plasma exchange treatment could not be documented. Survival information was reported for 379 patients, 232 (61%) died, and reported mortality rates varied from 0 to 100 percent. Autopsies have been reported for 35 patients who were diagnosed with TTP-HUS following allogeneic HPCT; none had systemic thrombotic microangiopathy, the diagnostic abnormality of TTP-HUS; and infection (19 patients) was the most commonly reported cause of death. The clinical features of TTP-HUS following allogeneic HPCT may be caused by common transplant-related complications; the benefit from plasma exchange treatment is uncertain.

Phenomenology and Comorbidity of Dysthymic Disorder in 100 Consecutively Referred Children and Adolescents: Beyond DSM-IV

Diagnostic criteria and nosological boundaries of juvenile dysthymic disorder (DD) are under-researched. Two different sets of diagnostic criteria are still discussed in the DSM-IV, the first giving major weight to somatic and vegetative symptoms and the second, included in the appendix, to more affective and cognitive symptoms. The aim of this study was to describe prototypical symptomatology and comorbidity of DD, according to DSM-IV criteria, in a consecutive series of referred children and adolescents, as a function of age and sex. One hundred inpatients and outpatients (36 children and 64 adolescents, 57 males, 43 females, age range 7 to 18 years, mean age 13.3 years) received a diagnosis of DD without comorbid major depressive disorder (MDD), using historical information, the Diagnostic Interview for Children and Adolescents-Revised (DICA-R), and symptoms ratings according to the DSM-IV criteria. Irritability, low self-esteem, fatigue or loss of energy, depressed mood, guilt, concentration difficulties, anhedonia, and hopelessness were present in more than 50% of subjects. Differences in symptomatic profile between male and female patients were not significant. Anxiety disorders were commonly comorbid with DD, mainly generalized anxiety disorder, simple phobias, and in prepuberal children, separation anxiety disorder. Externalizing disorders were reported in 35% of the patients, with higher prevalence in male patients. Adolescents showed more suicidal thoughts and anhedonia than children. The clinical picture of early-onset DD we found, based entirely on a pure sample without current and past MDD, is not totally congruent with the diagnostic criteria according to DSM-IV. A more precise definition of the clinical picture may help early diagnosis and prevention of superimposed mental disorders.