Different Sets Of Diagnostic Criteria Research Articles

Three sets of diagnostic criteria for major depression and correlations with serotonin-induced platelet calcium mobilization in cancer patients

Enhanced serotonin-induced platelet calcium mobilization has been proposed to be a biological marker for the pathophysiology of major depression in physically healthy patients. To determine the most appropriate method of diagnosing major depression in cancer patients, we compared serotonin-induced platelet calcium mobilization between patients with and without major depression diagnosed according to three different sets of diagnostic criteria (inclusive, substitutive and exclusive). Among the cancer patients referred to our institution between June 1997 and March 1998, 24 patients diagnosed as having major depression according to the inclusive approach (in which the nine traditional symptoms of major depression contribute towards the diagnosis of depression regardless of its presumed etiology) participated in the study. Serotonininduced platelet calcium mobilization was examined in these patients and in the same number of non-depressed controls matched for age, sex, cancer stage and cancer site. The depressed patients were then re-evaluated using substitutive and exclusive criteria, and calcium mobilization comparisons with the relevant controls were repeated. Compared with the controls, an enhanced serotonin-induced platelet calcium response was only observed in the patients with major depression according to the exclusive criteria. No significant enhancement was observed when the inclusive or substitutive approaches were used. These findings, based on the use of enhanced serotonin-induced platelet calcium mobilization as a biological marker, suggest that the exclusive approach might be the most valid and appropriate method of diagnosing major depression in cancer patients, while the inclusive and substitutive approaches might overestimate the occurrence of major depression in these patients.

The effect of different diagnostic criteria on the prevalence of malnutrition in a hospitalized geriatric population

Malnutrition is considered an important clinical problem in geriatric hospitalized patients, but no standard diagnostic criteria are available. The aim of this study was to investigate the effect of 7 different sets of diagnostic criteria (6 in hospitalized elderly and 1 in healthy elderly) from nutritional research studies on the prevalence of malnutrition in 151 elderly patients (49 men, 102 women, mean age 82.8 years) consecutively admitted to an acute geriatric ward. Nutritional status was assessed using anthropometric (body mass index, triceps skinfold thickness, mid arm circumference, arm muscle circumference), and laboratory (serum albumin) parameters, and 1 nutritional questionnaire (Mini Nutritional Assessment). The proportion of patients with malnutrition varied between 6.5 and 85%. It is important to assess the nutritional status in elderly patients because the prevalence of malnutrition in hospitalized elderly patients is substantial whatever criteria are used. However, the criteria for the diagnosis can differ by a factor of more than 10 in the number of patients classified as malnourished. A major goal for further research on malnutrition is to define more standardized and validated criteria in order to make comparisons of prevalence and outcome more meaningful, and ensure that all those who will benefit from a nutritional intervention are identified and treated.

Diagnosis of infective endocarditis. Sensitivity of the Duke vs von Reyn criteria.

Because of the highly variable clinical manifestations of infective endocarditis (IE), different sets of diagnostic criteria have been used to standardize case definitions of IE. We evaluated the validity of the recently proposed Duke criteria, as compared with the older von Reyn criteria, in patients with no history of injecting drug abuse. A total of 243 consecutive episodes of suspected IE in 222 patients treated during the years 1980 through 1995 in a Finnish teaching hospital were retrospectively evaluated for the likelihood of IE by means of these 2 classification schemes. Of all disease episodes, 114 were designated as definite IE by the Duke criteria, as compared with 64 episodes so classified by the von Reyn criteria (P < .001; Fisher exact test). Moreover, as many as 115 disease episodes were rejected by the von Reyn criteria, whereas only 37 episodes were rejected by the Duke criteria (P < .001). Of the cases rejected by the von Reyn criteria, the Duke clinical criteria designated 6 (5%) as definite IE and 72 (63%) as possible IE. Among histopathologically verified episodes, 46 were designated as definite IE by the Duke clinical criteria, as compared with a diagnosis of probable IE by the von Reyn criteria in 33 episodes (P = .02). Moreover, 26 pathologically proved cases would have been rejected by the von Reyn criteria had surgery not been performed, as compared with none being rejected by the Duke criteria (P < .001). Corroborating earlier findings, the higher sensitivity of the Duke criteria, as compared with the von Reyn criteria, was demonstrated in this study. These results confirm the validity of the Duke criteria in diagnosing IE in a non-drug-addict patient population.

Cross-system agreement among demographic subgroups: DSM-III, DSM-III-R, DSM-IV and ICD-10 diagnoses of alcohol use disorders

Increasing importance is being place on the appropriateness of methodologies for different population subgroups, such as women as well as men, non-Whites as well as Whites, and older and younger individuals. In the alcohol field, this applies to a number of areas, including the agreement between diagnoses of alcohol use disorders by different sets of diagnostic criteria. We tested the agreement between DSM-III, DSM-III-R, DSM-IV and ICD-10 criteria for alcohol dependence and abuse in demographic subgroups of a sample of 962 community residents screened for heavy drinking in the previous 12 months. Good to excellent agreement was found for current diagnoses of dependence across all subgroups and classification systems. For past diagnoses, agreement was good across all subgroups for comparisons that did not involve DSM-III, and quite low for comparisons of DSM-III to other classification systems across subgroups. With few exceptions, cross-system agreement for diagnoses of alcohol abuse was poor. This result was also consistent across demographic subgroups. Results suggest that studies can be compared equally well for diagnoses of alcohol dependence subsequent to DSM-III for males and females, Whites and non-Whites, and older and younger respondents. Abuse remains a problematic category psychometrically across all demographic categories, even in this sample of largely untreated household residents.

Growth hormone response to clonidine in neuroleptic-free patients with multidiagnostically defined schizophrenia

The role of α 2-adrenergic receptor sensitivity in schizophrenia was examined by measuring growth hormone (GH) response after the intravenous administration of clonidine (1.3 μg/kg) in 26 healthy control subjects and 26 neuroleptic-free, acutely psychotic patients with at least 1 out of 11 possible diagnoses of schizophrenia derived from a multidiagnostic psychopathological assessment. GH responses were significantly (0.01) lower than control values in schizophrenias defined by E. Bleuler, M. Bleuler, Schneider, Langfeldt, Taylor and Abrams, and Cloninger, but not in DSM-III, World Health Organization, Feighner, Kraepelian, and Research Diagnostic Criteria (RDC) schizophrenias. Eight patients with RDC schizoaffective disorder also had a blunted response. However, there were no correlations with any symptom measures. There were no differences between paranoid and nonparanoid patients, although there was a significant difference between nonparanoid patients and control subjects. These findings support the presence of noradrenergic dysfunction in some patients within the schizophrenia syndrome, possibly those whose illnesses have an affective component. The study also illustrates the need for simultaneous investigation of several different sets of diagnostic criteria for schizophrenia in neurobiological research.

Preliminary criteria for the classification of Sjögren's syndrome. Results of a prospective concerted action supported by the European community

Different sets of diagnostic criteria have been proposed for Sjögren's syndrome (SS), but none have been validated with a large series of patients or in a multicenter study. We conducted the present study involving 26 centers from 12 countries (11 in Europe, plus Israel), with the goals of reaching a consensus on the diagnostic procedures for SS and defining classification criteria to be used in epidemiologic surveys and adopted by the scientific community. The study protocol was subdivided into two parts. For part I, questionnaires regarding both ocular and oral involvement were developed; they included 13 questions and 7 questions, respectively. For part II a limited set of diagnostic tests was selected, and the exact procedure to be followed in performing these tests was defined. Part I of the study included 240 patients with primary SS and 240 age- and sex-matched controls. Two hundred forty-six patients with primary SS, 201 with secondary SS, 113 with connective tissue diseases but without associated SS, and 133 control patients were studied in part II. The study resulted in (a) the validation of a simple 6-item questionnaire for determination of dry eyes and dry mouth, which showed good discriminant power between patients and controls, to be used in the initial screening for sicca syndrome; and (b) the definition of a new set of criteria for the classification of SS. The sensitivity and specificity of the criteria in correctly identifying patients with either the primary or the secondary variant of SS were also determined. Using the findings of this prospective multicenter European study, general agreement can be reached on the diagnostic procedures to be used for patients with SS. Final validation of the preliminary classification criteria for SS is underway.

Epidemiology of headache and childhood migraine in an urban general practice using Ad Hoc, Vahlquist and IHS criteria.

In a survey conducted by a UK urban general practice, 98.1 per cent (1083) of the children registered aged three to 11 years took part in an interview. Possible migraine subjects took part in an extended interview, the results of which were recorded using three different sets of diagnostic criteria: Vahlquist, Ad Hoc and International Headache Society. The prevalence of migraine ranged from 3.7 to 4.9 per cent, depending on the criteria used. The prevalence of migraine with aura (1.5 per cent) was similar by all criteria, whereas that for migraine without aura ranged from 2.2 to 3.4 per cent. The prevalence of migraine increased with age. The IHS criteria appeared less sensitive than the Ad Hoc for migraine without aura. Operational criteria using three attacks lasting longer than one hour may be more specific for the diagnosis of migraine in young children.

The diagnosis of bulimia nervosa

The interpretation of research into the eating disorder bulimia nervosa is complicated by the use of two different sets of diagnostic criteria. In North America the DSM III criteria are usually employed (American Psychiatric Association, 1980), whereas in Britain Russell's criteria (Russell, 1979) are preferred. While the two sets of criteria appear to be designed to identify people with essentially the same disorder, they embrace different, but over-lapping, populations. Discrepancies between the findings of various investigations may therefore be attributed in part to the fact that different patient groups have been studied. In this paper both these sets of diagnostic criteria and the proposed DSM III R criteria (American Psychiatric Association, 1985) are reviewed in the light of current knowledge. In addition, the relationship between bulimia nervosa and anorexia nervosa is examined. Certain revisions to the diagnostic criteria for both disorders are suggested reflecting the view that extreme concerns about shape and weight are a central psychopathological feature uniting anorexia nervosa and bulimia nervosa.

Effectiveness of lithium prophylaxis in schizoaffective psychoses:application of a polydiagnostic approach

The effectiveness of lithium prophylaxis has been tested in a group of patients fulfilling the relatively broad ICD-9 definition of schizophrenic psychosis, schizoaffective type, and in each of the subgroups resulting from the application to the same patients of four different sets of diagnostic criteria for schizoaffective or cycloid psychoses. Moreover, a comparison has been made, within the whole patient population, between responders and non-responders to treatment, with respect to some clinical and biological variables. The mean number of morbid episodes and the mean total morbidity have been found significantly reduced during the treatment period, as compared with a control period of the same length, in the whole patient population as well as in subjects meeting RDC and Kendell's criteria for schizoaffective disorder (with special regard to schizomanics) and Perris's criteria for cycloid psychoses. No significant difference between the two periods has been observed in patients diagnosed as schizoaffectives according to Welner et al. Clinical/historical variables (with special regard to those concerning the course of the illness and the family history of major psychoses) have been found the most reliable predictors of response, whereas biological variables did not discriminate between responders and nonresponders to prophylaxis.

Different definitions of alcoholism, I: Impact of seven definitions on prevalence rates in a community survey.

The authors applied seven different sets of diagnostic criteria for alcoholism to data obtained by using the Schedule of Affective Disorders and Schizophrenia (SADS) in a community sample. They found that the different diagnostic schemes for alcoholism are hierarchical in the sense that some definitions identify smaller groups of subjects as alcoholic than do other definitions. This study illustrates a potentially useful empirical approach to comparing diagnostic criteria for psychiatric disorders in epidemiologic or clinical studies.

Impact of recent changes in diagnostic criteria on the apparent natural history of diabetes mellitus.

The effect of changing from the original to the new National Diabetes Data Group diagnostic criteria for diabetes mellitus was to delete 16.5% of the original diabetes incidence cohort described among Rochester, Minnesota, residents in 1945-1969, to shift the clinical spectrum at diagnosis toward more severe disease, to reduce relative survival, and to increase the risk of developing macro- or microvascular complications. The changes in apparent natural history were unexpectedly modest in magnitude, however, and should have little practical effect on comparisons of diabetes prognosis under the two different sets of diagnostic criteria.

Computer analysis of the orthogonal electrocardiogram in pulmonary emphysema

Orthogonal electrocardiograms (Frank system) were recorded from 405 patients with pulmonary emphysema of moderate and severe degree. The diagnosis was based on clinical and radiologic or pulmonary function studies, or both, according to uniform study protocols. Of 333 electrocardiographic measurements computed from each record, different sets of diagnostic criteria were selected for optimal separation of records of patients with pulmonary emphysema from those of normal subjects, using a variety of statistical techniques. The first set consisted of five scalar and vector measurements which can be easily obtained and which do not require access to computer facilities. With these criteria, 80 percent of the records of patients with pulmonary emphysema could be correctly classified, with a false positive rate of 11 percent. With a second set of 14 more complex measurements intended for computer use, 81 percent of pulmonary emphysema tracings were classified correctly, with a reduction in false positives to 5 percent. With the use of additional criteria, a series of 140 records from patients with right ventricular hypertrophy due to pure mitral stenosis could be differentiated from records of patients with pulmonary emphysema in 80 percent of cases. Reduction of the R wave and the R:S ratio in lead X proved to be the best discriminators between records of normal subjects and those of patients with pulmonary emphysema. Correlations with arterial pCO 2 showed progression of R x changes, a QRS shift in a superior direction and a rightward shift of the P wave as the best indicators of deteriorating pulmonary function. Classification procedures were tested on independent record samples including 1 sample of 22 autopsy cases of pulmonary emphysema. Results were nearly identical. They exceeded those reported in the literature, which may be attributed to the use of more reliable electrocardiographic leads and to application of more efficient multivariate classification procedures.