DSM-III Diagnostic Criteria Research Articles

Methylphenidate in Aggressive Hyperactive Boys: II. Indirect Effects of Medication Treatment on Peer Behavior

ABSTRACT The present study examines the indirect "spillover" effects of methylphenidate on the behavior of the classmates of drug-treated children in public school settings, and it measures the extent to which medication normalizes hyperactive and noncompliant-aggressive behaviors. Eleven aggressive hyperactive boys, who met DSM-III diagnostic criteria for attention deficit disorder, received placebo and methylphenidate in a double-blind crossover design. Medication effects were assessed by conducting observations of the drug-treated boy and his peers in the classroom and lunchroom settings. In most classrooms, a spillover effect did not occur for most of the behaviors assessed, but there was a decrease in the rate of nonphysical aggression exhibited by peers as a function of the hyperactive child's methylphenidate dose. Peers were generally less aggressive when the hyperactive boys were receiving methylphenidate than when they received placebo. In the lunchroom, in contrast, peers appeared slightly more noncompliant and aggressive when the aggressive hyperactive boys were receiving medication compared with placebo, but these differences did not attain statistical significance. Methylphenidate effectively normalized the negativistic behaviors of the aggressive hyperactive boys in the classroom. In some cases, the frequency of occurrence of certain behaviors dropped significantly below the level of the hyperactive child's peers. This "supranormalization" may reflect behavioral toxicity of the psychostimulant.

Treating depression in the context of marital discord: Outcome and predictors of response of marital therapy versus cognitive therapy

Forty five couples in which both partners were complaining of marital discord and in which the wife met DSM-III diagnostic criteria for either major depression and/or dysthymia participated in 15–20 treatment sessions. Couples were randomly assigned to marital therapy (BMT, n =15), individual cognitive therapy for the depressed wife (CBT, n =15), or wait-list control group (WL, n =15). Women in both cognitive therapy and marital therapy experienced significantly greater reductions in depressive symptomatology than did women in the wait-list control group. In addition women in marital therapy had significantly greater increases in marital adjustment than either women in cognitive therapy or women in the wait-list condition. Of special importance in this report, and complimenting our earlier work, were process analyses which indicated that reductions in level of depression among wives in the marital therapy condition were mediated by increases in marital adjustment. Further, exploratory analyses suggested that pre-therapy levels of marital variables and dysfunctional cognitions could predict differential response to marital therapy and cognitive therapy.

Do Different Subtypes of Hospitalized Depressives Have Different Long-term Outcomes?

In 1965 and 1966, a consecutive series of 89 patients admitted to the Maudsley Hospital, London, England, with depressive illness were interviewed, and various personality questionnaires were administered; 18 years later, they were followed up and reinterviewed. Then, on the basis of the index data alone and without knowledge of their eventual outcomes, they were subtyped according to the Research Diagnostic Criteria, DSM-III, Newcastle Index, and Present State Examination diagnostic criteria. Patients who met the various subtype criteria at index were compared with those who did not in respect to their long-term outcome. Subtyping had little prognostic utility except for three endogenous criteria that were all associated with poor outcome. In addition, DSM-III melancholia had an interactive effect with the personality measure neuroticism, so that those melancholic patients who at index had high neuroticism scores were very likely to have a poor outcome.

Physician Practices in the Diagnosis of Dementing Disorders

Because there are both treatable and untreatable causes of dementia, the physician's ability to conduct (or refer a patient for) a differential diagnosis could have a profound effect on health outcomes for patients and on health care costs. This study was undertaken to assess physician practices with regard to the diagnosis of dementing disorders. Data from 53 physicians (a response rate of 48%) in several specialties were obtained from a self-administered mail questionnaire. Results indicate that the majority of physicians provided history taking, physical examination, and neurological examination. Physicians were more likely to refer patients for psychiatric and neuropsychological examinations than to provide these services themselves. The results also point to deficiencies in two key areas: the use of formal, published diagnostic criteria, and the use of mental status and cognitive function tests. Over 75% of physicians surveyed did not use either DSM-III or NINCDS-ADRDA diagnostic criteria, and 42% of physicians did not provide any mental status tests themselves. The need for continuing education to close knowledge gaps is emphasized.

Neuroradiological Facets of Cognitive Abnormality in Schizophrenia

Cognitive abnormality has long been regarded as a core feature of schizophrenia, but its nature and etiopathology have been poorly understood. Predicated on new tests that characterize fundamental cognitive impairments, we investigated their relationship to four neuroradiological markers that have been previously implicated in schizophrenia: choroid plexus calcification, cerebellar atrophy, third ventricle enlargement, and pineal calcification. Twenty-three chronic schizophrenic inpatients meeting RDC and DSM-III diagnostic criteria were stabilized on chlorpromazine and assessed independently on a cognitive battery and on CT scan. The results indicated that all four neuroradiological variables were independent of one another and of demographic, historical, and general intellectual measures. The neuroradiological assessments, however, correlated significantly with different cognitive parameters, implying separate pathophysiological bases for distinct profiles of cognitive abnormality. The findings support a "dual-process model" of cognitive dysfunction that posits developmental and arousal-related components which may, more generally, underlie the positive-negative dimension of schizophrenia.

DSM-III personality disorders in obsessive-compulsive disorder: Changes with treatment

Twenty-seven patients meeting DSM-III diagnostic criteria for obsessive-compulsive disorder (OCD) completed the Personality Diagnostic Questionnaire (PDQ; a self-rating scale designed to assess the axis II personality disorders [PDs] from the DSM-III) before and after 12 weeks of treatment with clomipramine. Treatment was accompanied with reduction on several personality variables, including the number of personality diagnoses assigned, the distribution of traits in the sample, and the number of items endorsed in each personality category. The data also showed that improvement in personality functioning was significantly greater in responders compared with nonresponders or partial responders. Further investigation of the relationship between personality and treatment outcome did not provide strong support for the notion that personality factors may have prognostic significance in the treatment of OCD. These findings suggest similarities and differences with panic/agoraphobia which are briefly discussed.

Effect of combined substance use on laboratory markers of alcoholism.

This article examines the commonly used laboratory indicators of heavy alcohol use (elevated MCV, GGTP and AST values) in subgroups of drug-using and non-drug-using alcoholic men admitted to an inpatient alcoholism treatment program. A total of 380 consecutive admissions meeting DSM-III diagnostic criteria for alcohol use or dependence were studied. Of these subjects, 75% used both alcohol and drugs. The most frequently used drugs were marijuana, cocaine, amphetamines and tranquilizers. Overall, subjects who used drugs with alcohol had significantly lower MCV and GGTP values than subjects who used alcohol alone. More specifically, cocaine use was associated with lower MCV values, marijuana use with lower AST values and heroin use with higher AST and GGTP values. These differences between drug-using and non-drug-using alcoholics were significant even after controlling for variables that affect the laboratory values such as age, quantity, frequency and duration of alcohol consumption. These findings indicate that any study of laboratory markers of alcoholism needs to consider concomitant illicit drug use patterns.

Psychopathology in children aged 10–17 of bipolar parents: Psychopathology rate and correlates of the severity of the psychopathology

Seventy-two proband children aged 10–17 of bipolar parents, matched with 72 control children of normal parents, were investigated using DSM-III diagnostic criteria and multiple sources of information. The psychopathology rate in children (61% in probands versus 25% in controls) was related to the impact of psychic disorders on the children's adaptive functioning. The effect of several variables describing the psychiatric status of both parents and familial environment on the severity of psychopathology in children was analysed. Disordered and non-disordered probands were compared with respect to illness characteristics of their parents, familial environment, personality traits, and IQ by means of canonical discriminant analysis.

Transmembrane lithium distribution and hypertension in manic depressive patients

1. The association of hypertension and depression has long been recognized. The purpose of this study was to explore the relationship between RBC level/plasma level of lithium (Li), blood pressure (BP) and weight in bipolar affective disorder patients. 2. All patients were evaluated by the same examiner using DSM-III Diagnostic Criteria. Measurement of patients' Li values, BP and weight were carried out on the same day or within 24 hours. 3. We evaluated 103 bipolar patients treated with lithium (mean age: 44 years, mean duration of Li treatment, 6 years). Ten percent of these patients were hypertensive. 4. No significant difference was found between hypertensive (H) and non-hypertensive (NH) patients with respect to their RBC, plasma or RBC/plasma Li ratio. This finding was consistent in patients treated with Li alone or Li combined with other neuroleptics. 5. Our study did not confirm previous findings (McCoy et al, 1982) indicating that there is a correlation between low Li ratio (< 0.30) and hypertension in bipolar affective disorder patients.

The predictive power of the salivary cortisol dexamethasone suppression test for three-year outcome in major depressive illness

Seventy patients satisfying DSM-III and Research Diagnostic Criteria for major depression were given a salivary cortisol dexamethasone suppression test, with samples collected at 0700h, 1500h and 2300h after dexamethasone. The patients were classifird as nonsuppressors (mean post-dexamethasone salivary cortisol concentration ≥ 2.0 ng/ml, N = 27) and suppressors (mean post-dexamethasone salivary cortisol concentration < 2.0 ng/ml, N = 43). At 3-yr follow-up there was no difference in illness outcome as assessed by the life table method or by the length of rehospitalization for several periods after the index episode. In multiple regression and discriminant function analyses, with outcome as the dependent variable (readmitted within 1 yr, readmitted between 1 and 3 yr, not readmitted), the mean post-dexamethasone salivary cortisol concentration was not significantly predictive of outcome.

Genetic and Perinatal Factors in Antisocial Personality in a Birth Cohort

Abstract Previous research has demonstrated a relationship between perinatal factors, genetic factors, and some kinds of antisocial behavior. The current project investigates the possibility of a similar relationship between perinatal difficulties and/or genetic factors and Antisocial Personality Disorder (ASP). The Danish birth cohort examined here consists of 94 Danish men, half of whom (N = 47) had evidenced serious criminal behavior by age 36. Of these criminal men, 12 met the DSM-III diagnostic criteria for Antisocial Personality Disorder. The results showed no relationship between ASP, genetic variables, and perinatal complications and are interpreted as implying etiological differences between antisocial behavior and Antisocial Personality Disorder.

Fragile X syndrome: genetic predisposition to psychopathology.

Fragile X syndrome is a newly recognized X-linked disorder which has been associated with a high prevalence of psychiatric disturbance, particularly attention deficit disorder and autism. The present study involved the neuropsychiatric evaluation of 14 males with the disorder who were between the ages of 3 to 27 years. Pervasive hyperactivity, impulsivity, and attentional deficits were found among all of the subjects, while a significant degree of anxiety was manifested by more than half. Although the majority of subjects exhibited poor eye contact, atypical speech and language functioning, and stereotyped behavior, only one met DSM-III diagnostic criteria for a persistent pervasive developmental disorder. Gaze aversion, noted among half of the subjects, was attributed to underlying anxiety rather than to autistic social dysfunction because of the otherwise socially engaged and affectionate behavior exhibited by the subjects. Failure to make this distinction in the context of cognitive and linguistic impairments associated with fragile X syndrome may account for the high rates of autism reported by other investigators.

Prevalence of panic in adolescents: a brief report.

In a recent survey of panic attacks administered to 338 high school students, a significant number of adolescents (31.9%) reported experiencing at least one panic attack meeting DSM-III diagnostic criteria. In addition, 4.7% of the students reported experiencing panic severely and frequently enough to fulfill diagnostic criteria for panic disorder. These prevalence rates are consistent with the findings of current research into the incidence of panic phenomena among adults and provide evidence for the commonality of panic across various age groups. As there are few data concerning the incidence of anxiety disorders in adolescents, further investigation into the prevalence of panic in this population is warranted.

Anorexia nervosa and schizophrenia

The authors present 12 patients who met the DSM-III diagnostic criteria for both anorexia nervosa and schizophrenia. The negative symptoms of schizophrenia were prominent, and the patients had an unremitting course for the eating disorder. The coincidence of anorexia and schizophrenia is discussed.

Convergence between statistically derived behavior problem syndromes and child psychiatric diagnoses

The relations between scores on statistically derived behavior problem syndromes and DSM-III diagnoses were examined for 270 clinically referred children aged 6 through 16. Each child's parent completed the Child Behavior Checklist (CBCL) and was administered the NIMH Diagnostic Interview Schedule for Children (DISC)--a structured interview covering DSM-III diagnostic criteria. Numerous behavior problems scales scored from the CBCL were significantly related to one or more diagnoses. The strongest relations were between scores on the Hyperactive, Delinquent, and Depressed scales and diagnoses of Attention Deficit Disorder, Conduct Disorder, and Depression/Dysthymia, respectively. This convergence supports the validity of some syndromal constructs common to both assessment paradigms.

DSM-III at the cinema: Madness in the movies

A kaleidoscopic view of commercial film and television depiction of mental disorders is presented. Films portraying various types of mental disorder, from psychoses through personality disorders, are identified and examined in terms of DSM-III diagnostic criteria. It is concluded that although few generalizations can be made, a surprisingly large number of films are reasonably accurate in their representations of various disorders, and some may even be considered prototypal in their portrayal of the mentally ill.

The International Classification of Impairments, Disabilities and Handicaps: Its Usefulness in Classifying and Understanding Biopsychosocial Phenomena

The International Classification of Impairments, Disabilities and Handicaps (ICIDH) was developed because of the growing awareness that ICD-9 failed to reflect many of the problems that people bring to health care systems. The ICIDH was designed to classify the consequences of disease such as the disruption of daily activity and the social disadvantage that accompany illness. However, since its introduction, the ICIDH has largely been ignored by psychiatry, despite its conceptual strength. In particular, it provides a framework for applying the biopsychosocial model and studying the phenomena of mental illness. The latter is an important issue because of clinical psychiatry's inherent weakness in distinguishing between symptoms of disease and the psychosocial consequences, a particular inadequacy of the DSM-III diagnostic criteria. The utility of the ICIDH is shown in the study of the phenomena of panic disorder and agoraphobia, where I conclude that agoraphobia should be classified as a disability/handicap and not a disorder.

The phenomenology of posttraumatic stress disorders following a natural disaster.

This study examined the utility of the DSM-III diagnostic criteria for posttraumatic stress disorder (PTSD) in a high-risk group of 50 firefighters who had had an intense exposure to a natural disaster 8 months before being interviewed. Follow-up over the next 3 years allowed examination of the ability of these diagnostic criteria to predict a pattern of chronic posttraumatic morbidity. They predicted a pattern of chronic disorder, demonstrated by the finding that eight of the 15 subjects who had definite or borderline PTSD at 8 months remained symptomatic 3 years later. A disturbance of attention and concentration appeared to be the best predictor of chronic PTSD. The longitudinal course of posttraumatic morbidity in these 50 firefighters was compared with a matched group of 96 uninterviewed subjects 11 and 29 months after the disaster. Although the interview provoked an emotional catharsis in a number of firefighters, the long-term morbidity in the two groups was comparable. Fourteen subjects who did not have PTSD continued to experience intense imagery 8 months after the disaster. This observation raises questions about whether such thoughts and feelings have adequate specificity as diagnostic criteria for PTSD in a group that has recently been exposed to a traumatic event.

Psychogenic Pain and Psychological Variables: a Psychometric Study

A sample of 41 women suffering from psychogenic pain according to DSM-III diagnostic criteria were psychometrically studied, in order to ascertain if they showed specific psychological traits or mechanisms. Type A behavior, extraversion, neuroticism, psychoticism and dissimulation and hostility-aggressivity traits were the psychological variables studied both in the pain sample and in a matched control group. Psychogenic pain patients were significantly more neurotic and suspicious and less physically aggressive than healthy subjects and also scored significantly higher in dissimulation, which suggests a tendency to use defense mechanisms of denial.

The Borderline Syndrome: An Empirically Developed Prototype

A prototype of the borderline patient was developed using descriptions generated by 50 mental health workers (social workers, psychiatrists, clinical psychologists, and two student groups). The prototype was semantically organized using cluster analytic techniques. The three professional groups differed little in their conceptualization of borderline patients. In contrast, with increasing levels of experience, descriptions of borderline patients become more specific. The prototype developed is very similar to the DSM-III diagnostic criteria for borderline personality disorder, and it constitutes a subset of the clinical features proposed by Gunderson and Singer as a tentative definition of the borderline patient. The cluster structure of the prototype is similar to the organization of Kernberg's structural diagnosis.