International Diagnostic Checklists 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.

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.

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.

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.

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.

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

Diagnosing ICD-10 Depressive Episodes: Superior Criterion Validity of the Patient Health Questionnaire

Background: Diagnosing and monitoring depression in primary care remains an issue of significant public health concern. Clinicians and researchers need to know if any one screening instrument is superior to the others in diagnosing ICD-10 depressive episodes. This study aimed to examine the criterion validity for diagnosing ICD-10 depressive episodes of the Patient Health Questionnaire (PHQ) in comparison with 2 well-established instruments, the Hospital Anxiety and Depression Scale (HADS), and the WHO Well-Being Index 5 (WBI-5). Methods: Five hundred and one medical outpatients completed the questionnaires and had a clinical interview. The presence of a depressive episode was determined with the International Diagnostic Checklists (IDCL) for ICD-10 as the criterion standard. Coefficient kappa (ĸ), sensitivities and specificities were calculated and a statistical comparison of the areas under the receiver operating characteristic curves was performed. Results: Diagnostic agreement between the questionnaires and the IDCL was moderate (ĸ = 0.34–0.56), with the highest values for the PHQ. While all 3 questionnaires had reasonable sensitivity and specificity, the operating characteristics for the PHQ were significantly superior to both the HADS and the WBI-5 (p = 0.02). Conclusions: Any of the 3 screening instruments can be recommended for clinical use. However, this is the first comparative study to demonstrate the diagnostic advantage of a particular depression-screening instrument using the ICD-10 diagnostic criteria. The superior criterion validity of the PHQ is likely attributable to its closer representation of the current concept of depressive disorders.

Quality of Life of Schizophrenic Psychiatric Outpatients as a Criterion for Treatment Planning in Psychiatric Institutions

Subjective quality of life (QoL) is an indispensable part of the current concept of health. Therefore it should serve as a criterion for treatment planning in social psychiatric institutions. We looked at the QoL of our outpatients diagnosed with schizophrenia in order to identify possible areas of life that might need further attention in treatment planning. We used the short German version of the Lancashire Quality of Life Profile (BLEP-KF) to evaluate the QoL of 164 schizophrenic outpatients. All patients were diagnosed with the International Diagnostic Checklists (IDCL) for ICD-10. Demographic and treatment data are analysed cross-sectionally in relation to their QoL. The majority of patients was moderately happy with their general QoL. They were least satisfied in the domains of job and financial situation, mental health and sexuality. Psychopathology and especially the quality of individual care had a significant influence on the evaluation of QoL. This result supports an argument in favour of more individual patient-centred forms of case management to reduce the burden of severe psychopathological symptoms experienced in everyday activities by patients suffering from schizophrenia.

Classification of obsessive-compulsive disorder in childhood and adolescence.

In child and adolescent psychiatry the validation of the diagnosis must be seen in the context of development. Comparing different diagnostic formulations DSM-IV and ICD-10-DCR in a clinical sample of children and adolescents suffering from obsessive-compulsive disorder (OCD) and their validation on external criteria represent such a heuristic approach. We investigated 61 children seen consecutively in a specialized out-patient clinic for OCD. All of them were assessed by the International Diagnostic Checklists (IDCL). Diagnosis and diagnostic certainty were validated regarding age, age of onset and duration of illness. The agreement between the two diagnostic systems was low. The diagnostic stability of ICD-10-DCR was highly dependent on age, whereas that of the criteria DSM-IV did not depend on age and almost all subjects could be diagnosed definitely. This study suggests that the DSM-IV criteria are superior to that of ICD-10-DCR for diagnosing OCD in children and younger adolescents.

ICD-10 checklists—A tool for clinicians' use of the ICD-10 classification of mental and behavioral disorders

The Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) checklists are a set of semistructured instruments designed for clinician assessment of mental and behavioral disorders according to ICD-10 criteria. The checklists have been produced as a package consisting of the ICD-10 Symptom Checklist and Glossary and the International Diagnostic Checklists (IDCL) for ICD-10 and Manual. This report describes the main features of the newly released World Health Organization (WHO) instruments and specifies areas of possible application by clinicians.

Comparison of a Diagnostic Checklist with a Structured Interview for the Assessment of DSM-III-R and ICD-10 Personality Disorders

The International Diagnostic Checklists for the assessment of the DSM-III-R and ICD-10 personality disorders (IDCL-P) were compared with a structured interview, the International Personality Disorder Examination (IPDE), using a balanced test-retest design with forty psychiatric inpatients. The results, using pairwise kappa for the calculation of agreement, were as follows: any personality disorder versus no personality disorder 0.52 for DSM-III-R diagnoses and 0.75 for ICD-10 diagnoses. The range for the single personality disorders diagnosed at least five times was from -0.07 to 0.71 for DSM-III-R diagnoses and from 0.38 to 0.68 for ICD-10 diagnoses. Only for DSM-III-R diagnoses do figures exist from three other studies comparing two structured interviews with each other. The results of all four studies suggest that 60% of the variance in personality disorder diagnoses represents variance not attributable to the patients, which is scientifically unacceptable.

Routine psychiatric examinations guided by ICD-10 diagnostic checklists (International Diagnostic Checklists).

A systematic assessment of psychiatric diagnoses according to the new classification system ICD-10 can be guided and enhanced by the International Diagnostic Checklists (IDCL). This instrument was developed and evaluated primarily for use in routine clinical care. It consists of 30 separate lists in pocket form, each assigned to a specific disorder and allowing immediate and operationalized diagnostic decisions (without the need of computer assistance). Personality disorders are covered by a separate 12-page booklet (IDCL-P). Examples of the checklists are given together with possible areas of application. First studies have indicated good clinical practicability and satisfactory to excellent diagnostic reliability.