Manual Of Mental Disorders 4th Edition Research Articles

Pilot study indicate role of preferentially transmitted monoamine oxidase gene variants in behavioral problems of male ADHD probands

BackgroundAttention deficit hyperactivity disorder (ADHD) is an etiologically complex childhood onset neurobehavioral disorder characterized by age-inappropriate inattention, hyperactivity, and impulsivity. Symptom severity varies widely and boys are diagnosed more frequently than girls. ADHD probands were reported to have abnormal transmissions of dopamine, serotonin, and/or noradrenaline. Monoamine oxidase A (MAOA) and B (MAOB), mitochondrial outer membrane bound two isoenzymes, mediate degradation of these neurotransmitters and thus regulating their circulating levels. Case-control analyses in different populations, including Indians, suggested involvement of MAOA and MAOB genes in the etiology of ADHD. Due to high heritability rate of ADHD, we tested familial transmission of MAOA and MAOB variants to ADHD probands in 190 nuclear families having ADHD probands from Indo-Caucasoid ethnicity.MethodsSubjects were recruited following the Diagnostic and Statistical Manual of Mental Disorders-4th edition (DSM-IV). Appropriate scales were used for measuring the behavioral traits in probands. Genotyping was performed through PCR-based amplification of target sites followed by DNA-sequencing and/or gel-electrophoresis. Data obtained were analyzed by family based statistical methods.ResultsOut of 58 variants present in the analyzed sites only 15 were found to be polymorphic (30 bp-uVNTR, rs5906883, rs1465107, rs1465108, rs5905809, rs5906957, rs6323, rs1137070 from MAOA and rs4824562, rs56220155, rs2283728, rs2283727, rs3027441, rs6324, rs3027440 from MAOB). Statistically significant maternal transmission of alleles to male probands was observed for MAOA rs5905809 ‘G’ (p = 0.04), rs5906957 ‘A’ (p = 0.04), rs6323 ‘G’ (p = 0.0001) and MAOB rs56220155 ‘A’ (p = 0.002), rs2283728 ‘C’ (p = 0.0008), rs2283727 ‘C’ (p = 0.0008), rs3027441 ‘T’ (p = 0.003), rs6324 ‘C’ (p = 0.003), rs3027440 ‘T’ (p = 0.0002). Significantly preferential maternal transmissions of different haplotype combinations to male probands were also noticed (p < 0.05), while female probands did not reveal such transmission bias. Behavioral traits of male probands exhibited significant association with gene variants. Age of the mother at pregnancy also revealed association with risk variants of male probands.ConclusionsIt may be inferred that the MAOA and MAOB variants may contribute to the etiology of ADHD in the Indo-Caucasoid population and could be responsible for higher occurrence of ADHD in the boys.

Social communication in children with autism spectrum disorder (asd): Correlation between DSM-5 and autism classification system of functioning-social communication (ACSF:SC).

The aim of this study was to classify children with Autism Spectrum Disorder (ASD) according to Autism Classification System of Functioning: Social Communication (ACSF:SC) criteria, in order to investigate the association between social communication ability, ASD severity, adaptive functioning, cognitive abilities and psychoeducational profile. The severity of social communication impairment was specified through Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) and ACSF:SC tool. The ADOS-2, Vineland-II and PEP-3 were administered to all participants. We found a positive correlation between DSM-5 levels and ACSF:SC-Typical Performance (r = 0.35; P = 0.007) and ACSF:SC-Capacity (r = 0.31; P = 0.01) levels. Children included in the five levels of ACSF:SC (Typical Performance and Capacity) showed statistically significant differences in ADOS-2 (Social Affect), Vineland-II (Communication and Socialization), and PEP-3 (Communication, motor skills, maladaptive behavior) scores. The results of this study indicate that ACSF:SC provide a better understanding of functional profile of children with ASD based on the social communication abilities. Children with greater severity of social communication showed more difficulty in adaptive behavior and psychoeducational profiles. In conclusion, the ACSF:SC could help clinicians and therapists not only to understand the strength and weakness of preschool children with ASD but also to devise specific treatment in order to promote their social integration. Autism Res 2017. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. Autism Res 2017, 10: 1249-1258. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

The prevalence and risk factors of attention deficit hyperactivity disorder among the elementary school students in Ardabil, Iran, in 2011-2012

Introduction: Attention deficit hyperactivity disorder (ADHD) is the most prevalent neurodevelopmental disorder among children and adolescents. Given the importance of this disorder, the aim of this study was to investigate the prevalence of ADHD and the relevant factors among the elementary school students in Ardabil, Iran. Methods: Using the stratified random cluster sampling method, this cross-sectional descriptive study was conducted on 2826 schoolchildren aged 6-11 in Ardabil, in the year 2011-2012. The necessary information was collected in the first step employing the ADHD questionnaire based on 18 Diagnostic and Statistical Manual of Mental Disorders-4th edition (DSM-IV) criteria filled out by parents and teachers. Then the students were interviewed by psychiatrists in the second step. SPSS was used to analyze the research findings. Results: The research results indicated that the life-time prevalence of ADHD was 9.8%. The most prevalent type of ADHD was the hyperactive-impulsive (6.8%). The results also indicated that the prevalence of ADHD was higher in boys than girls. One-third of affected children were premature at birth and 49.2% had attended kindergartens. The ADHD group was significantly different from the normal students in terms of the average discipline score and the overall grade at school. Conclusion: There is a relatively high prevalence of ADHD in elementary school students; therefore, it is strongly recommended to identify and treat it appropriately in the years prior to school.

Effectiveness and safety of high dose transcranial magnetic stimulation in schizophrenia with refractory negative symptoms: a randomized controlled study

To evaluate the efficacy and safety of high dose transcranial magnetic stimulation (rTMS) in patients with schizophrenia with refractory negative symptoms. From January 2013 to April 2014 at our institute, 70 hospitalized patients of schizophrenia, according to the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV), aged from 18 to 45 were randomly divided into study group (n = 33) and control group (n = 37). Both kinds and dosages of antipsychotics were preserved as before. All patients were treated with 10 Hz rTMS. rTMS was delivered to the left dorsolateral prefrontal cortex (DLPFC) with a figure-eight solid core coil at 100% motor threshold, 2 times daily for 10 days within 2 weeks. Sham stimulation was used in control group. In both groups, Positive and Negative Syndrome Scale (PANSS) and Treatment Emergent Symptom Scale (TESS) were used to evaluate the efficacy and safety before treatment, at week 1 and week 2, and subjective visual analogue scale (VAS) score was checked after each rTMS session. PANSS was performed 3 times at followup visits of week 4, week 8 and week 12. Compared with before treatment the total score of PANSS and the score of negative symptoms at week 2 declined in study group (q = 3.780, 4.258, P < 0.05), especially the factors of blunted affect, emotional withdrawal and passive/apathetic social withdrawal (q = 3.829, 4.089, 4.072, P < 0.05). At the follow-up of week 4, week 8 and week 12 after treatment, none of the above factors got significant changes in study group (P > 0.05). After 2 weeks' treatment, the effective rates were 43.75% and 11.43% in study group and control group, respectively, and there was a significant difference between two groups (X2 = 8.888, P =0.003). The incidence of headache in study group was higher than that in control group(37.50% vs 8.57%, χ2 = 8.051, P = 0.005). The highest score of pain was (49 ± 14) in study group, which occurred after the first rTMS treatment. Along with the treatment, the score gradually become lower, and the lowest was (11 ± 5) after 20th treatment. Among schizophrenia patients with refractory negative symptoms, 10 Hz rTMS applied 2 times daily within 2 weeks is effective and safe, especially, may improve blunted affect, emotional withdrawal and passive/apathetic social withdrawal.

Demographic correlates of children and adolescents with Autistic disorder

Introduction: Comparison of the demographic characteristics of patients provides useful information to their identification. This study aimed to determine the demographic characteristics of children and adolescents with autistic disorder (AD). Methods: In this cross-sectional case-control study, 115 children and adolescents with AD were selected from Autism Society Rehabilitation Center in Tabriz, Iran, and 112 normal children and adolescents from the public schools, in 2014. The participants in both groups were matched regarding age and gender. Diagnosis of AD was performed using diagnostic and statistical manual of mental disorders-4th edition (DSM-IV) criteria and clinical diagnostic interviews by two child and adolescent psychiatrists. The demographic information of children and adolescents and their parents were collected from the medical records of children and interviews with their mothers. Results: Most of the children with autism had second or higher birth order and had families with more than three members. Mothers of children with autism had significantly lower levels of education and were mostly housewives. Fathers of autistic children mostly had high school diploma and fewer had university education, and most of them were employed. However, there was no statistically significant difference between the AD group and the control group regarding the average height and weight of children and the residence (urban or rural) and age of parents at childbirth.Conclusion: The demographic characteristics of the two groups of children and adolescents with AD and normal controls were different from each other regarding family size, birth order, parent occupation, and parent education variables.

An analysis of post-traumatic stress symptoms in United States Air Force drone operators

Remotely piloted aircraft (RPA), commonly referred to as “drones,” have emerged over the past decade as an innovative warfighting tool. Given there is a paucity of empirical research assessing drone operators, the purpose of this study was to assess for the prevalence of PTSD symptoms among this cohort. Of the 1084 United States Air Force (USAF) drone operators that participated, a total of 4.3% endorsed a pattern of symptoms of moderate to extreme level of severity meeting criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders-4th edition. The incidence of PTSD among USAF drone operators in this study was lower than rates of PTSD (10–18%) among military personnel returning from deployment but higher than incidence rates (less than 1%) of USAF drone operators reported in electronic medical records. Although low PTSD rates may be promising, limitations to this study are discussed.

Annual Research Review: A developmental psychopathology approach to understanding callous‐unemotional traits in children and adolescents with serious conduct problems

Recent research has suggested that the presence of significant levels of callous-unemotional (CU) traits designates a clinically important and etiologically distinct subgroup of children and adolescents with serious conduct problems. Based on this research, CU traits have been included in the most recent revision of the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5; American Psychiatric Association, 2013)--as a specifier for the diagnosis of conduct disorder. In this review, we attempt to understand CU traits within a developmental psychopathological framework. Specifically, we summarize research on the normal development of the prosocial emotions of empathy and guilt (i.e., conscience) and we illustrate how the development of CU traits can be viewed as the normal development of conscience gone awry. Furthermore, we review research on the stability of CU traits across different developmental periods and highlight factors that can influence this stability. Finally, we highlight the implications of this developmental psychopathological framework for future etiological research, for assessment and diagnostic classification, and for treatment of children with serious conduct problems.

Aripiprazole as augmentation therapy in bipolar patients with current minor or subsyndromal mood symptoms.

BackgroundThis study aims to evaluate the effectiveness of aripiprazole augmentation of maintenance treatment for bipolar disorder in patients with minor or subsyndromal mood episodes while on a stable dose of a mood stabiliser and/or antidepressant.MethodsAll subjects had a diagnosis of bipolar I or II disorder (Diagnostic and Statistical Manual of Mental Disorders-4th Edition, Text Revision). Open-label aripiprazole was given over 8 weeks initially. The starting dose was 5 to 15 mg/day with a mean final dose of 11.5 mg (±4.6). Patients were assessed at weeks 0, 2, 4 and 8 with the Montgomery-Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS) and Clinical Global Impression of Severity (CGI-S).Results and discussionSeventeen of 20 (85%) patients completed week 4, while 14 (70%) patients completed 8 weeks. For intention-to-treat data, there was a significant decrease in MADRS scores over the course of treatment, with a reduction of 6.40 points at endpoint (p < 0.0005). Improvement from baseline was significant at week 2 and remained through to week 8. Similarly, CGI-S scores significantly decreased over the course of study, but not YMRS scores. Aripiprazole was shown to be a modestly effective augmentation therapy for depressive symptoms in bipolar I and II in this small open-label study.

Association Between HTR1A Gene Polymorphisms and Attention Deficit Hyperactivity Disorder in Korean Children

Attention deficit hyperactivity disorder (ADHD) is a common disorder of the school age population. ADHD has been shown to be familial, and genetic studies estimate its heritability at 80%-90%. The aim of the present study was to investigate the association between the genetic type and alleles for the HTR1A gene in Korean children with ADHD. The sample consisted of 142 ADHD children and 139 control children. We diagnosed ADHD according to the Diagnostic and Statistical Manual of Mental Disorders-4th edition. ADHD symptoms were evaluated with Conners' Parent Rating Scales and Dupaul Parent ADHD Rating Scales. Blood samples were taken from the 281 subjects, DNA was extracted from blood lymphocytes, and polymerase chain reaction was performed for HTR1A polymorphism. Alleles and genotype frequencies were compared using the chi-square test. We compared the allele and genotype frequencies of HTR1A gene polymorphism in the ADHD and control groups. This study showed that there was a significant correlation among the frequencies of the rs10042486 (OR=1.55, 95% CI=1.02-2.30, p=0.041), rs1423691(OR=1.55, 95% CI=1.02-2.30, p=0.041),and rs878567(OR=1.60, 95% CI=1.06-2.43, p=0.027) alleles of HTR1A, but the final conclusions are not definite. Follow-up studies with larger patient or pure subgroups are expected. These results suggested that HTR1A might be related to ADHD symptoms.

Pain Perception in Schizophrenia: Evidence of a Specific Pain Response Profile

Ever since the characterization of schizophrenia, clinicians have noted abnormal pain sensitivity in their patients. The published literature, however, is inconsistent concerning the nature of the change reported. The objective of this study was to characterize the pain response profile of schizophrenic patients by providing both acute and prolonged (i.e., rapidly repeating) painful stimuli to schizophrenic participants and control subjects. Twelve schizophrenic subjects and eleven controls were included in the final analysis. Diagnosis was made according to Diagnostic and Statistical Manual of mental disorders-4th edition, text revision (DSM-IV-TR) criteria. Intermittent, transcutaneous stimulations of the left sural nerve were administered to all participants. Painful sural nerve stimulations provoked a nociceptive flexion reflex response which was measured using an electromyographic recording of the bicep femoris muscle. Pain ratings were obtained using a 0-10 verbal numerical scale. Among schizophrenic participants, the relationship between subjective pain, reflex amplitude, and clinical features was investigated. The Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, and Subjective Scale to Investigate Cognition in Schizophrenia were used to evaluate clinical features. Compared with controls, schizophrenic subjects showed increased sensitivity to acute pain (i.e., lower pain thresholds; P = 0.019), but decreased subjective pain sensitization (P = 0.027). Group differences in subjective pain sensitization were not accompanied by group differences in nociceptive reflex activity (P = 0.260), suggesting supraspinal origins to the change in pain experienced by schizophrenic subjects. Moreover, positive symptoms correlated negatively with pain threshold values among schizophrenic participants (r = -0.696, P = 0.012), suggesting that distortions of thought and function relate to pain sensitivity in schizophrenic patients. Results indicate that schizophrenic subjects present a specific experimental pain response profile, characterized by elevated sensitivity to acute pain but reduced sensitivity to prolonged pain.

Taxometric analysis of DSM-IV and DSM-5 alcohol use disorders

BackgroundWith preparations currently being made for the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5), one prominent issue to resolve is whether alcohol use disorders are better represented as discrete categorical entities or as a dimensional construct. The purpose of this study was to investigate the latent structure of DSM-4th edition (DSM-IV) and proposed DSM-5 alcohol use disorders. MethodsThe study used the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to conduct taxometric analyses of DSM-IV and DSM-5 alcohol use disorders defined by different thresholds to determine the taxonic or dimensional structure underlying the disorders. ResultsDSM-IV and DSM-5 alcohol abuse and dependence criteria with 3+ thresholds demonstrated a dimensional structure. Corresponding thresholds with 4+ criteria were clearly taxonic, as were thresholds defined by cut-offs of 5+ and 6+ criteria. ConclusionsDSM-IV and DSM-5 alcohol use disorders demonstrated a hybrid taxonic-dimensional structure. That is, DSM-IV and DSM-5 alcohol use disorders may be taxonically distinct compared to no disorder if defined by a threshold of 4 or more criteria. However, there may be dimensional variation remaining among non-problematic to subclinical cases. A careful and systematic program of structural research using taxometric and psychometric procedures is warranted.

Questões relacionadas ao gênero no diagnóstico e classificação de transtornos por uso de álcool entre pacientes mexicanos que buscam serviços especializados

The objective of the study was to examine the role of gender in the endorsement of symptoms included in both the International Classification of Diseases-10th Edition and the Diagnostic and Statistical Manual of Mental Disorders-4th Edition. Six hundred patients treated for alcohol-related problems in outpatient services in Mexico were evaluated with the Substance Abuse Module of the Composite International Diagnostic Interview. Confirmatory factor analyses using the International Classification of Diseases-10th Edition and Diagnostic and Statistical Manual of Mental Disorders-4th Edition criteria produced two factors that included a combination of abuse/harmful alcohol use and dependence symptoms, which explained 40% and 49.2% of the total variance, respectively. In the abuse/harmful use groups of patients, symptoms and social consequences differed according to gender: withdrawal syndrome, lack of control and legal problems were more frequent in men, while women exhibited higher rates of attempts to give up alcohol and difficulties to accomplish daily activities. Specific gender-related factors differentiated abuse/harmful use from dependence, such as loss of control and time spent to drink in the case of men and desire to drink among women, according to the Diagnostic and Statistical Manual of Mental Disorders-4th Edition dependence criteria; and presence of physical symptoms in men and family/social problems, craving, and futile effort to stop drinking in women, according to the International Classification of Diseases-10th Edition dependence criteria. Future classification systems of substance abuse disorders should take into account differences between genders in order to help closing the treatment gap for women.

Psychological Predictors of Mortality in Heart Transplanted Patients: A Prospective, 6-Year Follow-Up Study

Some reports suggest a link between poor psychological adjustment to heart transplantation and an increased risk of subsequent adverse clinical outcome. Despite its prognostic and therapeutic implications, this issue is still lacking adequate empirical studies. We prospectively tested the predictive value of a complete set of psychiatric and psychological variables, collected with both self-rating and observer-based instruments at midterm after heart transplantation, on the subsequent 6-year survival status. Ninety-five heart transplanted patients underwent the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders-4th Edition and the structured interview for Diagnostic Criteria for Psychosomatic Research and filled three questionnaires assessing the dimensions of psychological distress, quality of life, and psychological well-being. Demographic characteristics and several clinical parameters were also collected. A 6-year follow-up survival was performed. Analyses of survival showed that hostility, depression, purpose in life, the occurrence of at least one cardiac event, chronic renal insufficiency, diabetes, number of drug prescriptions, a New York Heart Association (NYHA) class more than or equal to II, and ischemic origin of the cardiopathy significantly predicted subsequent survival duration. When multivariate analyses were performed, high levels of hostility and the presence of diabetes resulted the independent predictors of survival status. These findings point out the predictive role of specific components of psychological adjustment to heart transplantation and pose the basis for the evaluation of whether the provision of pharmacologic and psychotherapeutic interventions, aimed at reducing the empirically identified psychological risk factors, may result in a better long-term outcome.

Steady-State Concentrations of Mirtazapine, N-Desmethylmirtazapine, 8-Hydroxymirtazapine and their Enantiomers in Relation to Cytochrome P450 2D6 Genotype, Age and Smoking Behaviour

Mirtazapine is a tetracyclic antidepressant drug available as a racemic mixture of S(+)- and R(-)-mirtazapine. These enantiomers have different pharmacological properties, and both contribute to the clinical and adverse effects of the drug. Cytochrome P450 (CYP) 2D6 has been implicated in the metabolism of S(+)-mirtazapine. However, the effect of CYP2D6 on serum concentrations of the enantiomers of mirtazapine and its metabolites has not been assessed in patients on long-term treatment. The main objective of the study was to evaluate the effect of the CYP2D6 genotype on enantiomeric steady-state trough serum concentrations of mirtazapine and its metabolites N-desmethylmirtazapine and 8-hydroxymirtazapine. The effects of sex, age and smoking behaviour were also assessed. The study included 95 patients who had depression according to the Diagnostic and Statistical Manual of Mental Disorders-4th Edition and were treated for 4 weeks with a daily dose of mirtazapine 30 mg. The serum concentrations of the enantiomers of mirtazapine and its metabolites were analysed by liquid chromatography-mass spectrometry, and the subjects were genotyped for CYP2D6 alleles *3, *4, *5 and *6 and gene duplication. Three subjects (3%) were classified as ultrarapid metabolizers (UMs), 56 (59%) as homozygous extensive metabolizers (EMs), 30 (32%) as heterozygous EMs and 6 (6%) as poor metabolizers (PMs) of CYP2D6. The median trough serum concentrations of S(+)-mirtazapine were higher in PMs (59 nmol/L, p = 0.016) and in heterozygous EMs (39 nmol/L, p = 0.013) than in homozygous EMs (28 nmol/L). PMs and heterozygous EMs also had higher mirtazapine S(+)/R(-) ratios (0.4) than homozygous EMs (0.3, p = 0.015 and 0.004, respectively). The S(+)-N-desmethylmirtazapine concentration was higher in PMs (16 nmol/L) than in homozygous EMs (7 nmol/L, p = 0.043). There was an association between the CYP2D6 genotype and the ratio between S(+)-8-hydroxymirtazapine and S(+)-mirtazapine, with a significantly higher ratio in homozygous EMs than in heterozygous EMs (0.11 vs 0.05, p = 0.007). The influence of the CYP2D6 genotype on S(+)-mirtazapine, the mirtazapine S(+)/R(-) ratio and S(+)-N-desmethylmirtazapine remained significant after correction for the influence of sex, age and smoking. Smokers had significantly lower concentrations of S(+)-mirtazapine (23 vs 39 nmol/L, p = 0.026) and R(-)-N-desmethylmirtazapine (39 vs 51 nmol/L, p = 0.036) and a significantly lower mirtazapine S(+)/R(-) ratio (0.28 vs. 0.37, p = 0.014) than nonsmokers, and the effect of smoking remained significant after multivariate analysis. This study is the first to show the impact of the CYP2D6 genotype on steady-state serum concentrations of the enantiomers of mirtazapine and its metabolites. Our results also support the role of CYP1A2 in the metabolism of mirtazapine, with lower serum concentrations in smokers than in nonsmokers.

Prevalence of DSM-IV disorders in Chinese adolescents and the effects of an impairment criterion

To provide preliminary prevalence estimates of common DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-4th Edition) disorders in a sample of Hong Kong Chinese adolescents. 541 Chinese adolescents were recruited from Grades 7, 8 and 9 of 28 mainstream high schools in Hong Kong (mean age=13.8 years; SD=1.2). The adolescents and their parents were separately administered the Youth and Parent versions of DISC-IV (Diagnostic Interview Schedule for Children-Version 4), respectively. Based upon both symptom and impairment criteria, as required by DSM-IV, the overall prevalence estimate of DSM-IV disorders in our sample of Chinese adolescents was 16.4%. Estimates for such individual disorders/diagnostic groupings as anxiety disorders, depressive disorders, attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), and substance use disorders were 6.9, 1.3, 3.9, 6.8, 1.7, and 1.1%, respectively. These rates were largely compatible with those reported in previous studies with perhaps lower rates of generalized anxiety disorder (GAD), depressive disorders, CD, and substance use disorders, but a higher rate of ODD. The rate of ADHD was somewhat higher, but this might reflect the current DSM-IV diagnostic practice. The rate of anxiety disorders was not as high as predicted from some previous questionnaire surveys. The application of an impairment criterion had discernible impacts on prevalence estimates, greater on anxiety and substance use disorders, but smaller on depressive and disruptive behavior disorders. There was a lack of gender difference in rates of ODD and CD. While the findings reported here are broadly compatible with those of other studies, there may be cross-cultural differences in rates of some individual disorders, e.g., GAD, depressive disorders, ODD, CD, and substance use disorders, as well as in gender difference regarding rates of ODD and CD. However, exact comparison between studies is confounded by methodological differences in sample characteristics, measures, and case definition. Standardization of methodology in epidemiological surveys should allow more precise identification of any within- or between-culture variations in prevalence estimation.

Sensibilité et spécificité du questionnaire sur les inquiétudes et l’anxiété (QIA) dans un échantillon d’utilisateurs de soins de santé au Québec

Generalized anxiety disorder (GAD) is a prevalent anxiety disorder characterized by persistent, excessive worrying. Even if GAD's ill consequences on health and quality of life are well documented, this disorder is still difficult to identify in primary care. The worry and anxiety questionnaire (WAQ) is a questionnaire assessing specific GAD symptoms, as defined by the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV).This study aimed at assessing the capacity of the French version of the WAQ's to identify individuals with GAD in a sample of individuals reporting a certain level of anxiety. A second objective was to identify which of its items better distinguish individuals with GAD from those without. According to these results, different scoring algorithms have been developed and their effect on the WAQ's sensitivity and specificity indicators has been explored.The sample was drawn from a mother study in which 1110 health-care users completed questionnaires while waiting for a medical consultation with a family physician. Of those, a subsample of 219 individuals reported anxiety symptoms typical of GAD, as assessed by the WAQ. Among those who agreed to participate in the study's second phase (n=176), 100 were randomly selected and invited within one to three months to a clinical interview assessing their anxiety symptoms more thoroughly. Thirty-three individuals accepted and thus formed the present sample. The clinical interview was the anxiety disorders interview schedule (ADIS). The ADIS is a semi-structured diagnostic interview following the DSM-IV criteria. It assesses all anxiety disorders and includes screening questions on mood, substance use and psychotic disorders. Participants also completed the WAQ for a second time at the time of the interview.Nineteen individuals received a diagnosis of GAD after completing the ADIS while 13 did not. Sixteen of the 19 individuals with GAD were correctly identified with the WAQ, compared to eight out of 13 for individuals without GAD. Sensitivity of the WAQ's actual scoring algorithm is thus of 84.2% and its specificity of 61.5%. The number of false negatives produced by the WAQ in this sample (3/19, 15.8%) was lower than the number of false positives (5/13, 38.5%). Positive and negative predictive power is thus of 76.2% and 72.7%, respectively. Receiver-operating characteristic (ROC) curves analyses indicated that the most useful items to identify individuals with GAD were those assessing the presence of excessive worrying, the number of days disturbed by worries, the degree with which worries interfere with daily functioning and the degree of control over worries. Knowing an individual's outcome on the WAQ increases the probability of correctly identifying an individual with or without GAD by 8.5 times compared to mere chance. A new scoring algorithm, where the cut-off score on the excessive worrying item was increased by one unit, considerably improves the WAQ's specificity (84.6%), without altering its sensitivity by much (78.9%). This new scoring algorithm thus increases the probability of correctly identifying individuals with and without GAD to 20.6 times (again compared to chance).The WAQ is thus a useful instrument in screening GAD, even in a sample of anxious individuals. Its original scoring algorithm shows excellent sensitivity, a valued quality in an instrument used for screening. On the other hand, it is possible to increase the specificity of the WAQ by raising the cut-off point on the excessive worrying item, making the instrument useful as a diagnostic aid or as a screening questionnaire for GAD, in particular among a sample displaying anxiety. This questionnaire is thus an easy-to-complete and adaptable instrument that can be used by family physicians to help them identifying individuals with GAD.

Sexual functioning in patients with hepatocellular carcinoma

The objectives of the current study were to assess the rates of sexual dysfunction in patients with hepatocellular carcinoma (HCC) and compare the rates of sexual morbidity with a sample of patients diagnosed with chronic liver disease (CLD) and the general population. It was expected that patients diagnosed with HCC would have a greater prevalence of sexual dysfunction than those diagnosed with CLD and the general population, respectively. Furthermore, those patients who reported a sexual dysfunction would also have a poorer quality of life (QOL). Twenty-one men diagnosed with HCC and 23 men diagnosed with CLD completed a battery of questionnaires that included the Sexual History Questionnaire and the Functional Assessment of Cancer Therapy-Hepatobiliary. Results indicated that 41% of patients reported a current sexual problem (29% of HCC patients and 71% of patients with CLD) and 43% met the Diagnostic and Statistical Manual of Mental Disorders-4th edition (DSM-IV) criteria for at least 1 type of sexual dysfunction (25% of patients with HCC and 75% of patients with LD). Of the total sample, 68% reported being diagnosed with a comorbid medical condition or taking a medication that had potential sexual side effects. After eliminating cases with comorbid medical conditions and/or who were taking medications that contributed to sexual morbidity, the rate of sexual problems were found to be similar to that of the general population. Clinically significant differences were found with regard to the QOL. People who were experiencing sexual problems also reported a poorer QOL. Although a large percentage of sexual dysfunction may have been secondary to comorbid medical problems and medications, treatment of the sexual dysfunction is still warranted.

Is Gender Identity Disorder in Children a Mental Disorder

Empirical studies were evaluated to determine whether Gender Identity Disorder (GID) in children meets the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV, American Psychiatric Association, 1994) definitional criteria of mental disorder. Specifically, we examined whether GID in children is associated with (a) present distress; (b) present disability; (c) a significantly increased risk of suffering death, pain, disability, or an important loss of freedom; and if (d) GID represents dysfunction in the individual or is simply deviant behavior or a conflict between the individual and society. The evaluation indicates that children who experience a sense of inappropriateness in the culturally prescribed gender role of their sex but do not experience discomfort with their biological sex should not be considered to have GID. Because of flaws in the DSM-IV definition of mental disorder, and limitations of the current research base, there is insufficient evidence to make any conclusive statement regarding children who experience discomfort with their biological sex. The concluding recommendation is that, given current knowledge, the diagnostic category of GID in children in its current form should not appear in future editions of the DSM.