Met DSM-III Criteria Research Articles

Subtypes of schizophrenia: a cluster analytic approach.

To identify empirical subtypes of schizophrenia, based upon the symptoms recorded over the duration of the illness, and to validate the resulting clusters against other systems that are used for subtyping schizophrenia. Data for 55 symptoms of schizophrenia over the history of the illness from 107 chronic schizophrenia patients were analyzed using hierarchical cluster analysis with Euclidean distance and Ward's method. Except for 1 patient, all met DSM-III criteria. There were 40 men and 67 women, average (SD) age of 38.2 (9.91) years, with a mean (SD) hospitalization of 27.9 (27.35) months. No clear and unambiguous solution for the number of clusters was evident. Examination of the clusters led to further analysis of 2- and 6-cluster solutions. These were contrasted with DSM-III, DSM-III-R, and DSM-IV criteria and with the subtypes taken from the literature. There was limited support for any of these types, with none replicating, including the paranoid-nonparanoid distinction. Empirical clusters derived from lifetime symptom data failed to agree with either the established DSM or other empirically derived subtypes. Subtypes may have little utility when the variability of symptoms over the longitudinal course of the illness is considered.

Haloperidol decanoate doses of 200, 100, or 50 mg/month reduced symptomatic exacerbations more than a 25 mg/month dose in schizophrenia

Kane JM, Davis JM, Schooler N, et al. A multidose study of haloperidol decanoate in the maintenance treatment of schizophrenia. Am J Psychiatry2002 Apr ; 159 : 554 –60 [OpenUrl][1][CrossRef][2][PubMed][3][Web...

Underuse of Antidepressants in Major Depression

Epidemiologic studies have reported disturbingly low rates of treatment for major depression in the United States. To better understand this phenomenon, we studied the prevalence and predictors of antidepressant treatment in a national sample of individuals with major depression. Between 1988 and 1994, 7589 individuals, aged 17-39 years and drawn from a national probability sample, were administered the Diagnostic Interview Schedule as part of the National Health and Nutrition Examination Survey. Interviewers asked about prescription drug use and checked medication bottles to record the name and type of medications. A total of 312 individuals, or 4.1% of the sample, met DSM-III criteria for current major depression. Only 7.4% of those with current major depression were being treated with an antidepressant. Among individuals with current major depression, being insured and having a primary care provider each predicted a 4-fold increase in odds of antidepressant treatment; telling the primary provider about depressive symptoms predicted a 10-fold increase in treatment. The study's findings support the notion that a serious gap exists between the established efficacy of antidepressant medications and rates of treatment for major depression in the "real world." Underreporting of depressive symptoms to providers and problems with access to general medical care appear to be 2 major contributors to this problem.

Standardised nortriptyline and psychotherapy were more effective and more expensive than usual care in major depression

Lave JR, Frank RG, Schulberg HC , et al. Cost-effectiveness of treatments for major depression in primary care practice. Arch Gen Psychiatry1998 Jul; 55 : 645 –51 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4]...

Double-blind comparison of citalopram and placebo in depressed outpatients with melancholia

This multicenter study compared the efficacy and safety of citalopram and placebo in a population of moderately to severely depressed patients with melancholia. This randomized, double-blind, parallel-group study compared citalopram (flexible dose; 20-80 mg/day) with placebo in 180 psychiatric outpatients with a DSM-III diagnosis of major depression or bipolar disorder, depressed, who also met DSM-III criteria for melancholia. Following a 1-week placebo washout period, patients meeting study entry criteria were randomized to 4 weeks of double-blind treatment with either citalopram or placebo. Efficacy measures included the Hamilton Rating Scale for Depression (HAM-D), the Clinical Global Impressions (CGI) Scale, and the Zung Self-Rating Depression Scale. Patients treated with citalopram showed significantly greater improvement at endpoint than placebo patients on the HAM-D, CGI, and Zung scales. On the HAM-D, citalopram patients exhibited significantly greater improvement than placebo patients after 1 week of double-blind treatment and at all subsequent study visits. Endpoint analyses of the HAM-D subscales demonstrated that citalopram produced significant improvement of the psychomotor retardation, cognitive disturbance, sleep disturbance, and melancholia symptom clusters. Nausea, dry mouth, somnolence, dizziness, and increased sweating were reported at higher rates by citalopram-treated patients than by placebo-treated patients, but there were no significant citalopram-placebo differences in the incidence of activation (e.g., anxiety, nervousness, insomnia) or sexual dysfunction. Analysis of electrocardiograms, vital signs, and laboratory tests did not reveal any clinically significant effects of citalopram treatment. The results of this study indicate that citalopram is safe and effective in the treatment of depressed patients with melancholia, and is associated with a favorable side effect profile and a potentially rapid onset of action.

Double‐blind comparison of citalopram and placebo in depressed outpatients with melancholia

This multicenter study compared the efficacy and safety of citalopram and placebo in a population of moderately to severely depressed patients with melancholia. This randomized, double-blind, parallel-group study compared citalopram (flexible dose; 20–80 mg/day) with placebo in 180 psychiatric outpatients with a DSM-III diagnosis of major depression or bipolar disorder, depressed, who also met DSM-III criteria for melancholia. Following a 1-week placebo washout period, patients meeting study entry criteria were randomized to 4 weeks of double-blind treatment with either citalopram or placebo. Efficacy measures included the Hamilton Rating Scale for Depression (HAM-D), the Clinical Global Impressions (CGI) Scale, and the Zung Self-Rating Depression Scale. Patients treated with citalopram showed significantly greater improvement at endpoint than placebo patients on the HAM-D, CGI, and Zung scales. On the HAM-D, citalopram patients exhibited significantly greater improvement than placebo patients after 1 week of double-blind treatment and at all subsequent study visits. Endpoint analyses of the HAM-D subscales demonstrated that citalopram produced significant improvement of the psychomotor retardation, cognitive disturbance, sleep disturbance, and melancholia symptom clusters. Nausea, dry mouth, somnolence, dizziness, and increased sweating were reported at higher rates by citalopram-treated patients than by placebo-treated patients, but there were no significant citalopram-placebo differences in the incidence of activation (e.g., anxiety, nervousness, insomnia) or sexual dysfunction. Analysis of electrocardiograms, vital signs, and laboratory tests did not reveal any clinically significant effects of citalopram treatment. The results of this study indicate that citalopram is safe and effective in the treatment of depressed patients with melancholia, and is associated with a favorable side effect profile and a potentially rapid onset of action. Depression and Anxiety 9:54–60, 1999. © 1999 Wiley-Liss, Inc.

Are depression and denutrition good predictors of dexamethasone suppression test (DST) in anorexia nervosa?

This study was conducted to investigate the corticotropic axis in anorexia nervosa. In 93 female inpatients who met DSM-III-R criteria for anorexia nervosa, subsample (n = 64) with DSM-III criteria was also considered. Using stepwise regression analysis, this study examined the relationship between independent variables ie, age, body mass index, scores on depression scales and postdexamethasone serum cortisol, considered as a dependent variable. In patients who met DSM-III criteria, 16.7% of the variance of serum cortisol can be explained. The main predictors are depressive retardation, emaciation and age. Using stepwise logistic regression the main categorical predictors of the test suppression vs non suppression are of the same nature. The condition of realisation of DST are discussed.

The role of trauma and dissociation in cognitive-behavioral psychotherapy outcome and maintenance for panic disorder with agoraphobia

The relationship between traumatic experiences and dissociation with pretreatment psychopathology and rates of recovery, relapse and maintenance for patients receiving cognitive-behavioral treatments for panic disorder with agoraphobia (PDA) were investigated. One-hundred and forty-seven subjects who met DSM-III criteria for agoraphobia with panic attacks and who completed participation in one of two previously conducted treatment outcome studies were mailed packets containing measures to assess history of trauma, victimization and dissociation. Eighty-nine of these were returned and completed sufficiently to be included in the present study. It was hypothesized that a variety of trauma-related variables (e.g. history of traumatic experience, type of trauma, age at which the trauma first occurred, perceived responsibility, social supports available, self-perceived severity, level of violence, and whether or not the traumatic event was followed by self-injurious or suicidal thoughts and/or behaviors) and dissociative symptomatology would be predictive of (1) greater psychopathology at pretreatment, (2) poorer treatment response and (3) higher relapse rates and poorer maintenance over a 1 year longitudinal follow-up. These hypotheses were supported by the findings and the theoretical, empirical and clinical implications are discussed.

The relationship of attributional style to agoraphobia severity, depression, and treatment outcome

The present study examined the relationship of attributional style, as measured with a revised version of the Attributional Style Questionnaire (ASQ) and measures of agoraphobia severity, depression, and treatment outcome in 73 S s who met DSM-III criteria for agoraphobia with panic attacks and participated in one of three 13-week treatment conditions: paradoxical intention, graduated exposure, or progressive deep muscle relaxation training. Subjects completed assessments at four periods: pretreatment, midtreatment, posttreatment, and at 3 month follow-up. In addition to the three dimensions typically examined on the ASQ, this revised version also measured S s' estimates of the perceived importance, and future likelihood for both positive and negative events. Congruent with previous research, moderate but somewhat inconsistent associations were observed between attributional style and depression both within and across assessment periods. Predictions about associations between attributional style and agoraphobic severity were not supported; however, an interaction was observed between depression and attributional style with respect to severity of agoraphobia. There was no evidence of group differences across treatment types, although there were several significant changes in attributional style across time. Attributions for health related events were also examined. Conceptual, clinical, and research issues related to the findings are discussed.

The relationship of attributional style to agoraphobia severity, depression, and treatment outcome

The present study examined the relationship of attributional style, as measured with a revised version of the Attributional Style Questionnaire (ASQ) and measures of agoraphobia severity, depression, and treatment outcome in 73 Ss who met DSM-III criteria for agoraphobia with panic attacks and participated in one of three 13-week treatment conditions: paradoxical intention, graduated exposure, or progressive deep muscle relaxation training. Subjects completed assessments at four periods: pretreatment, midtreatment, posttreatment, and at 3 month follow-up. In addition to the three dimensions typically examined on the ASQ, this revised version also measured Ss' estimates of the perceived importance, and future likelihood for both positive and negative events. Congruent with previous research, moderate but somewhat inconsistent associations were observed between attributional style and depression both within and across assessment periods. Predictions about associations between attributional style and agoraphobic severity were not supported; however, an interaction was observed between depression and attributional style with respect to severity of agoraphobia. There was no evidence of group differences across treatment types, although there were several significant changes in attributional style across time. Attributions for health related events were also examined. Conceptual, clinical, and research issues related to the findings are discussed.

Symptom patterns in schizophrenia for men and women.

Differences on symptoms and anamnestic variables were studied in a sample of 112 Canadian patients (42 men and 70 women) who met DSM-III criteria for schizophrenia. Men were more often rated as providing unreliable information than were women. A smaller proportion of men than women showed spontaneous remissions (a return to premorbid level), and fewer men also displayed phasic changes in appetite, weight, or sexual activity. It is noteworthy that men and women did not differ on general indices of severity of illness such as the number of past hospitalizations or length of hospital stay. In contrast to numerous past studies, an earlier age of onset of the illness for men was nonsignificant.

Service utilization and expenditures for the treatment of panic disorder

The outpatient service utilization and estimated expenditures for the treatment of panic disorder for patients prior to their enrollment in a large clinical trial were examined. Data were drawn from the Cross-National Collaborative Panic Study. The sample consists of 391 patients who met DSM-III criteria for panic disorder and were enrolled at one of the US sites of the trial. The rate and frequency of outpatient mental health visits to primary care and specialty mental health providers for the current episode of panic disorder are examined. Estimates of direct expenditures for these services are presented (in 1993 US dollars). Over 70% of the patients used primary care for mental health services whereas about 47% of the patients used specialty mental health services. Nearly half of the patients (46.8%) saw a nonpsychiatrist medical specialist, most often a cardiologist (20.6%). Among all patients, those with more frequent panic attacks were more likely to use some form of outpatient mental health services for panic disorder. Among users of any services, those with more severe impairment were more likely to use specialized mental health services. The mean estimated expenditure for the panic episode was $3339, about half of which was accounted for by specialty mental health expenditures. Among users, the median estimated expenditures was $518 for primary care physicians and $2122 for specialty mental health services. In conclusion, the service utilization in this sample of patients with panic disorder is highly varied. Both the primary care and specialty mental health sectors play prominent roles in the community treatment of panic disorder.

Subtypes of alcohol-dependent men: a typology based on relative genetic and environmental loading.

Using scales that distinguish between relative genetic and environmental loading, cluster analysis was used to identify three subtypes of alcohol dependence in Caucasian men from the Epidemiologic Catchment Area study (n = 911). Although all subjects met DSM-III criteria for alcohol dependence, only the severe subtype showed evidence of substantial genetic influence. When compared on a range of clinical characteristics, the mild subtype (53% of the sample) was typically least adversely affected and the severe subtype (17%) most affected, with the dyssocial subtype (30%) falling between. Severe subtype subjects had significantly greater comorbid drug dependence and were at least four times more likely than mild subjects to have sought treatment for alcohol problems. Ratio of genetic scale score to total symptom count (genetic ratio) was highest for the severe subtype (mean = 0.37), and negatively correlated with age of first alcohol problem (rs = -0.16) and years between first intoxication and first problem (rs = 0.19). No significant correlations were found between these clinical features and genetic ratio for the mild or dyssocial subtypes. Use of these scales and subtypes may improve our ability to detect specific gene effects in genetic linkage studies and to identify environmental influences in behavioral and epidemiological studies.

Bupropion Hydrochloride in Attention Deficit Disorder with Hyperactivity

This is a multisite, double-blind, placebo-controlled trial to determine the safety and efficacy of bupropion in the treatment of children with attention deficit disorder with hyperactivity (ADDH). In a four-center, double-blind comparison of bupropion (n = 72) and placebo (n = 37), children aged 6 to 12 years meeting DSM-III criteria for ADDH were randomized to receive bupropion 3 to 6 mg/kg per day or placebo, administered twice daily, at 7 A.M. and 7 P.M. Measures of efficacy included the Conners Parent and Teacher Questionnaires (93-item, 39-item, and 10 item), Clinical Global Impressions Scales of Severity and Improvement, the Sternberg Short-Term Memory Task, and the Continuous Performance Test. Screen and posttreatment physical examinations, electrocardiograms, electroencephalograms, and clinical laboratory evaluations were performed. Height, weight, and vital signs were measured and adverse experiences were assessed weekly. A significant treatment effect, apparent as early as day 3, was present for both conduct problems and hyperactivity on the Conners 10-item and 39-item teacher's checklist, and at day 28 for conduct problems and restless-impulsive behavior on the 93-item parent questionnaire. Findings were of smaller magnitude for parent ratings than teacher ratings. Significant treatment effects were present on both the Continuous Performance Test and memory retrieval test. Effect sizes of bupropion/placebo differences for teacher and parent ratings in this study were somewhat smaller than for standard stimulant drugs used to treat ADDH. Bupropion appeared to be well tolerated in most children. Dermatological reactions were twice as frequent in the drug group as the placebo group, with four reactions involving rash and urticaria that were serious enough to require discontinuation of medication. Bupropion may be a useful addition to available treatments for ADDH. Comparative trials with such standard drugs as methylphenidate are warranted to determine the relative clinical merits of bupropion.

DSM-III-R and DSM-III Criteria for Conduct Disorder in Preadolescent Girls: Specific But Insensitive

To determine whether DSM-III and DSM-III-R criteria for conduct disorder identify girls in the general population with early-onset, persistent, and pervasive antisocial behavior. 2,251 girls, representative of all girls entering kindergarten in Qúebec, were assessed using parent and teacher ratings of antisocial behavior; a subsample was then rated for the next 6 years (ages 7 to 12) by parent and teacher. At age 10 years, the girls who been rated as antisocial in kindergarten, along with a random sample of those not rated as antisocial, were assessed for DSM-III and DSM-III-R diagnoses of conduct and oppositional defiant disorder using a structured psychiatric interview (Diagnostic Interview Schedule for Children) administered to the parent, teacher, and/or child (n = 381). Of the girls with early-onset, persistent, and pervasive antisocial behavior, 3% met DSM-III-R criteria and 22% met DSM-III criteria for conduct disorder. Conduct disorder was not diagnosed at all in girls who had not been initially rated as antisocial in kindergarten. Lowering the threshold for a DSM-III-R conduct disorder diagnosis to two symptoms and adding the criterion of violation of rules increased the rate of diagnosis to 35% in the pervasively antisocial girls but only to 1% in girls who did not have persistent antisocial behavior. DSM-III-R criteria for conduct disorder do not identify most preadolescent girls with early-onset, pervasive, and persistent antisocial behavior. Modifications to the DSM-III-R criteria resulted in increased sensitivity without a loss of specificity.

A long-term follow-up of male alcohol abuse.

This study attempted to determine the course of male alcohol abuse from the age of 40 years to 60 or 70 years, to estimate the duration of abstinence required for stable remission and to study the hypothesis of progression of symptoms in chronic alcohol abuse. The subjects were 268 former Harvard University (Cambridge, Mass) undergraduates (college sample) and 456 nondelinquent inner-city adolescents (core city sample) who had been repeatedly studied in multidisciplinary fashion since 1940. Since 47 years of age, these men have been followed up biennially by questionnaire and every 5 years by physical examination. At some point during their lives, 55 (21%) of the college and 150 (33%) of the core city men met DSM-III criteria for alcohol abuse. The college cohort has been followed until the age of 70 years, the core city cohort until age 60 years. The dependent variables were mortality and alcohol abuse status every 5 years. By 60 years of age, 18% of the college alcohol abusers had died, 11% were abstinent, 11% were controlled drinkers, and 59% were known to be still abusing alcohol. By 60 years of age, 28% of the core city alcohol abusers had died, 30% were abstinent, 11% were controlled drinkers, and only 28% were known to be still abusing alcohol. In three respects the two socially divergent samples resembled each other. After abstinence had been maintained for 5 years, relapse was rare. In contrast, return to controlled drinking without eventual relapse was unlikely. Alcohol abuse could continue for decades without remission or progression of symptoms. The samples differed in that the core city men began to abuse alcohol when younger and, although they were more likely than the college men to become alcohol dependent, the core city men were twice as likely to achieve stable abstinence.

In vivo D2 dopamine receptor density in psychotic and nonpsychotic patients with bipolar disorder.

A prior positron emission tomographic study from The Johns Hopkins University, Baltimore, Md, using N-methylspiperone labeled with carbon 11 reported elevated basal ganglia D2 dopamine receptor density (Bmax) values in neuroleptic-naive schizophrenic patients compared with controls. We have now extended these studies to include patients with bipolar disorder. Patients with bipolar disorder (n = 14) either had never received neuroleptic medication or had been neuroleptic-free for more than 6 months, and they met DSM-III criteria for currently symptomatic affective disorder. Patients with bipolar disorder were compared with matched schizophrenic patients and normal controls. All received two positron emission tomographic scans, the second of which was preceded by oral administration of haloperidol lactate, to permit the calculation of D2 dopamine receptor Bmax. Diagnostic groups differed in Bmax by analysis of variance (P < .0001); post hoc tests showed higher Bmax values for psychotic patients with bipolar disorder and schizophrenic patients compared with normal controls and for schizophrenic patients and psychotic patients with bipolar disorder compared with nonpsychotic patients with bipolar disorder. Among patients with bipolar disorder, Bmax values correlated significantly with the severity of psychotic symptoms (r = .63) on the Present State Examination but not with the severity of nonpsychotic mood symptoms. We conclude that, like schizophrenic patients, patients with psychotic bipolar disorder have elevations of D2 dopamine receptor Bmax values and that such elevations in affective disorder are more closely associated with the presence of psychosis than with mood abnormality. Elevations in dopamine receptor values thus may occur in psychiatric states that are characterized by psychotic symptoms rather than being specific to schizophrenia.

Comorbidity of obsessive compulsive disorder in bipolar disorder

The comorbidity of OCD and bipolar disorder has not been systematically examined. Therefore, we determined the frequency of patients meeting DSM-III criteria for OCD syndrome in a sample of 149 inpatients with DSM-III major affective disorder who had received a clinically reviewed structured diagnostic interview. The frequency of OCD syndrome was not significantly different between subjects with major depression (35.2%, n = 105) and bipolar disorder (35.1%, n = 37). This suggests that OCD is equally common in bipolar as in unipolar patients.

A 16- to 45-year follow-up of 71 men with antisocial personality disorder

We examined the long-term outcome of 71 men with antisocial personality disorder (ASPD) admitted to the University of Iowa Psychiatric Hospital. The subjects all met DSM-III criteria for ASPD based on admission records. Patients had been admitted between 1945 and 1970 and were evaluated between 1986 and 1990, an average of 29 years following hospital discharge. We traced 68 (96%), and 26 (36.6%) received a full or partial interview; 17 (23.9%) had died. Based on personal interviews, interviews with informants, and medical and legal records, we were able to rate globally 45: 12 (26.6%) had remitted, 14 (31.1%) had improved but not remitted, and 19 (42.2%) were unimproved. A Diagnostic Interview Schedule (DIS) was administered to 21 subjects; tobacco dependence, alcohol dependence, generalized anxiety disorder, and major depression were frequent lifetime disorders. Remission was associated with lower symptom severity at intake and follow-up evaluation of more than 25 years and current sobriety. Based on the study results, we conclude that for many, ASPD is chronic and is associated with ongoing psychiatric, medical, and social problems.

Comorbid Depression and Alcoholism: A Clinical Profile

Alcohol use often confounds the evaluation of patients with affective disorder, and the clinical profile of patients with both disorders is uncertain. This large study from an urban university psychiatric hospital compared the presenting characteristics of patients who met DSM-III criteria for either alcohol-use disorder, major depression, or both. Researchers reviewed …