Nomenclature Of Disorders Research Articles

Editors' note: Ethical, palliative, and policy considerations in disorders of consciousness

In “Ethical, palliative, and policy considerations in disorders of consciousness,” a complement to the American Academy of Neurology guideline on disorders of consciousness, authors Fins and Bernat reviewed (1) the nomenclature of disorders of consciousness, (2) the responsibilities that clinicians have to both patients and their families, and (3) the resources required and barriers to provision of care to patients with disorders of consciousness. Authors Fins and Bernat objected to the Guideline's use of the term “unresponsive wakefulness syndrome” because it relies on the bedside examination of consciousness while failing to allow for the possibility of covert consciousness detected only with functional neuroimaging. Dr. Sethi shares his reservations with this term, but his rationale differs, as he believes it could falsely suggest the possibility for improvement. He also voices concern that both a country's income level and a hospital's size could affect ability to implement this guideline. Authors Fins and Bernat respond that all patients with disorders of consciousness deserve consideration of rehabilitation and that rehabilitation may ultimately decrease longitudinal costs by leading to improvements in functional status, but prospective studies are needed. In “Ethical, palliative, and policy considerations in disorders of consciousness,” a complement to the American Academy of Neurology guideline on disorders of consciousness, authors Fins and Bernat reviewed (1) the nomenclature of disorders of consciousness, (2) the responsibilities that clinicians have to both patients and their families, and (3) the resources required and barriers to provision of care to patients with disorders of consciousness. Authors Fins and Bernat objected to the Guideline's use of the term “unresponsive wakefulness syndrome” because it relies on the bedside examination of consciousness while failing to allow for the possibility of covert consciousness detected only with functional neuroimaging. Dr. Sethi shares his reservations with this term, but his rationale differs, as he believes it could falsely suggest the possibility for improvement. He also voices concern that both a country's income level and a hospital's size could affect ability to implement this guideline. Authors Fins and Bernat respond that all patients with disorders of consciousness deserve consideration of rehabilitation and that rehabilitation may ultimately decrease longitudinal costs by leading to improvements in functional status, but prospective studies are needed.

CLASSIFICATION AND MECHANISM OF PATHOGENESIS OF DISEASES OF THE CLAWS OF DAIRY CATTLE

The analysis of the nomenclature of disorders (diseases) of the claws of dairy cattle and on the basis of this attempt to make the concept of the classification of the damage to the claws and their pathogenesis.

Personality, Interpersonal Circumplex, and DSM–5: A Commentary on Five Studies

Much of personality is interpersonal, and what is interpersonal can be elegantly organized through the crossing of 2 fundamental dimensions of personality: agency and communion. The interpersonal circumplex has enriched substantially what is known about personality and in particular personality disorder, emphasizing to clinicians the importance of considering maladaptive interpersonal functioning when conducting clinical assessments. The purpose of this article is to provide a commentary on 5 articles concerning the interpersonal perspective on personality assessment. The contributions of these 5 studies are also understood relative to the proposed revisions to the American Psychiatric Association's personality disorder nomenclature, as the proposed revisions will be cutting out half of the interpersonal circumplex from further recognition.

A Simplistic Understanding of the Five-Factor Model

Back to table of contents Previous article Next article Letter to the EditorFull AccessA Simplistic Understanding of the Five-Factor ModelTHOMAS A. WIDIGER, Ph.D., , and TIMOTHY J. TRULL, Ph.D., THOMAS A. WIDIGERSearch for more papers by this author, Ph.D., Lexington, Ky., and TIMOTHY J. TRULLSearch for more papers by this author, Ph.D., Columbia, Mo.Published Online:1 Aug 2005https://doi.org/10.1176/appi.ajp.162.8.1550-aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Jonathan Shedler, Ph.D., and Drew Westen, Ph.D. (1), argued that the five-factor model “omits key clinical constructs and may not capture the complexity of personality syndromes seen in clinical practice” (p. 1743). To demonstrate this, they constructed an abbreviated measure of the five-factor model using a small subset (30%) of the 200 items contained within the Shedler-Weston Assessment Procedure (SWAP-200). It was a foregone conclusion that the results of a factor analysis of 30% of the SWAP-200 items would not correspond to a factor analysis of the entire SWAP-200. In addition, one should ask whether their SWAP-200 items provided an adequate assessment of the five-factor model. They never attempted to validate their five-factor model measure, and a visual inspection of the items indicates inaccurate representation of the five-factor model. Finally, it is highly unlikely that their small set of SWAP-200 items would provide anything close to a reasonably comprehensive assessment of the five-factor model. In sum, there was little reason to expect that an incomplete and inadequate assessment of the five-factor model with a subset of the SWAP-200 would account for the variance within the entire SWAP-200.Drs. Shedler and Westen suggested that the constructs assessed by the 12 SWAP-200 scales are outside of the realm of the five-factor model. They ignored many, many studies that indicated otherwise. For example, two other compelling dimensional models of personality disorder have been developed by Dr. Livesley (the Dimensional Assessment of Personality Pathology) and Dr. Clark (the Schedule for Nonadaptive and Adaptive Personality). A complete description of and references for these measures, as well as others, is provided by Widiger and Simonsen (2). The clinical constructs assessed by these scales include narcissism, identity problems, eccentric perceptions, affective lability, aggression, detachment, self-harm behaviors, and compulsivity that resemble closely the scales of the SWAP-200, and many studies have documented well that the constructs assessed by the Dimensional Assessment of Personality Pathology and the Schedule for Nonadaptive and Adaptive Personality are well within the realm of the five-factor model.Drs. Shedler and Westen (1) derogatorily characterized the five-factor model as providing a simplistic lay description of personality. What was simplistic was their characterization of the five-factor model. The five-factor model is a rich dimensional model of general personality structure that has been used successfully in many areas of science and practice, including (but not limited to) the study of temperament, gender differences, heritability, behavioral medicine, and aging. An integration of the DSM-IV personality disorder nomenclature with the five-factor model would go far in integrating DSM-IV with basic science research on personality structure (3). We regret that Drs. Shedler and Westen (1) argued instead for a distinct separation of our clinical understanding of personality disorders and basic science research on personality structure.

Millon's Dimensional Polarities

Millon has presented a grand and rich theory of personality disorder. Fundamental to this theory are three polarity dimensions (active-passive, pleasure-pain, and self-other) from which the personality disorders are said to be derived. This article reviews these polarity dimensions with respect to their conceptual relation with the personality disorder nomenclature, their assessment, and their empirical support.

Narrowing of the drinking repertoire criterion: should it have been dropped from ICD-10?

To present data on the reliability of the narrowing of the drinking repertoire criterion in the ICD-10 substance use disorder nomenclature and possible justification for its exclusion from ICD-10. This criterion has been one of the hallmarks of the Edwards and Gross dependence concept. The sample of 318 consisted of 175 substance users from St. Louis area substance abuse treatment programs and 143 substance users from the St. Louis Epidemiologic Catchment Area Project, a general population survey. Respondents were interviewed about their substance use with the CIDI-SAM and reinterviewed approximately 1 week later. "Narrowing of the drinking repertoire" was reported by 24%. Overall, the agreement from interview 1 to interview 2 was fair to good (kappa = 0.5851). Men and drinkers in treatment were found to be more reliable reporters than women and drinkers recruited from the general population. The decision to drop the repertoire criterion seems justified, especially when non-clinical samples are interviewed. However, since our data found it highly associated with meeting criteria for a dependence disorder it is clinically valid. Additional research among varied populations is necessary to determine if the concept of narrowing is culture or gender specific and if its deletion affects rates of dependence.

Neonatal diagnosis of orotic aciduria: An experience with one family

2. Ulick S: Diagnosis and nomenclature of disorders of the terminal portion of the aldosterone biosynthetic pathway. J Clin Endocrinol Metab 43:92, 1976. 3. Royer P, Lestradet H, deMenibus CH, Vermeil G: Hypoaldosteronisme familial chronique ~. debut neo-natal. Ann Pediatr (Paris) 8:133, 1961. 4. Visser HKA, Cost WS: A new hereditary defect in the biosynthesis of aldosterone: Urinary C2~-corticosteroid pattern in three related patients with a salt-losing syndrome, suggesting an 18-oxidation defect. Acta Endocrinol (Copenh) 47:589, 1964. 5. David R, Golan S, Drucker W: Familial aldosterone deficiency: Enzyme defect, diagnosis, and clinical course. Pediatrics 41:403, 1968. 6. R6sler A, Rabinowitz D, Theodor R, Ramirez LD, Ulick S: The nature of the defect in a salt-wasting disorder of Jews of Iran: J Clin Endocrinol Metab 44:279, 1977. 7. Veldhuis JD, Kulin HE, Santen R J, Wilson TE, Melby JC: Inborn error in the terminal step of aldosterone biosynthesis: Corticosterone methyloxidase type II deficiency in a North American pedigree. N Engl J Med 303:117, 1980. 8. Kowarski A, Katz H, Migeon C J: Plasma aldosterone concentration in normal subjects from infancy to adulthood. J Clin Endocrinol Metab 38:489, 1974. 9. Siegler RL, Crouch RH, Hackett TN Jr, Walker M, Jubiz W: Potassium-renin-aldosterone relationships during the first year of life. J PEDIATR 91:52, 1977. 10. Pratt JH, Holbrook MM, Dale SL, Melby JC: The measurement of urinary tetrahydroaldosterone by radioimmunoassay. J Steroid Biochem 8:677, 1977. 11. Mattox VR, Nelson AN: Determination of urinary tetrahydroaldosterone glucosiduronic acid by radioimmunoassay. J Steroid Biochem 14:243, 1980. 12. Zurbriigg RP: Congenital adrenal hyperplasia. In Gardner LI, editor: Endocrine and genetic diseases of childhood and adolescence, ed 2. Philadelphia, 1975, WB Saunders, p 476.

Edited correspondence on the status of homosexuality in DSM-III.

In 1973, after a prolonged period of social agitation and professional conflict, the American Psychiatric Association deleted homosexuality from its official listing of psychiatric disorders (DSM-II). In its place a new classification for homosexuals distressed over their orientation was to be included in DSM-II. Four years later an acrimonious dispute surfaced over the status of homosexuality in the revised APA nomenclature of disorders (DSM-III). The edited correspondence of the participants in this dispute is presented here as a way of revealing the lingering conflict over homosexuality within American psychiatry.

INTERNATIONAL NOMENCLATURE OF DISEASES

To the Editor.— The Council for Organizations of Medical Sciences, conjointly with the World Health Organization, is engaged in a project for an International Nomenclature of Diseases, whose object is to provide a method by which medical practitioners throughout the world would use consistent terminology to describe diseases. This, it is believed, would simplify communication and complement the statistical information based on the WHO'sInternational Classification of Diseases. The project is receiving support from the US Public Health Service, and fascicles presenting a provisional international nomenclature of certain systems have already been published. Work is under way on a fascicle dealing with the nomenclature of disorders of the nervous system. If there are readers of theArchiveswho would like to collaborate on this project, we would be happy to provide them further information. We trust that we may keep your readers informed from time to time as to