Psychiatric Association's DSM-IV Research Articles

Sex differences in the prevalence and clinical features of comorbid depressive symptoms in patients with never-treated, first-episode schizophrenia

BackgroundMany aspects of schizophrenia are thought to be sex-specific, and patients with schizophrenia experience depressive symptoms at all disease phases. We investigated sex differences in patients with co-occurring schizophrenia and depressive symptoms, and investigated sex-specific relationships between depressive symptoms and clinical correlates. MethodsIn this cross-sectional study, we recruited Han Chinese inpatients (aged 16–45 years) in the Huilongguan mental hospital (Beijing, China) who had an acute, untreated first episode of schizophrenia that met the American Psychiatric Association's DSM-IV criteria for schizophrenia. Symptoms at the time of recruitment had to be moderate or severe according to the Clinical Global Impression Scale (≥4 points) and could not have lasted for more than 60 months. The Positive and Negative Syndrome Scale (PANSS) was used to assess clinical psychopathological symptoms and the 17-item Hamilton Depression Rating Scale (HDRS-17) for comorbid depressive symptoms. Pearson's χ2 test was used to calculate the incidence of co-occurring depressive symptoms in male and female patients. Odds ratios (ORs) were calculated using logistic regression comparing patients with and without depressive symptoms. The study was approved by the Insitutional Review Board of Huilongguan hospital and participants gave written informed consent before recruitment. FindingsBetween June 1, 2013, and Dec 20, 2015, 267 inpatients were recruited from consecutive admissions to the hospital. 27 were excluded because of documented medical abnormalities (n=7), substance dependence other than tobacco (n=5), other comorbid psychiatric disorders (n=6), or refusal or inability to provide consent (n=9). 240 patients (111 men and 129 women) were evaluable. Significantly more men (69 [62%]) than women (62 [48%]; χ2=4·28, p=0·039) had depressive symptoms (defined as total HDRS-17 score ≥8 points), which were also more severe (t=2·75, p=0·0058). Age, age at schizophrenia onset, and smoking were associated with significant sex differences for female patients, as were total, general psychopathology, negative PANSS symptoms, and cognitive factor subscale PANSS scores (all p<0·05). We found sex differences in the correlation between HDRS score and clinical phenotype, showing that in men, the PANSS general psychopathology subscore (β=0·75, t=7·72, p<0·0001) and the PANSS total score (β=0·44, t=4·81, p<0·0001) significantly predicted the HDRS-17 total score, whereas in women, the HDRS-17 total score was significantly predicted by the PANSS general psychopathology subscore (β=0·74, t=8·45, p<0·0001), the PANSS total score (β=0·47, t=5·71, p<0·0001), and the PANSS cognitive factor score (β=0·24, t=2·60, p=0·011). InterpretationOur results indicate that there are sex differences in the prevalence and severity of comorbid depressive symptoms, as well as their association with clinical correlates, in patients with never-treated, first-episode schizophrenia. Men had more severe depression, whereas disease in women was affected more by external factors. However, a cross-sectional deisgn could not establish definitive causative associations between sex and depressive or psychotic symptoms. FundingNational Natural Science Foundation of China (grant 81371477) and CAS Pioneer Hundred Talents Program.

Agreement between definitions of pharmaceutical opioid use disorders and dependence in people taking opioids for chronic non-cancer pain (POINT): a cohort study

Classification of patients with pharmaceutical opioid use disorder and dependence varies depending on which definition is used. We compared how WHO's ICD-10 and proposed ICD-11 and the American Psychiatric Association's DSM-IV and DSM-5 classified individuals in a community-based sample of Australians with chronic non-cancer pain for which opioids have been prescribed. We studied participants in the Pain and Opioid IN Treatment (POINT) cohort, a 2 year prospective cohort study of 1514 people prescribed pharmaceutical opioids for their chronic pain who were recruited in 2012-13 from community-based pharmacies across Australia. After giving patients the Composite International Diagnostic Interview about their opioid use, we assessed which patients would be categorised as having disorders of pharmaceutical opioid use by ICD-10, the draft ICD-11, DSM-IV, and DSM-5. We examined agreement between classification systems, and tested the unidimensionality of the syndrome with confirmatory factor analysis. We included 1422 participants (median time of pain disorder 10 years [IQR 5-20]; median length of strong opioid prescription 4 years [IQR 1·5-10·0]; mean age 58 years). Similar proportions of individuals met lifetime criteria for dependence with DSM-IV (127; 8·9%), ICD-10 (121; 8·5%), and ICD-11 (141; 9·9%). Criteria in DSM-5 classified 127 (8·9%) participants with moderate or severe use disorder. There was excellent agreement between ICD-10, ICD-11 and DSM-IV dependence (κ>0·90). However, there was only fair to moderate agreement between ICD-10 and DSM-IV dependence diagnoses, and DSM-5 use disorder (mild, moderate, or severe). There was only good agreement between moderate to severe use disorder in DSM-5 and the other definitions. Criteria for all definitions loaded well on a single factor; the best model fit was for the definition for dependence in the draft ICD-11, the worst was in DSM-5. Classification of problematic pharmaceutical opioid use varies across editions of ICD and DSM. The much lower levels of agreement between DSM-5 and other definitions than between other definitions might be attributed to DSM-5 containing an increased number of criteria and treating dependence and problematic use as a continuum. The more parsimonious ICD-11 dependence definition showed excellent model fit and excellent agreement with previous classificatory systems. Australian National Health and Medical Research Council.

Ensuring contributions to the revision of the classifications from the world scientific community: Example of German speaking countries

Classification of patients with pharmaceutical opioid use disorder and dependence varies depending on which definition is used. We compared how WHO's ICD-10 and proposed ICD-11 and the American Psychiatric Association's DSM-IV and DSM-5 classified individuals in a community-based sample of Australians with chronic non-cancer pain for which opioids have been prescribed.We studied participants in the Pain and Opioid IN Treatment (POINT) cohort, a 2 year prospective cohort study of 1514 people prescribed pharmaceutical opioids for their chronic pain who were recruited in 2012–13 from community-based pharmacies across Australia. After giving patients the Composite International Diagnostic Interview about their opioid use, we assessed which patients would be categorised as having disorders of pharmaceutical opioid use by ICD-10, the draft ICD-11, DSM-IV, and DSM-5. We examined agreement between classification systems, and tested the unidimensionality of the syndrome with confirmatory factor analysis.We included 1422 participants (median time of pain disorder 10 years [IQR 5–20]; median length of strong opioid prescription 4 years [IQR 1·5–10·0]; mean age 58 years). Similar proportions of individuals met lifetime criteria for dependence with DSM-IV (127; 8·9%), ICD-10 (121; 8·5%), and ICD-11 (141; 9·9%). Criteria in DSM-5 classified 127 (8·9%) participants with moderate or severe use disorder. There was excellent agreement between ICD-10, ICD-11 and DSM-IV dependence (κ>0·90). However, there was only fair to moderate agreement between ICD-10 and DSM-IV dependence diagnoses, and DSM-5 use disorder (mild, moderate, or severe). There was only good agreement between moderate to severe use disorder in DSM-5 and the other definitions. Criteria for all definitions loaded well on a single factor; the best model fit was for the definition for dependence in the draft ICD-11, the worst was in DSM-5.Classification of problematic pharmaceutical opioid use varies across editions of ICD and DSM. The much lower levels of agreement between DSM-5 and other definitions than between other definitions might be attributed to DSM-5 containing an increased number of criteria and treating dependence and problematic use as a continuum. The more parsimonious ICD-11 dependence definition showed excellent model fit and excellent agreement with previous classificatory systems.Australian National Health and Medical Research Council.

Psychiatric Diagnostic Dilemmas in the Medical Setting

To review the problems posed for doctors by the failure of existing taxonomies to provide a satisfactory method for deriving diagnoses in cases of physical/psychiatric comorbidity, and of relating diagnoses on multiple axes. Review of existing taxonomies and key criticisms. The author was guided in selection by his experience as a member of the working parties involved in the creation of the American Psychiatric Association's DSM-IV. The attempts of the two major taxonomies, the ICD-10 and the American Psychiatric Association's DSM-IV, to address the problem by use of glossaries and multiple axes are described, and found wanting. Novel approaches, including McHugh and Slavey's perspectives of disease, dimensions, behaviour and life story, are described and evaluated. The problem of developing valid and reliable measures of physical/psychiatric comorbidity is addressed, including a discussion of genetic factors, neurobiological variables, target markers and other pathophysiological indicators. Finally, the concept of depression as a systemic illness involving brain, mind and body is raised and the implications of this discussed. Taxonomies require major revision in order to provide a useful basis for communication and research about one of the most frequent presentations in the community, physical/psychiatric comorbidity.

Student Instant Message Use in a Ubiquitous Computing Environment: Effects of Deficient Self-Regulation

Patterns of instant message software use among 409 college students at a small college with universal computing access were investigated based on dependency concepts using American Psychiatric Association DSM-IV criteria in an effort to identify effects of deficient self-regulation. Responses indicated that effects of deficient self-regulation were present, that instant messaging usurped the role of other socialization tools-including face- to-face communication-for many, and that a substantial amount of time was devoted to using it.

Platelet serotonergic binding sites in alcohol-dependent patients.

The serotonin (5-hydroxytryptamine, 5-HT) uptake sites assessed with both [3H]imipramine and [3H]paroxetine, and the 5-HT2A receptors were simultaneously measured in platelets from 24 male subjects meeting the American Psychiatric Association's DSM-IV criteria for alcohol dependence and admitted for inpatient detoxification. Blood samples from alcoholic patients were collected during acute alcohol intoxication (day 0), during withdrawal (day 1), and after 2 weeks of abstinence (day 14). All patients met the criteria for type II alcoholism. Alcohol misuse was found to be associated with an increased number and a lower affinity of [3H]paroxetine binding in comparison to the control values. Abstinence from alcohol for 2 weeks (day 14) resulted in a decrease in the number of 5-HT uptake sites labelled with [3H]paroxetine compared to normal values, together with a significant decrease in the number of 5-HT2A binding sites. The present data indicate that altered serotonergic function existing in alcoholic patients is a reversible phenomenon that normalizes after detoxification and withdrawal.

Premenstrual dysphoric disorder: literature review

The original research literature concerning premenstrual disorders appearing since the review of the American Psychiatric Association's DSM-IV work group in 1994 is reviewed. Principal areas covered include methodologic approaches to premenstrual dysphoric disorder and related syndromes; biological, neuropsychiatric, and behavioral aspects of premenstrual dysphoric disorder and related syndromes; treatment of premenstrual dysphoric disorder and related syndromes.

Multiaxial diagnosis and psychotherapy planning: on the relevance of ICD-10, DSM-IV and complementary schemas.

This paper reviews, first, the historical development of multiaxial diagnostic schemas, with particular attention to those designed for the World Health Organisation's Tenth Revision of the International Classification of Diseases (ICD-10) and the American Psychiatric Association's DSM-IV. To complement standardized or nomographic multiaxial schemas, several personalized, or idiographic formulations are outlined, i.e. cultural, biographic, psychodynamic, group dynamic, and one dealing with quality of life. Contributions of comprehensive diagnosis (multiaxial and idiographic formulations) to psychotherapy planning and psychotherapy research are then discussed. The potential contributions of the psychotherapy process to diagnostic verification and clarifications are considered as well. Finally, the need for empirical validation research on the outlined relationships as well as the potential value of exploring further the synergism of nomographic and idiographic approaches are elaborated.

Late luteal phase dysphoric disorder in 670 women evaluated for premenstrual complaints.

The American Psychiatric Association's DSM-IV Work Group on Late Luteal Phase Dysphoric Disorder (LLPDD) reanalyzed existing data from prospective, daily symptom ratings to evaluate the DSM-III-R criteria for LLPDD. The objectives were to 1) evaluate the individual symptoms presently required for the diagnosis and other symptoms, 2) determine the proportion of treatment-seeking women who meet the LLPDD criteria, and 3) explore the association between LLPDD and other mental disorders. Data from over 1,000 women seeking evaluation for premenstrual complaints at five U.S. sites were examined. The data from 670 of these women were sufficiently complete to warrant evaluation by four different methods of assessing symptom change. Depending on the assessment method used, 14% to 45% of the women met the criteria for LLPDD. The current DSM-III-R symptoms were classified as positive for 7% to 54% of the women. Each of these symptoms was significantly more common among women with LLPDD regardless of the assessment method used. Five symptoms not presently included were also significantly more common. Women who had had mental disorders in the past, but not present, showed a significantly greater, but very small, relative risk of LLPDD. The variability in the frequency of LLPDD diagnosis according to method of assessing symptom change underscores the need for a uniform assessment method. The five additional symptoms with frequencies comparable to those of the DSM-III-R symptoms should be studied further for possible inclusion in the criteria.