Structured Clinical Interview For DSM-IV Disorders Research Articles

Alcohol-related disorders among medical and surgical in-patients in a Nigerian teaching hospital

Alcohol use disorders exist in a high proportion of hospitalized patients and this often complicates patient management, but a large proportion of them still go unrecognized by the managing clinicians. The objective was to provide data on the proportion of inpatients 18 years and above with alcohol-related disorders, and ability of the managing clinicians to detect these disorders. Alcohol use disorders were assessed in 339 consecutive patients admitted into medical and surgical wards of University of Ilorin Teaching Hospital (UITH), Ilorin, using the Structured Clinical Interview for DSM-IV Disorders (SCID) -- Alcohol module, for a period of 5 months. They were also assessed for the presence or absence of alcohol-related problems (physical, psychological, and social) by direct questioning. In addition, patients' case notes were scrutinized for additional information on alcohol-related problems and ability of managing clinicians to detect alcohol-related problems in their patients. All patients with alcohol use disorders were males. The point prevalence for alcohol abuse and alcohol dependence using DSM-IV criteria were 16.4% and 8.5%, respectively among males while another 1.2% who did not meet DSM-IV criteria for abuse and dependence, had alcohol-related problems. Marital disharmony, financial problems, and deteriorating work performance were the most common psychosocial problems among the drinkers. Gastritis occurred in 18.5% of cases with alcohol abuse and 21.4% of cases with alcohol dependence. Other physical problems among drinkers included liver cirrhosis, malnutrition, and various injuries. Significantly more patients aged (45-64 years) and patients of low educational status compared to abstainers had alcohol use disorders and alcohol-related problems. In addition, significantly more patients with alcohol use disorders/alcohol-related problems compared to abstainers were observed to have physical and psychosocial health problems. Alcohol-related problems were detected in only 10.9% of the alcohol users by the managing clinicians. There is a considerable case load of patients with alcohol-related disorders in the hospital. There is therefore the need to improve ability of the managing clinicians to detect and manage cases of alcohol-related disorders, with referrals where appropriate.

Validity of the Beck Depression Inventory as a Screening Tool for a Clinical Mood Disorder in Bariatric Surgery Candidates

The Beck Depression Inventory (BDI) is one of the most commonly used instruments to assess depression in persons with obesity. While it has been validated in normal and psychiatric populations, in obese populations, its validity remains uncertain. This study aimed to investigate the validity and reliability of the BDI-IA and BDI-II in severely obese bariatric surgery candidates. Consecutive new candidates at a bariatric surgery clinic were invited to participate in the study by their consulting surgeon. All candidates were assessed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I); 118 completed the BDI-IA and 83 completed the BDI-II. Two hundred one patients (response rate, 88 %) participated in the study. The current sample (82 % female) had an average body mass index of 42.83 ± 6.34 and an average age of 45 ± 12 years. Based on the SCID-I, 54 candidates (26.9 %) met the criteria for a mood disorder, with 37 meeting the criteria for current major depressive disorder. Individuals diagnosed with a clinical mood disorder had significantly higher scores on the BDI (BDI-IA, 23.59 ± 9.69 vs. 12.76 ± 8.29; BDI-II, 22.93 ± 5.22 vs. 11.25 ± 8.44). Our results indicated that, as a screening tool for a clinical mood disorder, the BDI-II had an optimal cutoff of 13, with a sensitivity of 100 and specificity of 67.75. Results indicated that the BDI-IA should not be used as a tool to measure depressive symptomatology in obese bariatric surgery candidates. No cutoff was identified with adequate sensitivity and specificity, and over 20 % of patients were misclassified. As a screening tool for a clinical mood disorder, the BDI-II was adequate; however, prevalence rates were significantly overestimated.

The Edinburgh Postnatal Depression Scale: Translation and antepartum validation for a Hungarian sample

Objectivethe Edinburgh Postnatal Depression Scale (EPDS) is an important screening instrument routinely used during the peripartum period for the identification of depression. The purpose of the study was to assess the validity of the 10-item EPDS in screening for antepartum depression (APD) in Hungary. Designvalidation study carried out between July and December 2010. SettingDepartment of Obstetrics and Gynecology, University of Szeged, Hungary. Participants219 women attending a routine check-up at 12 weeks antepartum. Interventionsparticipants completed the newly translated Hungarian version of the EPDS and underwent a clinical assessment with the Structured Clinical Interview for DSM-IV disorders (SCID-I). Measurement and findingsseven (3.2%) of the mothers were diagnosed with major antepartum depression and 15 persons (6.85%) with minor depression on the basis of the SCID. Internal consistency of the EPDS was satisfactory (Cronbach α coefficients ≥0.728). The best cut-off on the Hungarian version of the EPDS for major depression was 8/9, with a sensitivity of 71.4%, and a specificity of 91.5%. The area under the ROC curve was found significant for combined depression as well and at a cut-off of 6/7 indicated a sensitivity of 81.8% and a specificity of 83.2%. Key conclusionsthe EPDS showed acceptable validity despite a considerable scatter in the total scores in our sample. Implication for practicethe EPDS is a reliable instrument for the screening of depressive disorders, especially major depressive disorder in early pregnancy among Hungarian women.

The Depressive Psychopathology Scale: presentation and initial validation in a sample of Peruvian psychiatric patients.

Presentation and validation of the Depressive Psychopathology Scale (DPS), a new, Spanish-language psychometric inventory, in a sample of Peruvian psychiatric patients. From 1999 to 2001, the DPS, Zung Self-rating Depression Scale (ZSDS), and Major Depressive Disorder (MDD) module of the Structured Clinical Interview for DSM-IV Disorders (SCID) were administered to 226 nonpsychotic outpatients referred to the National Institute of Mental Health in Lima, Peru, for their initial clinical evaluation. In the evaluation, attending psychiatrists 1) corroborated the general diagnosis and presence or absence of MDD and 2) rated depression severity based on clinical opinion and on Clinical Global Im-pression-Severity scale criteria. Mean time to complete the DPS was 7.22 minutes (standard deviation, 3.99). Cronbach's alpha value was 0.86. For diagnosis of MDD, based on the SCID, area under receiver operating characteristic curve (AUROC) was 0.872 and the selected cutoff score (26/27) had 81.32% sensitivity and 80% specificity; based on the attending psychiatrists' evaluation, AUROC was 0.832 and the selected cutoff score (25/26) had 77.67% sensitivity and 72.32% specificity. The DPS was significantly correlated with the ZSDS (rho = 0.8, P < 0.001). Some DPS items ("depression worse in the morning," "appetite disturbances," "mood reactivity," and "hypersomnia") showed low loadings on the five factors extracted through principal component analysis and/or did not significantly correlate with depression parameters. The DPS can predict MDD and has convergent validity, as shown by its correlation with the ZSDS. However, additional psychometric studies are recommended to simplify and improve it.

Insomnia is associated with impaired quality of life among bariatric surgery candidates

Little is known about the prevalence or impact of insomnia symptoms in obese individuals pursuing bariatric surgery. The present study from the Rhode Island Bariatric Surgery (RIBS) project examined insomnia symptoms among 2300 individuals pursuing bariatric surgery. Patients were evaluated using the Structured Clinical Interview for DSM-IV Disorders (SCID), Schedule for Affective Disorders (SADS), Rhode Island Bariatric Surgery Interview (RIBSI), and the SF-36 as a measure of quality of life. The presence of insomnia symptoms was determined via ratings for the SCID items assessing initial, middle, and terminal insomnia symptoms, and the SADS insomnia item was used to measure severity of insomnia symptoms. Clinical and demographic variables were obtained from the SCID and self-report measures. Insomnia symptoms were endorsed by 25.8% of participants. Bariatric patients with insomnia symptoms were rated as having a more severe clinical presentation and lower functioning, and were more likely to have a history of psychiatric treatment and/or hospitalization, compared to bariatric patients without insomnia. Linear regression analyses demonstrated that insomnia severity was a significant predictor for scores on each of the 8 SF-36 subscales after accounting for age, gender, race, education level, BMI, depression severity, and sleep apnea. Additionally, a multivariate analysis of covariance (MANCOVA) controlling for depression severity and sleep apnea demonstrated significantly poorer scores on 6 of the 8 SF-36 subscales for bariatric patients with current insomnia symptoms. Results revealed that insomnia symptoms are common among bariatric patients and are associated with reduced quality of life and poorer current functioning. This suggests that insomnia symptoms are an important clinical target in bariatric patients prior to surgery.:

Postpartum depression: the distribution of severity in a community sample

Dear Editor, The prevalence of postpartum depression (PPD) is well established by a wealth of epidemiological studies (Gavin et al. 2005). Nevertheless, because PPD status is often dichotomous and based on DSM-IV criteria for major depressive disorder (MDD) or on an established cutoff score, little is known about the variation in symptom severity among those diagnosed as depressed. Accounting for variation in severity levels among depressed women would not only inform treatment referrals, but would also improve specificity in the identification of research participants for treatment trials and may more accurately account for differential treatment responses. To describe variation in depression severity in a sample of clinically depressed women, we analyzed a previously collected data set (O'Hara et al. 2000) with demographic and diagnostic data from 292 women who were recruited for a treatment trial. The data reflect pretreatment depression status. Demographically, these women were predominantly white (96.9%, n=283), non-Hispanic (97.9%, n=286), and married (87.7%, n=256,) with an average age of 28.4 years. Over half (59.9%, n=175) were employed with an average annual household income of approximately US $40,200 and average educational level of 14.6 years. All women were diagnosed with MDD according to the Structured Clinical Interview for DSM-IV Disorders (SCID); women with minor depression were not included in the data set. Scores on the Hamilton Rating Scale for Depression (HRSD) were available for each woman. Using five previously established levels of depression severity based on HRSD scores (Furukawa et al. 2007), we calculated the frequency of depressed women at each severity level. These severity levels have been defined as “level 1—normal/no illness” (HRSD 0–3), “level 2—borderline ill” (HRSD 4–7), “level 3—mildly ill” (HRSD 8–15), “level 4—moderately ill” (HRSD 16–26), and “level 5—severely ill” (HRSD 27–50). The results indicate that even within a clinically depressed sample of women, there is a wide range of depression severity (Table 1). Noteworthy are the 5% of women who were diagnosed with MDD based on the SCID, yet received low HRSD scores. One explanation for this discrepancy is that the SCID and HRSD assess slightly different time periods; the SCID assesses the worst 2 weeks in the last month while the HRSD assesses the past week. Table 1 Prevalence of postpartum depression by severity level These results have important treatment and research implications. From a stepped care model perspective, depressed women with symptoms in the mild range may require less intensive treatment, such as a support group, while depressed women with more severe symptoms may require more aggressive treatment, like therapy or medication. Tailored treatment plans for women suffering from different severity levels of PPD have the potential to be efficient in terms of both time and cost. These results are also potentially informative for clinical research where treatments might have differential efficacy based on depressive severity level. Future treatment trials might examine outcome based on clusters of depression severity to better account for variation in treatment response. Although these results are not surprising, to our knowledge, this is the first study to analyze the frequency of PPD by severity level. Admittedly, the data set of the present analysis is homogenous in terms of both ethnicity and marital status, so it would be valuable for future studies to examine varying severities of PDD in a more diverse sample. In conclusion, given the aforementioned treatment and research benefits of identifying clinically depressed women by severity level, it is hoped that clinicians and researchers will consider this factor in the future.

Prevalence of psychiatric disorders in patients with chronic solvent induced encephalopathy (CSE)

IntroductionLong term occupational exposure to organic solvents may induce chronic solvent-induced encephalopathy (CSE), characterized by mild to severe cognitive impairment, generally seen as the key diagnostic feature. Psychiatric disorders are often diagnosed in subjects with CSE, but were never studied in more detail. This study was designed to establish the prevalence rates of DSM IV mood, anxiety, and alcohol and substance related disorders in patients with CSE. Materials and methodsIn CSE, n=203 (consecutively recruited between 2002 and 2005), defined according to the criteria of the World Health Organisation (WHO), one month prevalence rates of DSM IV mood, anxiety, and life time alcohol/substance related disorders were assessed using the Structured Clinical Interview for DSM IV disorders (SCID). These prevalences were compared with those from an age and gender matched community sample (n=3212) while controlling for insufficient neuropsychological test effort. ResultsIn CSE, prevalence rates for major depressive disorder (n=36, relative risk (RR)=7.4), dysthymia (n=15, RR=6.0), panic disorders (n=18, RR=7.1), agoraphobia (n=7, RR=5.5) and generalized anxiety disorder (n=19, RR=15.8) were increased. Reduced prevalence rates were found for alcohol related disorders (n=21, RR=0.3). Insufficient neuropsychological test effort was not associated with increased prevalence rates of DSM IV disorders in subjects suspected of CSE. Discussion and conclusionsIn conclusion, in this first large scale study in patients with CSE, prevalence rates of DSM IV mood and anxiety disorders were elevated as compared with those in the general community, while the prevalence rates of alcohol related disorders were reduced. Further study must determine whether CSE, and mood and anxiety disorders, share a same, solvent induced, neurobiological pathway, supporting the use of a more inclusive diagnostic approach. Additionally, randomised controlled trials are needed for the urgent issue of how to treat mood and anxiety disorders in CSE patients effectively.

The nature, frequency and course of psychiatric disorders in the first year after traumatic brain injury: a prospective study

Psychiatric disorders are common following traumatic brain injury (TBI). However, few studies have examined the course of disorder development and the influence of pre-injury psychiatric history. The present study aimed to examine the frequency of, and association between, psychiatric disorders occurring pre- and post-injury, and to examine the post-injury course of disorders. Participants were 102 adults (75.5% male) with predominantly moderate-severe TBI. Participants were initially assessed for pre-injury and current disorders, and reassessed at 3, 6 and 12 months post-injury using the Structured Clinical Interview for DSM-IV Disorders (SCID). Over half of the participants had a pre-injury psychiatric disorder; predominantly substance use, mood, and anxiety disorders. In the first year post-injury, 60.8% of participants had a psychiatric disorder, commonly anxiety and mood disorders. Post-injury disorders were associated with the presence of a pre-injury history (p<0.01), with 74.5% of participants with a pre-injury psychiatric history experiencing a post-injury disorder, which commonly presented at initial assessment or in the first 6 months. However, 45.8% of participants without a pre-injury history developed a novel post-injury disorder, which was less likely to emerge at the initial assessment and generally developed later in the year. Despite evidence that most post-injury psychiatric disorders represent the continuation of pre-existing disorders, a significant number of participants developed novel psychiatric disorders. This study demonstrates that the timing of onset may differ according to pre-injury history. There seem to be different trajectories for anxiety and depressive disorders. This research has important implications for identifying the time individuals are most at risk of psychiatric disorders post-injury.

Quitting a weight loss program is associated with anhedonia: preliminary findings of the Lifestyle Intervention Treatment Evaluation Study in northern Finland

Objectives. To examine whether a diagnosis for major depression, chronic depression or specific symptoms of depression is associated with the risk of quitting a weight loss program.Study design. The study involved 82 overweight adults participating in the Lifestyle Intervention Treatment Evaluation (LITE) follow-up study at Oulu University Hospital in northern Finland.Methods. Psychiatric diagnostic assessments were based on the Structured Clinical Interview for DSMIV disorders (SCID-I) conducted by a clinical psychiatrist. Anhedonia (lack of pleasure) was assessed as one of the core symptoms of major depression and chronic depression (dysthymia). Anhedonia was defined to be present if the participants reported having suffered a major loss of interest during the previous month.Results. Twenty participants (24.4%) quit during the 6-month intervention period. Anhedonia put individuals at risk of quitting the weight loss program (bivariate analysis OR 3.1, 95% CI 0.8–11.6, p=0.091, multivariate analysis OR 6.5, 95% CI 1.1-38.2, p=0.038). However, a diagnosis for major depression or chronic depression did not predict quitting.Conclusions. Individual assessments of obesity and overweight should also include an assessment for subthreshold depression, mainly anhedonia.

Severe insomnia is associated with more severe presentation and greater functional deficits in depression

Depression is among the most common reasons for seeking psychiatric treatment, and insomnia symptoms are common in the clinical picture of depression. The present study examines the clinical presentation and psychosocial functioning among depressed outpatients with severe symptoms of insomnia in comparison to depressed outpatients without severe insomnia symptoms. The present sample included 2900 treatment-seeking individuals, with 1057 patients having a principal diagnosis of Major Depressive Disorder (MDD). All patients were evaluated using the Structured Clinical Interview for DSM-IV Disorders (SCID), Schedule for Affective Disorders (SADS), and self-report measures of mood and psychosocial functioning. SADS Insomnia ratings were used to determine the presence of severe insomnia symptoms. Clinical, demographic, and psychosocial variables were obtained from the SCID and self-report measures. Among the patients with MDD, 24.7% endorsed severe insomnia symptoms. These individuals were older at time of presentation, were less likely to be married, had a lower education level, had a longer duration of the current depressive episode, were rated as more severe on the CGI, had poorer current functioning via GAF, and had higher HAM-D 21 scores. After controlling for severity, MDD patients with severe insomnia symptoms had poorer social functioning over the past 5 years, though this did not reach the significance level of p < .01, and significantly lower scores on 3 of the 8 SF-36 subscales (p < 0.01). These findings indicate that severe insomnia symptoms are associated with poorer psychosocial functioning and a more severe clinical presentation in patients with MDD. This argues for addressing severe insomnia symptoms among depressed patients, either via behavioral treatment or pharmacologic treatment options.

Validation of a screening instrument for postpartum depression in Southern Brazil

Objectives. The objectives of this investigation was to assess the prevalence of postpartum depression in a sample of 101 women and to validate a Portuguese version of the Postpartum Depression Screening Scale (PDSS) in Southern BrazilMethods. Research volunteers completed the PDSS and underwent an assessment based on the Structured Clinical Interview for DSM-IV disorders (SCID). Parameters under investigation included the demographic characteristics of the sample, internal structure, and discriminant validity.Results. All questions in the Portuguese version of the PDSS attained significant Cronbach's alpha of 0.62. The factorial analysis of the Portuguese version of PDSS identified one principal factor that contributed 38.8% of the variance. The best cut-off score for the Portuguese version of the PDSS was a score of 81, which accounted for a sensitivity of 89% and a specificity of 72% in this sample.Conclusions. The Portuguese version of the PDSS demonstrated sound psychometric properties. The results of the factorial analysis also demonstrated that the Portuguese version of the PDSS assesses postpartum depressive disorders in a coherent and integrated manner. The original English version of the PDSS was successfully adapted to Portuguese.

Psychiatric Disorders Following Traumatic Brain Injury

To retrospectively establish the nature and frequency of Axis I psychiatric disorders pre- and post-TBI. One hundred participants who were 0.5 to 5.5 years post mild to severe TBI and 87 informants, each evaluated at a single time point. The Structured Clinical Interview for DSM-IV Disorders (SCID-I). Preinjury, 52% received a psychiatric diagnosis, most commonly substance use disorder (41%), followed by major depressive disorder (17%) and anxiety (13%). Postinjury, 65% received a diagnosis, of which major depression became the most common (45%), followed by anxiety (38%) and substance use disorder (21%). Frequency of depression, generalized anxiety disorder, posttraumatic stress disorder, panic disorder, and phobias rose from preinjury to postinjury. More than two-thirds of postinjury depression and anxiety cases were novel and showed poor resolution rates. Few novel cases of substance use disorder were noted. Psychotic disorders, somatoform disorders, and eating disorders occurred at frequencies similar to those in the general population. A high frequency of postinjury psychiatric disorders was evident up to 5.5 years postinjury, with many novel cases of depression and anxiety. Individuals with TBI should be screened for psychiatric disorders at various time points post-injury without reliance on history of psychiatric problems to predict who is at risk, so that appropriate intervention can be offered.

The Correlation Between Postpartum Depression and Health Status

To investigate a purported correlation between postpartum depression and self-rated maternal general health status in a sample of mothers in Southern Brazil. As part of this process, the Personal Health Scale (PHS), a self-rated health status measure, was tested for the first time among postpartum women. Research volunteers completed the Structured Clinical Interview for DSM-IV Disorders (SCID), the 12-item General Health Questionnaire (GHQ), the PHS, the Postpartum Depression Screening Scale (PDSS), and the Edinburgh Postnatal Depression Scale (EPDS). Correlation coefficients were computed among the scores of the health status questionnaires and the postnatal depression scales. Bivariate linear regression analyses were conducted to evaluate the prediction of scores of postnatal depression scales having the scores of health status questionnaires as predictors. Significant correlations among both health status questionnaires and both postnatal screening tools attest to a significant interconnection between the expression of depressive symptoms and maternal health status in the postpartum period. The health status measures predicted the scores of postpartum depression scales. This study demonstrates that both general health questionnaires and postpartum depressive rating scales are useful tools for detecting depressive phenomena in postpartum women. The association between self-rated health measures and postpartum depression may be even more significant in the context of socioeconomic deprivation.

Young, single and not depressed: Prevalence of depressive disorder among young women in rural Pakistan

Background The prevalence of depression is very high among adult women in Pakistan but it is not known whether such a high prevalence occurs in younger women. We aimed to assess the prevalence and correlates of depression in 16 to 18-year old unmarried women in Pakistan. Method Population-based survey of all 16 to 18-year old unmarried women in one rural community in Rawalpindi District, Punjab, Pakistan. Depressive disorder and psychological distress were assessed using the Structured Clinical Interview for DSM-IV Disorders (SCID) and Self-Reporting Questionnaire (SRQ) respectively. Results 337 eligible women were identified of whom 321 (95%) were interviewed. Fourteen (4.4%) had depressive disorder; one third scored 9 or more on SRQ. On multivariate analysis a high SRQ score was associated with childhood experience of poverty, father's education, stressful life events, disturbed family relationships and mother's depression. Limitations The sample was derived from one rural community only and the results should be generalised with caution. Conclusion Depressive disorder is not common in young women in rural Pakistan though distress appears common and is associated with early and recent adversity and family difficulties. These results suggest future work might aim to understand onset and prevent chronic depression.

Prospective study of risk factors for attempted suicide among patients with bipolar disorder

There are few prospective studies on risk factors for attempted suicide among representative samples of psychiatric patients with bipolar I and II disorders. We conducted a prospective study to investigate risk for suicide attempts among a secondary-level sample of psychiatric in- and outpatients with bipolar disorder (BD). In the Jorvi Bipolar Study (JoBS), 1,630 psychiatric in- and outpatients from three Finnish cities were screened for BDs with the Mood Disorder Questionnaire (MDQ). Using the Structured Clinical Interview for DSM-IV Disorders (SCID)-I and -II, 191 patients were diagnosed with BDs (90 bipolar I and 101 bipolar II). Information on suicide attempts during the follow-up was obtained for 176 patients (92%) at the 6-month follow-up and for 160 patients (84%) at the 18-month follow-up. During the 18-month follow-up 20% of patients (35/176) attempted suicide. In a Cox regression model, baseline previous suicide attempts (OR 3.8, 95% CI 1.7-8.8; p = 0.001), hopelessness (OR 1.2, 95% CI 1.1-1.3; p < 0.001), depressive phase at index episode (OR 2.4, 95% CI 1.1-5.3; p = 0.03) and younger age at intake (OR 0.94, 95% CI 0.91-0.97; p < 0.001) were independent risk factors for suicide attempts during follow-up, whereas factors such as bipolar I or II, or comorbidity did not reach statistical significance. During a medium-term follow-up, as many as one-fifth of random psychiatric patients with BD attempted suicide, which highlights the public health importance of suicidal behavior in BD. Previous suicide attempts, hopelessness and depressive phase were the key indicators of risk.

A Brief Mental Health and Substance Abuse Screener for Persons with HIV

Mental illness and substance abuse are common among HIV-infected individuals and are associated with negative outcomes, including poor medication adherence. Therefore, quick and effective methods for detecting these co-occurring disorders are necessary for health care practitioners. This article reports on the creation and preliminary testing of a brief screening tool, the Substance Abuse and Mental Illness Symptoms Screener (SAMISS). The 13-item screener was developed primarily from existing scales and administered to HIV-infected individuals receiving care at infectious diseases clinics in the Southeast. To assess the validity of the SAMISS, a subset of those who screened positive for both mental illness symptoms and substance use problems (n = 207) were administered the Structured Clinical Interview for DSMIV Disorders (SCID). The positive predictive value of the screener in comparison to the SCID was 98.6% for mental disorders and 98.6% for substance use disorders. The agreement between specific screener symptoms and their corresponding SCID diagnoses was relatively high for alcohol dependence (kappa = 0.50, p < 0.001), drug dependence (kappa = 0.30, p < 0.001), and drug abuse (kappa = 0.42, p <0.001). The finding that the screener is highly predictive of having a general mental disorder and substance use disorder among those screening positive for mental illness symptoms and substance use problems, as well as its brevity and ease of administration, make it a useful tool to detect symptoms of co-occurring disorders so that patients can be referred to mental health and substance abuse specialists. The screener is not a diagnostic instrument and has limited value in predicting specific psychiatric diagnoses.

Psychiatric and social barriers to HIV medication adherence in a triply diagnosed methadone population.

Although antiretrovirals can prolong life, medication adherence also poses a constant challenge for HIV-infected individuals because the success of antiretroviral regimens demands nearly perfect adherence to medications. This paper describes the psychiatric and social barriers to adherence in a convenience sample of HIV-positive clients in methadone treatment in the Bronx, New York. The study sample was part of a national study of HIV treatment adherence and health care utilization among triply diagnosed populations, the HIV/AIDS Treatment Adherence Health Outcomes and Cost Study. The triply diagnosed study sample is defined here as HIV-infected individuals who screened into the study with at least one psychiatric diagnosis in addition to opioid dependence on agonist therapy (methadone treatment) and at least one substance use diagnosis. Interviewers utilized modified versions of the Structured Clinical Interview for DSM-IV Disorders (SCID-I), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), and the Addiction Severity Index (ASI-Lite), among a battery of Cost Study instruments. Results showed that within this sample, borderline personality disorder was significantly associated with nonadherence to HIV medications. A related finding showed a significant relationship between serious social/family problems and nonadherence. These findings build on previous research on the impact of psychiatric illness on HIV medication adherence and suggest that psychiatric assessment and treatment options be linked to adherence interventions.

Clinical and psychosocial characteristics of substance-dependent pregnant women with and without PTSD.

The present study compared psychiatric and psychosocial functioning in 123 pregnant opiate- and/or cocaine-dependent women with and without a comorbid diagnosis of posttraumatic stress disorder (PTSD). Participants were enrolled in a comprehensive perinatal drug treatment program and completed assessments upon admission. Lifetime diagnostic prevalence of PTSD [Structured Clinical Interview for DSM-IV Disorders (SCID) confirmed] among the sample was 19%. Participants with PTSD (n=24) reported greater need for psychiatric treatment, were more likely to report a previous suicide attempt, and had more previous drug treatments than participants without PTSD (n=99). Women with PTSD were twice as likely to have lifetime Axis I and Axis II disorders and had higher rates of abuse than women without PTSD. Lifetime sexual abuse and ASI family/social composite scores were significant predictors of PTSD. Findings suggest that pregnant drug-dependent women with comorbid PTSD may benefit from specialized treatment services for trauma and/or abuse issues.