Structured Clinical Interview For The DSM-III-R Research Articles

Psychiatric disorders in an Arctic community.

To determine the rates of depression, anxiety, and alcohol abuse, using modern nosology, in a random sample of residents aged 14 to 85 years living in an Arctic community. A cross-sectional 2-step survey of randomly selected households was undertaken, using a self-report questionnaire to screen for anxiety, depression, and alcohol abuse. The survey included the Hospital Anxiety and Depression Scale (HADS) and Ewing and Roose's 4-question alcohol screening instrument (the CAGE questionnaire). Cut-off scores for the HADS and CAGE were found by comparing HADS and CAGE scores with scores on the Structured Clinical Interview for the DSM-III-R (SCID) in a stratified subsample. Estimated rates of depression and anxiety were 26.5% and 19.0% respectively within the past week, and estimated rates of lifetime alcohol abuse were 30.5%. The estimated prevalence of psychiatric disorders in this Arctic community is higher than that indicated in previous findings on Native mental health.

Comparing the dis with the scid: Chronic fatigue syndrome and psychiatric comorbidity

This study investigated whether psychiatric comorbidity rates in individuals with Chronic Fatigue Syndrome (CFS) change as a function of the type and scoring of psychiatric interview instruments used. The number of DSM-III-R, Axis I psychiatric diagnoses were assessed two times for each of the 18 participants with CFS, once using the Diagnostic Interview Schedule (DIS) and once using the Structured Clinical Interview for the DSM-III-R (SCID). Participants received a significantly greater number of current and total lifetime psychiatric diagnoses resulting from the DIS interview, as opposed to the SCID interview. Fifty percent of participants received at least one current psychiatric diagnosis on the DIS, whereas only 22% received a current psychiatric diagnosis on the SCID. Findings suggested that psychiatric comorbidity rates in individuals with CFS are influenced by the type of psychiatric instrument used. These results help explain the large discrepancies in findings for psychiatric illness in individuals with CFS across investigative studies.

The Children of Alcoholics Screening Test (CAST): test-retest reliability and concordance validity.

The stability of the Children of Alcoholics Screening Test (CAST) has been called into question by several authors (Hart, 1989; Maxwell, 1985; Schinke, 1989; Stacey 1985). In a bid to verify these reservations, 376 college students were each evaluated twice by means of the CAST. Results confirm the high reliability and validity of this instrument in identifying grown-up children raised in homes with at least one alcoholic parent. Reliability was demonstrated by good internal consistency, high item-total scale correlations, and near perfect test-retest agreement (k = .83). Furthermore, concordance between high CAST scores and satisfaction of recognized criteria for alcohol dependence, as measured with the Structured Clinical Interview for the DSM-III-R (SCID), attests to the CAST's external validity (k = .78). Moreover, factor analysis shows the instrument to have a unidimensional structure. Finally, with a cutoff score of 6 or more, the CAST demonstrates excellent sensitivity and specificity.

The effects of psychiatric disorders and symptoms on quality of life in patients with type I and type II diabetes mellitus.

The purpose of this study was to evaluate the influence of psychiatric symptoms and illness status on the health-related quality of life (HRQOL) of out-patients with Type I and Type II diabetes mellitus. Using a two-stage design, all patients were assessed by two measures of quality of life (Diabetes Quality of Life Measure; Medical Outcome Study Health Survey) and a psychiatric symptoms checklist (SCL-90R). Patients scoring 63 or greater on the global severity index of the SCL-90R and 30% below this cutoff were then evaluated using the Structured Clinical Interview for the DSM-III-R (SCID). Quality of life in both Type I and Type II diabetes was influenced by the level of current psychiatric symptoms and presence of co-morbid psychiatric disorder, after controlling for number of diabetic complications (e.g. effect of lifetime psychiatric illness on diabetes-related HRQOL; F = 46.8; df = 3, 135; p < 0.005). These effects were found consistently across specific domains. Both recent and past psychiatric disorders influenced HRQOL. Separate analyses comparing patients with and without depression showed similar effects. No interaction effects between diabetes type, number of complications, and psychiatric status were found in analyses. Finally, increased severity of psychiatric symptoms was correlated with decreased HRQOL in patients without current, recent, or past psychiatric diagnosis. This study shows the consistent, independent contribution of psychiatric symptoms and illness to the HRQOL of patients with a co-existing medical illness. Thus, psychiatric interventions addressing common conditions, such as depression, could improve the HRQOL of patients without changing medical status.

Differences between detected and undetected patients in primary care and depressed psychiatric patients

The aim of this study was to explore differences between primary care and tertiary psychiatry patients meeting DSM-III-R criteria for depressive disorders in terms of a wide range of demographic and clinical variables including psychiatric comorbidity. A weighted sample of 153 depressed primary care patients was obtained from the waiting rooms of family physicians using a two-stage selection and assessment procedure including the Structured Clinical Interview for the DSM-III-R (SCID). A measure of physician detection was also obtained. The 123 depressed psychiatric patients were seeking evaluation and treatment at a university-based depression program, and DSM-III-R diagnoses were also obtained using the SCID. Overall, fewer depressed primary care patients met criteria for major depressive disorder, and more of those who did were only mildly depressed. Depressed primary care patients were more likely to be women, older, and had less education, less past treatment, and greater lifetime comorbidity. Clinical differences were greatest for the depressed patients who had gone undetected by their physicians: they were higher functioning, less distressed, and more mildly depressed. Findings are discussed in terms of the validity and acceptability of practice guidelines for depression in primary care.

Sleep and depression in combat-related PTSD inpatients

The sleep of 27 unmedicated Vietnam combat-related posttraumatic stress disorder (PTSD) inpatients was monitored for 3 nights. Depressive comorbidity was considered both as a diagnostic category using DMS-III-R criteria, and as a continuous variable using the Beck Depression Inventory (BDI). Data collected included sleep architecture features that have discriminated unipolar depressives from controls in many prior studies, rapid eye movement (REM) sleep latency, and slow-wave sleep time, as well as two additional indices that have sometimes discriminated depressives from controls in waking studies-baseline heart rate and facial electromyography. Structured Clinical Interview for the DSM-III-R (SCID)-diagnosed PTSD+major depressive disorder (MDD) patients failed to exhibit shorter REM latencies, greater REM percents of sleep, or greater REM densities than PTSD-MDD patients, but did exhibit less slow wave sleep. PTSD+MDD patients also exhibited less facial (mentalis) electromyographic activity. REM densities and baseline heart rates were equivocal. REM density, baseline heart rate, and mentalis electromyography all correlated with the BDI, the former two positively, the last, negatively. In summary, SCID-diagnosed PTSD+MDD patients failed to exhibit the classic REM sleep architectural modifications associated with unipolar depression, despite the fact that several other psychophysiologic indices of dysphoria were detectable in their sleep.

Childhood adversity, attachment and personality styles as predictors of anxiety among elderly caregivers

The purpose of this study was to examine the ways in which childhood adversity, attachment and personality styles influenced the likelihood of having an anxiety disorder among aged caregivers for terminally ill spouses. We also sought to determine how childhood adversity and attachment/personality styles jointly influenced the likelihood of developing an anxiety disorder among aged caregivers. Data were derived from semistructured interviews with 50 spouses (aged 60 and above) of terminally ill patients. The Childhood Experience of Care and Abuse (CECA) record provided retrospective, behaviorally based information on childhood adversity. Measures of attachment and personality styles were obtained from self-report questionnaires, and the Structured Clinical Interview for the DSM-III-R (SCID) was used to determine diagnoses for anxiety disorders. Logistic regression models estimated the effects of childhood adversity, attachment/personality disturbances, and the interaction between the two on the likelihood of having an anxiety disorder. Results indicated that childhood adversity and paranoid, histrionic and self-defeating styles all directly increase the odds of having an anxiety disorder as an elderly spousal caregiver. In addition, childhood adversity in conjunction with borderline, antisocial and excessively dependent styles increased the likelihood of having an anxiety disorder. The results indicate the need to investigate further the interaction between childhood experiences and current attachment/personality styles in their effects on the development of anxiety disorders.

Prevalence of psychopathology in carpal tunnel syndrome patients

This study assessed the prevalence rates of psychopathology in acute carpal tunnel syndrome (CTS) and acute low back pain (LBP) patients. Psychopathology was assessed with the Structured Clinical Interview for the DSM-III-R (SCID). The results showed that the CTS patients had significantly higher rates of anxiety disorders, both current and lifetime, than the LBP patients. However, LBP patients had significantly higher rates of lifetime substance abuse than the CTS patients. In regard to other types of psychopathology, such as depression, current substance abuse, and somatoform pain disorders, CTS patients had similar rates as the LBP patients. It was concluded that anxiety disorders may be a concomitant of carpal tunnel syndrome, and that treating psychological problems along with physical aspects of the syndrome may increase the patient's chance of a successful therapeutic outcome.

Prevalence, nature, and comorbidity of depressive disorders in primary care

This article examines the prevalence, nature, and comorbidity of depressive disorders using DSM-III-R criteria among patients recruited from the waiting rooms of family physicians. A total of 1928 family practice patients completed a screening form including the Center for Epidemiologic Studies-Depression Scale (CES-D), and patients with elevated CES-D scores were oversampled for possible interviews using the Structured Clinical Interview for the DSM-III-R (SCID). In the resulting weighted sample of 425, a prevalence of 13.5% was obtained for major depression and 22.6% for all depressive disorders. Over 40% of the patients with major depressive disorder (MDD) were only mildly depressed. Gender and other demographic variables failed to distinguish depressed patients, but a variety of self-ratings did. Depression was associated with comorbid anxiety disorders and substance abuse. Results are discussed in terms of the implications of depression in primary care as a public health problem, but also in terms of some diagnostic issues, particularly the use of an impairment criterion for major depression.

Prevalence of psychopathology in acute and chronic low back pain patients

This study assessed the differential prevalence rates of psychopathology in chronic and acute low back pain patients. Psychopathology was assessed with the Structured Clinical Interview for the DSM-III-R (SCID). The results showed that chronic low back pain patients (n=90), had much higher rates of psychopathology than did patients in the acute back pain group (n=90), and much higher than general population base rates. In particular, chronic low back pain patients had high rates of major depression, substance abuse, and personality disorders. Moreover, the chronic low back patients also had high rates of premorbid psychopathology. It was concluded that psychopathology is a major concomitant of chronic low pack pain, and that treating the psychological problems, along with the physical aspects of the chronic low back pain may increase the patient's chance of a successful therapeutic outcome.

Personality Disorders Co-Occurring with Panic Disorder with Agoraphobia

Thirty panic disorder with agoraphobia subjects were evaluated for co–occurring DSM-III-R Axis II disorders, using the Structured Clinical Interview for the DSM-III-R (SCID-II). A high prevalence of personality disorders (53%) was found. The most frequent diagnoses were avoidant personality disorder and obsessive–compulsive personality disorder. Interrater reliability (p$$ .05) was achieved among three independent raters for all 12 Axis II diagnoses, as well as for 99% of the individual SCID-II criterion items. This represents the first published data on interrater reliability for the SCID-II.