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El objetivo del presente estudio fue identificar comorbilidad entre TEPT y TDM en personas víctimas del desplazamiento forzado y factores asociados. Se realizó una investigación de enfoque cuantitativo, diseño no experimental de corte transversal y alcance descriptivo-analítico. Fueron evaluadas 120 personas, de ambos géneros, entre 18 a 57 años, seleccionadas a través de un muestreo no probabilístico por conveniencia. Se utilizó una entrevista clínica estructurada para diagnósticos del Eje I (SCID-I) basada en los criterios del DSM IV para el TEPT y TDM, posterior a la aplicación de un cuestionario de datos sociodemográficos y antecedentes clínicos con el que se registraron los factores de riesgos y síntomas asociados. La prevalencia para TEPT fue del 48%, para TDM del 32% y 21% para comorbilidad, asociada con ideación e intento suicida y síntoma de rumiación. Los resultados fueron discutidos a la luz de otros estudios de prevalencia y la importancia de los factores de riesgo asociados en la comprensión de la comorbilidad entre TEPT y TDM.

Background Numerous studies on seasonality of birth for mood disorders and schizophrenia have been published but findings are inconsistent 1. We aim to test the hypothesis of lack of seasonal birth differences in hospitalized Bipolar Disorder and Schizophrenia patients. Methods 15969 inpatient records in UTHealth Harris County Psychiatric Center between 2012-2014 were enrolled (HSC-MS-14-0274). Patients birth months that were diagnosed as Schizophrenia (n=4178) and Bipolar Disorder (n=5303) according to the DSM IV Criteria were tabulated including admitting diagnosis. Texas Birth statistics between 1903-1997 were obtained as control group (n= 17096471). Results There was no significant difference for winter births between schizophrenia patients and control group (P=0.738) and there was no significant difference for winter births between bipolar patients and control group either (P= 0.862). Mann Kendall Trend Analysis showed no significant trends of birth months for schizophrenia, bipolar and control groups. Limitations The study limitations include being a retrospective study, inability to control for environmental factors, and recruiting from a single location. Conclusions Our large sample showed no association between birth season or months with schizophrenia or bipolar disorder. Severe schizophrenia that requires admission may not be related with birth seasonality.

Poor cognitive insight in schizophrenia has been linked to delusions, hallucinations, and negative symptoms as well as to depressive/anxiety symptoms. Its impact on quality of life has been less studied, especially in schizophrenia subjects with ongoing auditory hallucinations. The Beck Cognitive Insight Scale (BCIS) and the Quality of Life Scale (QLS) were administered to subjects who met DSM IV criteria for schizophrenia after due translation and validation. All subjects reported ongoing auditory hallucinations at recruitment. Mean composite cognitive insight scores from participants (N = 60) (2.97 ± 2.649) were in the lower range as compared to published literature. Cognitive insight scores as well as self-reflectiveness subscale scores, but not self-certainty scores, correlated significantly with the QLS scores p < 0.001. Results suggest that better cognitive insight, especially self-reflectiveness, may be linked to better quality of life. Self-reflectiveness could be a useful construct to address in psychotherapy to improve rehabilitation.

ABSTACT The purpose of this study is to determine the effects of ARPA on the life quality of the individuals with autism. The sample consisted of 59 individuals diagnosed with autism according to DSM IV criteria. The participant ages were between 4 and 18 years, and they were involved in the eight-week ARPA programme. PedsQL supplementary form for parents was used as a data collection tool, which consisted of 4 sub-dimensions, and 23 items were developed by Varni et al. A t-test was used for the correlated samples and ANOVA was used for repeated measures. According to the results, there was a significant decrease in the PedsQL subdimensions scores of all participants in terms of physiological functionality and emotional functionality. As a conclution, ARPA can positively contribute to the emotional and physical development of the individuals with autism and it can be effective in supporting the life quality of autistic individuals.

This study investigated the relationship between disorders of the body self and personality defence mechanisms of women with bulimia nervosa. It was hypothesized that women with bulimia nervosa would not form a homogeneous group in terms of the body self disorder and that the extent of this disorder would be significantly related to personality functioning in terms of the defence styles adopted. The hypothesis was investigated with the aid of two questionnaires: the Body Self Questionnaire (Mirucka, 2005) and the Defence Style Questionnaire by Andrews, Singh and Bond (1993). 36 women aged between 15 and 25 years, who fulfilled the DSM IV criteria for bulimia nervosa participated in the study. Conclusions from the study were that: (1) the body self of bulimic women is differentially disordered at three levels: profound, moderate and minimal. (2) the degree to which the body self was found to be disordered is significant in psychological terms as it is related to the defence style adopted by the bulimic personality. The profound and moderate levels of body self disorder related to immature defence styles, while minimal levels of disruption to body self were associated with neurotic and mature styles.

The present study entitled "Prevalence of Eating Disorders in Adolescent girls in Srinagar city" was carried out in Srinagar. 100 adolescent girls from 5 schools, 20 from each, were selected randomly for the study. They were assessed through a structured questionnaire based on DSM IV criteria. It was found that the prevalence of eating disorders in our part of the world is very less as compared to the west as none of the adolescent girls in our study satisfied all the four criteria necessary for the diagnosis of anorexia nervosa or bulimia nervosa. However, about 30% of the adolescent girls satisfied two and 6% satisfied up to three criterias. As per the results obtained it was found that the mean weight of the sample was 47.90 kg with standard deviation of 6.36. Twenty three percent (23%) of the sample had weight less than 80% of expected for their age i.e. were malnourished. Although the prevalence of the eating disorders is very less in our city but the adolescent girls are becoming body conscious and many are at risk of developing eating disorder. As in the west no significant relation was found between family income and eating disorders although lower income groups showed higher prevalence of different criteria of eating disorders. Likewise there was no significant relation between eating disorder risk factors and features like age group, fathers and mothers qualification. Only one criterion, that is importance of being thinner than one's friends, showed statistically significant relation with age, qualification of parents etc. As many of the adolescent girls are at high risk of developing eating disorders, it seems to be right time to take preventive measures. Health education seems to be the best way to counter this problem. Both parents and children need to be educated. Mass media has to play a major role in bringing awareness regarding the problem.

Introduction- Diabetes mellitus (DM) is a major public health problem and it is a very common chronic metabolic disorder. There are so many studies which suggest co-morbidity of diabetes with depression and patients with depression have poor disease outcome. Aim- To study co-morbidity of diabetes and depression in outdoor patients. Material and Methods- Total 100 patients were studied. Diagnostic criteria of type 2 Diabetes Mellitus (type 2 DM) recommended by American Diabetes Association (ADA) was used. DSM IV criteria was adopted to diagnose depression. Hamilton score for depression was used to quantify the depressive symptoms. Plasma glucose values were compared in both the groups. Results and Conclusion- Prevalence of depression was higher in diabetic patients. Increasing severity of depression was associated with poor glycemic control.

A large number of criteria for evaluating of Internet addiction have been developed, recently. The research of Internet addiction among students of the Technical faculty in Bor, University of Belgrade has been conducted and its results are presented in this paper. The study included 270 students using criteria of Young’s Internet Addiction Test. In history of this University, that was the primarily research of this kind.

Delirium is common among old patients in hospital, especially those who undergo hip surgery. Various instruments have been developed for detecting delirium. One of these, the NEECHAM Confusion Sc ...

To assess diagnostic stability of initial autism spectrum disorder (ASD) diagnosed in children three years or less. Participants in the study included 77 (64 boys,13 girls) children in whom a diagnosis of Autistic Disorder (AD) and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) was made at age 3 years or less as per the DSM IV criteria. Children were recruited from the Outpatient services of the department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh. Multi-disciplinary evaluations including neurological, diagnostic, cognitive, and behavioral assessments were made. In addition, the Childhood Autism Rating Scale (CARS) was administered to assess symptom severity. Follow up was done around 4 years of age. At Time 1, 64 (83.11%) children were diagnosed as AD and 13 (16.88%) children with PDD-NOS. Follow up was possible in only 43 children (55.8%) at the mean age of 4 years 1 month (SD = 0.99) after a mean age interval of 1.65 years (SD = 0.95). At Time 2, 37 (86%) children were diagnosed as AD and 4 (9.3%) children were diagnosed with PDD-NOS, and 2 (4.65%) children were found to be off the ASD spectrum. The diagnosis of ASD (AD and PDD-NOS) was stable over time and 41 (95.3%) out of 43 children retained an ASD diagnosis. Looking at specific ASD diagnosis, AD diagnosis was stable for 33 out of 37 (89.18%) children and the PDD-NOS was stable for only 1 out of 6 (16.67%) children. An early and a stable diagnosis of ASD is possible provided there are expert clinicians available. Early detection and diagnosis of ASDs allows opportunities for children to profit more from early supports and interventions.

Background: The present study examines frequency of DSM-IV symptom and diagnostic criteria for separation anxiety disorder (SAD) by informant, age, and sex. Methods: Children aged 4–15 years with a primary DSM-IV diagnosis of SAD (N= 106) were assessed using structured diagnostic interviews (Kinder-DIPS; DSM-IV-TR Version). Frequency of DSM-IV symptom and diagnostic criteria were examined as a function of informant and child characteristics, along with impairment and distress ratings. Results: The most frequently reported symptoms were separation-related distress, avoidance of being alone/without an adult and sleeping away from caregivers or from home, with nightmares the least frequently endorsed criterion. Child report did not yield any significant sex or age differences. However, parent report revealed greater reluctance or avoidance of school attendance for girls than boys, and for younger children (

A diagnosis with HIV is often considered traumatic. According to the DSM-IV-TR's criteria for PTSD, a traumatic event precipitates a set of reactions in an individual that includes avoidant behaviour, intrusive thoughts, and physiologic hyperarousal. However, persons diagnosed with HIV are typically concerned with events that will occur in the future such as physical decline and death, access to treatment, the welfare of dependants, and stigma and discrimination. Their concerns are thus future-oriented rather than anchored to a past traumatic event, which is the requirement of PTSD. This article argues that an HIV diagnosis may be inappropriately regarded as traumatic.

This study examines the extent to which parents and teachers agree on the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and its subtypes, as per the DSM IV criteria. It assesses whether the extent of agreement between informants improves by making the ADHD criteria more flexible.Parents and teachers of 119 clinic-referred sample of children (mean age=8.4 years, S.D= 2.48) with disruptive behavioral symptoms completed the Vanderbilt Attention Deficit Hyperactivity Disorder Diagnostic Parent and Teacher Rating Scales, respectively. Concordance of parent and teacher reports for the presence or absence of diagnosis of ADHD and type of ADHD was examined by percent agreement and the kappa statistics.Of the 119 children referred for disruptive behavior disorders, 96 (80.6%) met criteria for any type of ADHD according to the parents' report; and only 68 (57.1%) met criteria according to the teachers' report. Parent and teacher agreement for the diagnosis of any type of ADHD was only 52% (k= .11, n.s); and the agreement regarding diagnosis of sub-type was even poorer. Making the criteria more flexible vis-à-vis impairment or number of symptoms did not improve agreement between the informants.Clear guidelines are needed to reconcile the differences between informants in order to promote uniform diagnostic practices among clinicians working with children having ADHD.

The controversy concerning the validity and reliability of generalized anxiety disorder (GAD) appears to be particularly relevant in the elderly, since physical symptoms associated with GAD can readily be considered as the consequences of normal aging. This study aims to analyze the structure invariance of a questionnaire assessing the DSM-IV diagnostic criteria across samples of older adults and college students. Ninety-seven adults aged 65 or over and 130 college students completed the Worry and Anxiety Questionnaire (WAQ). The results revealed that factorial invariance could be assumed and, in addition, that scores for severity of GAD symptoms were higher in younger subjects than in older ones. The results support the applicability of DSM-IV criteria for GAD in elderly people, as the factorial structure of the WAQ was the same for this age group as for younger adults. A higher degree of GAD severity was found in the younger sample.

Objective To evaluate (1) the Eating Disorder Not Otherwise Specified (EDNOS) prevalence in an eating disorder inpatient unit; (2) the impact of altering the diagnostic criteria for anorexia nervosa and bulimia nervosa on the prevalence of EDNOS. Method One hundred and eighty six eating disorder patients consecutively hospitalised were included in the study. The prevalence of anorexia nervosa, bulimia nervosa and EDNOS was evaluated with the Eating Disorder Examination (EDE). The EDNOS prevalence was recalculated after the alteration of three diagnostic criteria for anorexia nervosa and one for bulimia nervosa. Results Seventy eight patients (41.9%) met the diagnostic criteria for anorexia nervosa, 33 (17.8%) for bulimia nervosa and 75 (40.3%) for EDNOS. The alteration of the DSM-IV diagnostic criteria reduced the prevalence of EDNOS to 28 cases (15%). Conclusion EDNOS is a very frequent diagnostic category in an inpatient setting. Altering the diagnostic criteria for anorexia nervosa and bulimia nervosa reduced significantly the prevalence of EDNOS. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.

This study used data gathered from the Diagnostic Interview Schedule, Version Three, Revised (DIS-III-R), which calculated diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R), criteria and rescored the data to be compatible with the criteria of the Fourth Edition of the DSM (DSM-IV) for lifetime alcohol abuse and dependence.A psychologist reassigned questions from the DIS-III-R according to DSM-IV criteria. Another clinician evaluated the rescoring criteria and discrepancies were discussed and resolved. Using these criteria, SAS code was written to automate the rescoring of responses to DIS-III-R questions to DSM-IV diagnoses from a population of DWI offenders.There was a fair-to-good level of agreement between the DSM-III-R and rescored DSM-IV diagnoses (kappa = .65). Three hundred forty-eight subjects classified as alcohol dependent using DSMIII- R were reclassified as alcohol abuse in the DSM-IV rescore. Among subjects who were alcohol dependent based on DIS-III-R criteria, the distribution of DSM-IV diagnoses was similar across gender, age, and ethnic groups. There was no difference in agreement between DSMIII- R and the rescored DSM-IV diagnoses by age category. However, women and Hispanics had significantly higher weighted kappa statistics than men and non-Hispanic whites.Our rescoring results were consistent with earlier studies that compared DSM-III-R and DSM-IV diagnoses. Here, we offer an approach that may be useful to investigators who used the DIS-III-R in earlier studies. The DIS-III-R questions corresponding to DSM-IV criteria for alcohol abuse and alcohol dependence are on our Web site at www.bhrcs.org, along with the scoring algorithm.

Parents of 26 children With diagnoses of Asperger's disorder completed a symptom checklist to determine Whether the children met Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) criteria for Asperger's disorder, autism, or pervasive developmental disorder not otherWise specified. Results shoWed that almost all (20) met criteria for autism, and a DSM-IV-TR diagnosis of Asperger's disorder could not be confirmed in any child. Further, 95% of the parents Whose children did not have a DSM-IV-TR diagnosis of Asperger's disorder agreed With their child's diagnosis of Asperger's disorder. Our findings suggest that the hierarchical DSM-IV-TR criteria are not applied by clinicians to diagnose Asperger's disorder because most children With diagnoses of Asperger's disorder actually met DSM-IV-TR criteria for autism, Which precludes a diagnosis of Asperger's disorder. These findings are consistent With previous studies. Most experts noW agree that autism is a spectrum disorder and Asperger's disorder is actually high-functioning autism. Implications for the next revision of the DSM are discussed.

Objective: To determine the extent to which the developmental profile of children less than 4 years can help in distinguishing children with autism from children with developmental delay. Methods: Subjects were 32 children with autism as per the DSM IV criteria and 32 children with developmental delay matched on chronological and academic age. The Developmental Profile II was used to assess the developmental functioning in five domains including physical, social, self help, academic, and communication. Results: The two groups showed significantly different developmental profiles and these differences were accounted for mainly by significantly lower social skills and superior motor skills in the autistic group as compared to the developmentally delayed group. Conclusion: Developmental Profile II may help in distinguishing young children with autistic disorder from non-autistic children with comparable developmental delays.

The purpose of this study was to explore the utility of DSM‐IV criteria in diagnosing alcohol and marijuana abuse/dependence in adolescents. A modified version of the Structured Clinical Interview for DSM‐IV (SCID) was administered to assess substance abuse/dependence symptoms in 127 inpatient, treatment‐seeking adolescents with substance‐use disorders. The proportion of individuals with clinically relevant symptoms was examined separately for individuals classified with either abuse or dependence. Chi‐square tests of independence between the abusive/dependent classification and the presence/absence of a given symptom were also performed. Rates of DSM‐IV current substance use diagnoses were alcohol abuse 21 (16%), alcohol dependence 44 (35%), marijuana abuse 27 (21%) and marijuana dependence 72 (57%). A diagnosis of marijuana dependence was significantly more likely when tolerance symptoms were present but was not significantly dependent on the presence of withdrawal symptoms. By contrast, the presence of...

As human society is mainly cooperative, it is not clear how antisocial personality disorder (APD) persists. The current explanation is that sociopaths are cheaters who maximize their fitness by taking advantages from others. Although this argument is valid, we show here that society also benefits from APD. We propose that the old phylogeny of punishment, the fact of being a full member of society, the frequency of the disorder, genetics, linkage between two "contradictory" DSM IV criteria for the disorder, and the necessity for society to fight against antisocial behavior, play positive roles for society and/or human groups, especially in the ancestral environment.

Objective: To review the current knowledge on neurobiological aspects of autism and pervasive developmental disorders, as well as to provide pediatricians with up to date information on diagnosis and treatment of autism. Sources of data: Review of MEDLINE and Internet. Summary of the findings: Autism is the 3rd developmental disorder, with an incidence of 40 to 130/100,000 individuals. Diagnosis is based on clinical findings, following DSM IV criteria. Neuroimaging, investigation of fetal neurological status, and genetic investigation contribute towards a better understanding of the neurobiology of autism. Conclusion: Pediatricians are the first health professional to come in contact with patients with autism. Thus, they should be able to diagnose and to coordinate the multidisciplinary treatment of these patients.

Background: In Japan a new long-term care insurance (LTCI) system, the so-called ‘Kaigo-Hoken’, was started in April 2000. The present study analyzes the change in the type of destination after discharge from a senile dementia therapy ward before and after the implementation of LTCI at Fukuoka Prefectural Onga Hospital, Japan. Methods: The present study examines data from 199 inpatients discharged from the Fukuoka Prefectural Onga Hospital that had been diagnosed with dementia and met the DSM IV criteria for Alzheimer's type, vascular dementia or other type of dementia. For the purposes of comparison two periods were defined, ‘the first period’ was defined as the period from 1 April 1999 to 31 March 2000, before LTCI was implemented, while ‘the second period’ was defined as the period from 1 April 2000 to 31 March 2001, after LTCI had started. Subject data was analyzed on the basis of where the subject had resided pre-admission and their destination after discharge using the following classifications: nursing home or geriatric care facility, hospitalization, home and death. Results: While the certification rate of inpatients regarding long-term care increased slightly in the second period, no significant change was observed based on where the subject had resided pre-admission and their destination after discharge between the first and second periods. Conclusions: While LTCI is essential for Japan, it is necessary that people with dementia in senile dementia therapy wards are encouraged to return to their homes under the care and support of LTCI.

While diagnostic criteria for premenstrual syndromes (PMS) exist, studies rarely state how these criteria are operationally applied. We examined the consequences of application of different operational methods for DSM-IV criteria for premenstrual dysphoric disorder (PMDD) to individual cycles in women with PMS and controls. PMDD criteria require the presence of both certain types or numbers of symptoms (5/11 symptoms present premenstrually, at least one being one of four mood symptoms) and certain phenomenal characteristics (present premenstrually, absent postmenstrually, causing interference premenstrually). We identified individual cycles as symptomatic or asymptomatic by applying criteria that operationalized the required phenomenal elements of PMDD according to four severity thresholds: literal (i.e. present or absent), 30%, 50%, 70%. Data examined were Daily Rating Form symptom scores from two symptomatic menstrual cycles both in 25 women with PMS and 25 controls. Literal thresholds correctly identified 28% of symptomatic and 4% of asymptomatic cycles, compared with 86 and 70% identification with a 30% threshold, 60 and 86% with a 50% threshold, and 0 and 100% with a 70% threshold. An “optimal” combination of 30% thresholds for premenstrual symptomatology and premenstrual interference and a 50% threshold for postmenstrual symptomatology correctly identified 92% of symptomatic cycles in women with PMS and 72% of asymptomatic cycles in controls. Different criteria for cycle inclusion yield markedly different sample compositions. No single operational threshold of the phenomenal features maximizes selection of both symptomatic and asymptomatic cycles, largely consequent to the ubiquity of postmenstrual symptoms and premenstrual “interference” even in women without PMS. At the very least, the method for operationalizing DSM-IV criteria should be described in studies of PMDD.

Objective: To describe the characteristics of young people presenting with school refusal to a child and adolescent psychiatric unit and examine differences between those admitted for inpatient treatment and the rest. Method: One hundred and ninety-two adolescents who had been assessed or treated for school refusal between 1994 and 1998 at the Rivendell Unit, Sydney, Australia were identified. An instrument was developed and used to gather data from files. Diagnoses were made by the consensus of two of the investigators using DSM IV criteria from all sources of information. Results: The commencement of school refusal generally occurred in the first 2 years of high school. School refusers had a high prevalence not only of anxiety, but also of mood and disruptive behaviour disorders. A family history of psychiatric illness was present in over half the sample. There were no differences between those subsequently admitted as inpatients and the rest in terms of symptom scores, family composition, family conflict, family separation or history of abuse. Those admitted for inpatient treatment were more likely to have a diagnosis of mood disorders and comorbid diagnoses and to have a maternal history of psychiatric illness. Conclusions: School refusal in adolescence can be a symptom of a variety of disorders, particularly anxiety and mood disorder. Treatment programs need to be geared to the range of diagnoses which occur in this patient group and to the various circumstances associated with the onset of the problem.

This paper presents a revised version of DSM-IV-J criteria for youth, the DSM-IV-MR-J, together with psychometric data stemming from its use in a major prevalence study of adolescent gambling and problem gambling. The case is made for further development and testing of current and emerging instruments to screen for problem gambling in youth, with the aim of establishing one internationally accepted gold standard measure.

The assumption that participants receiving an ICD10 diagnosis of posttraumatic stress disorder (PTSD) will also receive a DSM-IV diagnosis of PTSD was tested. Data were gathered for 1,364 participants using the Composite International Diagnostic Interview (CIDI). The 12-month prevalence of PTSD was 3% for DSM-IV and 7% for ICD10 Diagnostic Criteria for Research (ICD10-DCR). The agreement between the two systems was fair (kappa = .50). Forty eight percent of the discrepancies between the systems were accounted for by the additional criterion requiring clinically significant distress or impairment included in DSM-IV. The inclusion of symptoms of general numbing of responsiveness accounted for 18% of the discrepancies. It is concluded that ICD10-DCR PTSD cannot be assumed to be identical to DSM-IV PTSD.

This meta-analysis reports the effects of cognitive-behavioural treatment (CBT) on bulimia nervosa as defined by the DSM-III-R or DSM-IV criteria. In a previous meta-analysis, 26 studies were included using less strict diagnostic criteria for inclusion. The present meta-analysis only included randomized controlled studies fulfilling the DSM-III-R or DSM-IV criteria. Computer searches in MedLine, PsychLIT and references cited herein resulted in a large number articles, of which only seven fulfilled the criteria for inclusion. Effect sizes for binge eating and purging frequency were estimated using both between-group (treatment vs control) and within-group (pre- vs post-treatment) comparisons. The combined within-group effect size for binge eating was r = 0.55 ( d = 1.32) and for purging r = 0.61 ( d = 1.54). The corresponding combined effects for the between-group comparisons were r = 0.23 ( d = 0.47) and r = 0.28 ( d = 0.58), respectively. The combined probabilities for frequency of purging in between- an...

Little is known about the boundaries between major depression and milder subsyndromal depressive states. With respect to depressive symptoms, does DSM-IV "carve nature at its joints"?In personally interviewed female twins from a population-based registry, the authors examined whether a range of values along three dimensions of the depressive syndrome assessed in the last year (number of symptoms listed in DSM-III-R under diagnostic criterion A for major depressive episode, level of severity or impairment required to score symptoms as present, and duration of episode) predicted future depressive episodes in the index twin and risk of major depression in the co-twin.An increasing number of criterion A symptoms predicted, in a monotonic fashion, a greater risk for future depressive episodes in the index twin as well as a greater risk for major depression in the co-twin. No such consistent relationship was seen with duration of episode. For severity, a single monotonic function predicted risk in the co-twin, while index twins with severe impairment had a substantially higher risk for future episodes than did those with less severe impairment. Four or fewer criterion A symptoms, syndromes composed of symptoms involving no or minimal impairment, and episodes of less than 14 days' duration all significantly predicted both future depressive episodes in the index twin and risk of major depression in the co-twin.The authors found little empirical support for the DSM-IV requirements for 2 weeks' duration, five symptoms, or clinically significant impairment. Most functions appeared continuous. These results suggest that major depression--as articulated by DSM-IV--may be a diagnostic convention imposed on a continuum of depressive symptoms of varying severity and duration.

The purpose of this study was to compare subsyndromal panic—infrequent panic (IP) and limited symptom attacks (LSA)—with panic disorder (PD) in psychiatric comorbidity, quality of life (QOL), and health care utilization and to assess validity of DSM-III-R criteria for panic disorder. Randomly selected adults were screened for the presence of PD, IP, and LSA by using the Structured Clinical Interview of the DSM-IIIR. Subjects with panic symptoms and matched controls completed a structured interview concerning comorbidity, QOL, and utilization. Although PD and IP subjects reported more psychiatric comorbidity than did LSA subjects, LSA subjects had more comorbid conditions than did controls. Differences in utilization were limited to PD subjects. Although subsyndromal panic was associated with poor QOL, panic-related work disability was primarily seen in PD subjects. Regression analyses demonstrated little difference between LSA and IP subjects, but interaction analysis supported the distinction between LSA and full-blown panic attacks. Compared with controls, LSA and IP subjects had more psychiatric comorbidity. PD subjects also had poorer QOL and more utilization. Interaction analysis supports DSM-IV criteria for panic disorder. Depression and Anxiety 8:33–38, 1998. © 1998 Wiley-Liss, Inc.

Background. Autism is a spectrum of neurodevelopmental disorders with manifestation within 3 years after birth. Manifestations of autism include behavior problems (hyperactivity, toys destruction, self-harm, and agression) and sleep and eating disorders. Etiology of autism is poorly understood. Oxidative stress and antioxidants can participate in pathobiochemical mechanisms of autism.Methods. Twenty-four children, aged 3–6 years, with autism according to the DSM IV criteria and using CARS were included in the study. Concentrations ofCoQ10-TOTAL,γ- andα-tocopherol,β-carotene, and lipid peroxidation were determined in plasma before and after three months of supportive therapy with ubiquinol at a daily dose2×50 mg. Data on behavior of the children were collected from parents at the same time.Results. Ubiquinol supportive therapy improved symptoms in children with autism, as communication with parents (in12%), verbal communication (in21%), playing games of children (in42%), sleeping (in34%), and food rejection (in17%), withCoQ10-TOTALplasma level above2.5 μmol/L.Conclusions. Beneficial effect of ubiquinol in children with autism has been demonstrated for the first time. We assume that plasma concentration ofCoQ10-TOTALand lipid peroxidation could be used as relevant biomarkers of ubiquinol supportive therapy.

This study investigated the utility of the PK scale of the MMPI-2 with college students. Results indicated that the PK scale, when combined with DSM IV criteria, does discriminate between college students who obtain a score of 65 or higher and those who score below 65.

Attention deficit hyperactivity disorder (ADHD) is the most common mental disorder in children. Despite an extensive amount of research, it remains a controversial diagnosis with changing diagnostic criteria. Descriptions of children with ADHD can be traced back as early as 1848 when a German physician, Heinrich Hoffmann, described a hyperactive child, "Fidgety Phil," and an inattentive child, "Harry Look in the Air," in a book he wrote for his children. In 1902, George Still presented a lecture series in England about 20 children who were aggressive, defiant, excessively emotional, and lacking inhibitory volition who were also noted to have impaired attention and overactivity. After World War I, similar behaviors were considered to be the result of brain damage associated with encephalitis. However, the disorder as it is now characterized first started to take shape in the 1960s and was known as minimal brain damage or dysfunction

article Objective: The aim of this study was to investigate the prevalence and clinical characteristics of the DSM IV major depressive disorder (MDD) among patients admitted to the General Internal Medicine Service of the Geneva University Hospital. Method: 557 patients admitted to the IM of the Geneva University Hospital aged 18 to 70 were investigated. Each subject was assessed by a clinical psychologist using the SCID (Structured Clinical Interview Depression for DSM-IV) questionnaire. Results: 69 patients (12.4%) met diagnostic criteria for MDD (men: 8.8%, women: 16.9%, p = .004). Among sub- jects with major depression, depressed mood (97%), fatigue (91%), and diminished interest and pleasure (81%) were the most prevalent symptoms. Recurrent thoughts of death were present in 48% of depressed patients. Conclusions: This study raises further evidence that an elevated proportion of patients admitted to an acute care general internal medicine facility meet DSM IV criteria for MDD with nearly half of depressed patients suffering from recurrent thoughts of death. It emphasizes the necessity of a targeted, continuous, and active support given by the psychiatry liaison service in the internal medicine setting.

Background The aims of the study were to examine the validity of the MADRS and to compare it with the validity of the Cornell Scale for Depression in Dementia (CSDD). Methods We included 140 patients without dementia, with mean age 81.5 (sd 7.7) years. Trained psychiatric nurses interviewed all of them using the MADRS. In addition, for 70 patients caregivers were interviewed using the CSDD. A psychiatrist who had no access to the MADRS or the CSDD results made a diagnosis of depression according to the DSM-IV criteria for major depression, and the ICD-10 criteria was also applied for the 70 patients assessed with the CSDD. Results Twenty-two out of the 140 had depression according to the DSM IV criteria, whereas 25 out of 70 had depression according to the ICD-10 criteria. The area under the curve (auc) in a receiver operating characteristic analysis was 0.86 (95% CI 0.79–0.93) for the MADRS using the DSM-IV criteria. The best cut-off point was 16/17 with sensitivity of 0.80 and specificity of 0.82. The AUC for the CSDD was 0.83 (95% CI 0.71–0.95). The recommended cut-off score on the CSDD of 7/8 was valid but not the best in this study. Limitations The patients were diagnosed with a diagnosis of depression by only one psychiatrist, and the procedures in the two centres were not exactly the same. Conclusions The MADRS has good discriminating power to detect depression in elderly persons and should be preferred to the CSDD for use with persons without dementia.

Proposed binge eating disorder (BED) diagnostic criteria were investigated to providenecessary psychometric characteristics and explore their utility in assessment. Onehundred four subjects (52 self-referred bingers, 52 comparison subjects) completed aninitial administration of the Questionnaire of Eating and Weight Patterns (QEWP). Theresults supported the ability of the two core BED criteria (i.e., episodic overeating, lossof control) to discriminate between clinical and nonclinical binge eaters. Thirty-nine ofthe self-referred and 40 of the comparison subjects completed a second QEWP admin-istration 3 weeks later. Results indicated that the BED diagnosis was moderately stableover the 3-week interval (kappa = .58, combined sample). Using self-monitoring datacompleted by the self-referred subjects, predictive efficiency analyses indicated thatthe QEWP was able to identify both high and low probability binge eaters. Implicationsof the findings for the definition, assessment, and utility of the BED diagnosis arediscussed. © 1994 by John Wiley & Sons, Inc.Recent attention in the eating disorders literature has been directed towards the newdiagnostic category of binge eating disorder (BED; Spitzer et al., 1992, 1993). Interest inBED emanates primarily from clinical and research reports of binge eating in the obese(Stunkard, 1980; Loro & Orleans, 1981). Specifically, a subset of the obese describerecurrent periods of overeating in which they feel out of control and experience consid

To determine the number of genetic factors underlying the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for alcohol dependence (AD), we conducted structural equation twin modeling for seven AD criteria, plus two summary screening questions, in 7133 personally interviewed male and female twins from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders, who reported lifetime alcohol consumption. The best-fit twin model required three genetic and two unique environmental common factors, and criterion-specific unique environmental factors. The first genetic factor was defined by high loadings for the probe question about quantity and frequency of alcohol consumption, and tolerance criterion. The second genetic factor loaded strongly on the probe question about self-recognition of alcohol-related problems and AD criteria for loss of control, desire to quit, preoccupation and activities given up. The third genetic factor had high loadings for withdrawal and continued use despite the problems criteria. Genetic factor scores derived from these three factors differentially predicted patterns of comorbidity, educational status and other historical/clinical features of AD. The DSM-IV syndrome of AD does not reflect a single dimension of genetic liability, rather, these criteria reflect three underlying dimensions that index risk for: (i) tolerance and heavy use; (ii) loss of control with alcohol associated social dysfunction and (iii) withdrawal and continued use despite problems. While tentative and in need of replication, these results, consistent with the rodent literature, were validated by examining predictions of the genetic factor scores and have implications for gene-finding efforts in AD.

Lack of consensus about criteria for recovery from eating disorders results in greatly varying percentages of recovered patients. Outcome studies not only use different criteria for recovery, but also quite different instruments, rendering their results incomparable. The same problem occurs among studies of predictors for recovery from eating disorders. Without consensus on criteria for recovery, it is not clear which goals of treatment are important to realize full recovery. In order to develop larger consensus on criteria for recovery, this study critically analyzes the most important outcome scores and the criteria for recovery deduced from the DSM-IV.

Autism spectrum disorders (ASD) are characterized by impairment in social interactions, communication deficits, and restricted repetitive interests and behaviors. A potential role for immune dysfunction has been suggested in ASD. To test this hypothesis, we investigated evidence of differential cytokine release in plasma samples obtained from 2 to 5 year-old children with ASD compared with age-matched typically developing (TD) children and children with developmental disabilities other than autism (DD). Partici- pants were recruited as part of the population based case-control CHARGE (Childhood Autism Risks from Genetics and Environment) study and included: 97 participants with a confirmed diagnosis of ASD using standard assessments (DSM IV criteria and ADOS, ADI-R), 87 confirmed TD controls, and 39 confirmed DD controls. Plasma was isolated and cytokine production was assessed by multiplex Luminex™ analysis. Observations indicate significant increases in plasma levels of a number of cytokines, including IL-1b, IL-6, IL-8 and IL-12p40 in the ASD group compared with TD controls (p < 0.04). Moreover, when the ASD group was separated based on the onset of symptoms, it was noted that the increased cytokine levels were predominantly in children who had a regressive form of ASD. In addition, increasing cytokine levels were associated with more impaired communication and aberrant behaviors. In conclusion, using larger number of participants than previous studies, we report significantly shifted cytokine profiles in ASD. These findings suggest that ongoing inflammatory responses may be linked to disturbances in behavior and require confirmation in larger replication studies. The characterization of immunological parameters in ASD has important implications for diagnosis, and should be considered when designing therapeutic strategies to treat core symptoms and behavioral impairments of ASD.

Objective: Several studies of nonpsychiatrist physicians suggest that there are deficits in the knowledge and application of the diagnostic criteria for major depressive disorder (MDD). This research raises questions about the clinical utility of the MDD criteria. The goal of the present study was to determine psychiatrists' reported use of the DSM-IV criteria for MDD to diagnose depression and to compare their use to the use by nonpsychiatrist physicians. Method: The subjects were 291 psychiatrists and 40 nonpsychiatrist physicians who attended a continuing medical education conference in 2006 or 2007 on the treatment and management of depression. Prior to a lecture, the subjects completed a questionnaire that included a question regarding how frequently the DSM-IV diagnostic criteria for MDD are used when diagnosing depression. Results: Nearly one-quarter of the psychiatrists indicated that they usually did not use the DSM-IV MDD criteria when diagnosing depression, and nearly half of the nonpsychiatrist physicians indicated that they rarely used the DSM-IV MDD criteria to diagnose depression. Conclusions: A substantial minority of psychiatrists and the majority of nonpsychiatrist physicians reported that they often do not use the DSM-IV MDD criteria when diagnosing depression. These findings raise questions about the clinical utility of the MDD criteria. These results, along with other studies demonstrating problems with recalling the MDD criteria, suggest that clinical utility should be considered in discussions of revising these criteria for DSM-V.

The aim of the present study was to investigate the possibility of sex bias in the diagnostic criteria for borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders. A clinical sample of 668 individuals was evaluated for personality disorder criteria using a semistructured interview, and areas of functional impairment were assessed with both self-report and semistructured interview. The authors used a regression model of bias to identify bias as differences in slopes or intercepts between men and women in the relationship between each diagnostic criterion and level of impairment. The results suggest that most of the diagnostic criteria examined do not seem to display sex bias. However, those criteria that displayed evidence of bias came largely from the borderline diagnosis.

The Bulimia Test-Revised ( BULIT-R; M. H. Thelen, J. Farmer, S. Wonderlich, & M. Smith, 1991 ) was given to participants who met the criteria in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) for bulimia nervosa and control participants to determine if the test continues to be a valid measure of bulimia nervosa. Although the BULIT-R was developed and validated with bulimic individuals as determined by the DSM-III-R ( American Psychiatric Association, 1987) criteria, it appears to be a valid instrument with which to identify individuals who meet DSM-IV criteria for bulimia nervosa.

A diagnostic and statistical manual (DSM)-IV diagnosis of agoraphobia in the context of panic disorder (PD) is based on three nosologically sufficient criteria: (1) avoidance, (2) use of companions, and (3) endurance of situations despite distress. Therefore, an agoraphobia diagnosis can be made across an extremely broad range of cases including when there are no avoidance behaviors (e.g., the patient endures the situation). It was hypothesized that clinicians do not weight these criteria equally and that the DSMs individual, sufficient criteria lead to poor inter-rater reliability. Clinicians (N=48) rated hypothetical patients with symptom profiles emphasizing each of these three criteria. Consistent with expectation, clinicians differentially weighted these criteria. Avoidance was relatively more apt to produce a diagnosis when only one criterion was emphasized in clinical vignettes. Inter-rater reliability was poor in instances when only one sufficient criterion was highlighted. Knowledge concerning DSM criteria resulted in a greater rate of agoraphobia endorsement, but knowledge did not account for the overall pattern of findings.

Objective To investigate the validity of developmentally modified DSM-IV criteria for preschool major depressive disorder (MDD). Method Subjects between the ages of 3.0 and 5.6 years were ascertained from community and clinical sites for a comprehensive assessment that included an age-appropriate psychiatric interview with the parent about the child. Minor developmental modifications to the formal DSM-IV MDD criteria were tested, including translations of symptoms to describe age-appropriate manifestations and setting aside the duration criterion. Preschool children who met modified criteria were compared with psychiatric and normal control groups. Results Validation for the modified criteria was supported by a specific and stable symptom constellation, social impairment, greater family histories of affective disorders, and higher child-reported symptoms of depression on an age-appropriate puppet interview. Preschool children with MDD displayed "typical" symptoms of depression, as well as vegetative signs. Standard DSM-IV criteria failed to capture 76% of children who met these modified criteria. Conclusions Evidence that preschool children can manifest typical symptoms of MDD when age-adjusted symptoms states are assessed is provided. Findings also suggest that standard DSM-IV criteria may not be sufficiently sensitive for preschool children, as they failed to capture a substantial proportion of symptomatic children. Minor modifications to DSM-IV criteria are recommended to capture clinically significant preschool MDD.