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Clinic patients with diagnoses of either major depression or somatization disorder were given the MMPI. Women with somatization disorder had high scores on Keane's MMPI scale (PK) for posttraumatic stress disorder. Following the procedure for the MMPI-2 (46 of the 49 PK items and MMPI-2 norms), 59% of the women with somatization disorder and 21% of the women with major depression would have T scores > or = 65 on the MMPI-2 scale although none of them were known to have developed psychiatric disorder after exposure to a life threatening event. The PK scale has little use in the differential diagnosis of women patients with somatization disorder.

44 items on the MMPI were identified which appear to correspond to some of the symptoms in nine of the 10 groups on the Perley-Guze checklist for somatization disorder (hysteria). This list was organized into two scales, one reflecting the total number of symptoms endorsed and the other the number of organ systems with at least one endorsed symptom. Full MMPIs were then obtained from 29 women with primary affective disorder and 37 women with somatization disorder as part of a follow-up study of a consecutive series of 500 psychiatric clinic patients seen at Washington University. Women with the diagnosis of somatization disorder scored significantly higher on the somatization disorder scales created from the 44 items than did women with only major depression. These new scales appeared to be slightly more effective in identifying somatization disorder than the use of the standard MMPI scales for hypochondriasis and hysteria. Further development is needed.

Objective: The criteria for borderline personality disorder seem to select patients with very high rates of Briquet's syndrome (hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorders. This study was undertaken to determine whether systematic assessment of patients with borderline personality disorder would reveal characteristic features of that condition which would distinguish it from these other disorders., Method: Eighty-seven white female patients (75 in St. Louis and 12 in Milan, Italy) who had borderline personality disorder according to both the DSM-III-R criteria and the Revised Diagnostic Interview for Borderlines were further examined with the DSM-III-R Checklist and the Perley-Guze Hysteria Checklist to determine their patterns of psychiatric comorbidity., Results: Every patient had at least one additional DSM diagnosis. Patients in St. Louis and Milan averaged five and four additional diagnoses, respectively. Eighty-four percent of the patients in St. Louis met criteria for either somatization disorder, Briquet's syndrome, antisocial personality disorder, or substance abuse disorders. Patterns of comorbidity for panic (51%), generalized anxiety disorder (55%), and major depression (87%) in St. Louis were consistent with those in other studies., Conclusions: The data indicate that the boundaries for the borderline condition are not specific and identify a high percentage of patients with these other disorders. Furthermore, the comorbidity profiles closely resemble the psychiatric profiles of patients with these disorders. If the borderline syndrome is meant to include all of these disorders, its usefulness as a diagnosis is limited. Until the fundamental features of borderline personality disorder that distinguish it from the others are identified, it is recommended that clinicians carefully assess patients for these other diagnoses. Efforts should be made to change the borderline personality disorder criteria by shifting away from overlap with the criteria for the other disorders.

Objective: The purpose of this study was to evaluate for APA a proposed strategy to diagnose somatization disorder for possible inclusion in DSM-IV., Method: Five sites--Washington University, University of Kansas, University of Iowa, University of Arkansas, and Mount Sinai Medical Center in New York--participated in a collaborative field trial. Female subjects (N = 353) were recruited from several different services (psychiatry, internal medicine, and family practice) and were evaluated for the presence or absence of the disorder. This assessment was performed with a new instrument constructed by combining all the criteria for somatization disorder from the proposed criteria for DSM-IV, DSM-III, DSM-III-R, Perley-Guze, and proposed criteria for ICD-10., Results: A high level of concordance was found between the proposed diagnostic strategy for DSM-IV and the current criteria (DSM-III-R), as well as the earlier criteria (Perley-Guze and DSM-III). The ICD-10 criteria agreed poorly with all other criteria sets. The level of experience of the rater (expert versus novice) with the earlier (Perley-Guze, DSM-III) and current (DSM-III-R) criteria did not influence the identification of cases by use of DSM-IV criteria. No racial effect was introduced by any of the criteria sets., Conclusions: The strategy for DSM-IV is an accurate and simpler method of diagnosing somatization disorder that does not require special expertise for proper use.

New revisions of diagnostic categories have produced the most recent classification systems, namely DSM-IV and ICD-10. The diagnostic approaches exemplified by these two nomenclatures are very similar to one another and represent a return to descriptive psychiatry in which careful observation of symptoms, signs, and course of mental diseases become the diagnostic criteria themselves. In many ways, these newest classification schemata can be considered a return to phenomenological psychiatry perhaps best exemplified at the start of this century by Emil Kraepelin. Thus, recent developments in psychiatric diagnosis can be thought of as "neo-Kraepelinian". Because they represent a relatively radical change from psychodynamic approaches to evaluation and diagnosis, they can also be called "revolutionary." This paper traces the roots of current diagnostic systems and compares and contrasts these systems to the classification schema described by Kraepelin. Diagnostic criteria for schizophrenia are used as an example of how diagnostic conventions have changed dramatically over the past 50 years. Discussion of the implications of this neo-Kraepelinian revolution in psychiatric diagnosis is included.

We describe the results of a follow-up study on patients with hysteria using the Minnesota Multiphasic Personality Inventory (MMPI) to evaluate the multiple complaints of these patients. MMPIs were obtained from 29 women with primary affective disorder and 37 women with Briquet's syndrome as part of a follow-up study of the St. Louis clinic 500. Patients with Briquet's syndrome were significantly less consistent and logical in answering MMPIs and were more likely to emphasize personal psychopathological conditions. They reported many more symptoms in many more problem areas than did women with primary affective disorder. Patients with Briquet's syndrome reported significantly more somatic symptoms and psychological/interpersonal problems than did the depressed group. It was suggested that such patients mimic multiple psychiatric and somatic disorders.

Major depressive disorder using Feighner et al. (Arch. Gen. Psychiatry 26, 57-63, 1972) and DSM-III or DSM-III-R criteria has proven to be a heterogeneous diagnosis. It apparently includes a wide variety of clinical conditions. This report, based upon the results of a multi-year blind follow-up of 500 randomly selected psychiatric outpatients focuses on certain problems associated with the diagnosis of primary unipolar affective disorders. At index, 141 patients received diagnoses of primary unipolar depression. At follow-up, only 62 (44%) of these received the same diagnosis, with an additional 14 (10%) receiving a diagnosis of undiagnosed: questionable primary unipolar depression, and 5 (4%) a diagnosis of bipolar disorder. Thus, about 43% received other diagnoses at follow-up: 35 (25%) diagnoses of secondary depression and 25 (18%) other diagnoses without indication of an affective component. Bipolar patients' stability was significantly better for those who were manic at intake.

Conversion symptoms are defined as symptoms that suggest neurologic disease but have no explanation after appropriate evaluation including physical examination, laboratory studies, and appropriate radiographic and other imaging studies. Conversion symptoms are more common in young women as compared with other groups. Conversion symptoms may be seen in essentially all psychiatric illness categories and are especially common in Briquet's syndrome and antisocial personality disorder. They are also seen in patients with neurologic disorders, including seizure disorder, central nervous system tumor, head injury, and multiple sclerosis. Family members of patients with conversion symptoms have a heterogeneous mixture of psychiatric illnesses parallel to the heterogeneous conditions seen in the probands. Psychosocial stressors and compensation factors, including monetary and legal aspects, appear to play important roles in many cases of conversion symptoms. Most individual conversion symptoms resolve, but the individual patient may experience other conversion symptoms as well as experience difficulty as a result of comorbid psychiatric illness.

One hundred ninety-nine case summaries of a consecutive sample of functional psychoses, which had been classified by Odegård, were diagnosed independently using DSM-III-R criteria by four experienced psychiatrists. Odegård's classification and DSM-III-R showed high concordance for schizophrenia and affective psychoses. Odegård's concept of reactive psychoses had high concordance with atypical psychoses in DSM-III-R. These findings imply that the results of genetic and follow-up studies from Scandinavia might be relevant for these diagnostic categories in DSM-III-R.

This article deals with the diagnostic issue of secondary depression and relates it to the broader question of comorbidity. The primary focus of the article is to summarize certain data supporting the validity of the concept of secondary depression; these data are used to point up an appropriate strategy for studying comorbidity involving psychiatric disorders.

This paper describes how the idea of substituting "Briquet Syndrome" for "Hysteria" developed. It emphasizes the need to base the diagnosis firmly on clinical features and also the value of differentiating "polysymptomatic" forms (Briquet Syndrome) from "conversion" symptoms (unexplained neurological symptoms). Other studies have shown that there is a preponderance of Briquet's Syndrome in women, and that female relatives of patients have an increased prevalence of Briquet's Syndrome, while male relatives have an increased prevalence of antisocial personality and of alcoholism. Conversely, a study of female relatives of a male prison population reveals a high prevalence of Briquet's Syndrome amongst them. It is suggested that the association between Briquet's Syndrome and antisocial personality may explain many clinical and epidemiologic observations.

The authors collected a large number of research interviews with relatives of patients from a psychiatric research clinic. Half of these patients were clinically depressed; their relatives as well as the rest of the relatives interviewed were therefore at high risk for depression. However, few of the relatives reported memorable dysphoria or any clustered episodes of other affective symptoms. The authors conclude from these data that, contrary to the opinions expressed by some, not everyone has episodes of depression. Everybody is not depressed.

The Washington University Psychiatry Clinic, St Louis, study began with the systematic clinical evaluation of a cross section of 500 of the clinic's patients. This was followed by a "blind" follow-up of the index subjects and a blind study of first-degree relatives. This report deals with the diagnosis of schizophrenia at index, at follow-up, and among the first-degree relatives. The results indicate that the criteria used for the diagnosis of schizophrenia select patients who show a high degree of diagnostic consistency over many years, although not all patients who meet these criteria after follow-up receive the diagnosis of schizophrenia initially. Most important, the diagnostic criteria select cases associated with a strong familial increase in the risk of schizophrenia (nearly fivefold). The follow-up results indicate also that Feighner-positive schizophrenics often experience intercurrent depressions, but that the presence of such depressions does not affect the familial incidence of either schizophrenia or primary affective disorders.

A study of 253 patients with primary and secondary affective disorders disclosed that psychotic features were more frequent among bipolar patients. Except for more frequent psychiatric hospitalization among unipolar patients with psychotic features, no demographic, family history, or parental home variable was found to distinguish between those with and without psychotic features. Chance variation probably accounted for the few symptoms whose frequencies were different depending on the presence or absence of psychotic features. The results failed to support the validity of a classification of affective disorders based on the presence or absence of psychotic features.

Comparisons were made between alcoholics and nonalcoholics in a sample of Danish adoptees (mean age 30) and it was found that the alcoholics, as children, were more often hyperactive, truant, antisocial, shy, aggressive, disobedient, and friendless. The literature suggesting a relationship between the hyperactive child syndrome and subsequent alcoholism is reviewed, as well as a possible relationship between these disorders and antisocial behavior. The adoptive parent of the two groups did not differ with regard to socioeconomic class, psychopathology, or drinking histories. However, 10 of the 14 alcoholics had biological parents who were alcoholic, with no known alcoholism among the biological parents of the nonalcoholics. As adults, the alcoholics differed from the nonalcoholics only with regard to drinking history, use of drugs, and overt expression of anger.

Total or all-cause mortality data were determined from a prospective study of 500 randomly selected psychiatric outpatients during a mean follow-up period of seven years. With the use of age-, sex-, and race-adjusted methods, a mortality nearly twice that expected from reference population rates was observed. Mortality was excessive among younger, but not older, patients; and among white men and women and black men, but not among black women. Certain psychiatric diagnoses (based on structured personal interviews performed at index and using explicit criteria) were associated with excess mortality: alcoholism, antisocial personality, drug addiction, homosexuality, organic brain syndrome, and schizophrenia. Excess mortality was not observed among patients with primary affective disorders, ie, disorders not antedated by nonaffective psychiatric illness.

The study began with the systematic clinical evaluation of a cross-section of 500 of the clinic's patients. This was followed by a 'blind' follow-up of the index subjects and a 'blind' study of first-degree relatives. The present report deals with the diagnosis of Briquet's syndrome (hysteria, somatisation disorder) at index, at follow-up, and among first-degree relatives. The data indicate that the criteria used for the diagnosis of Briquet's syndrome select patients who show a high degree of diagnostic consistency over many years, although not all patients who meet these criteria at follow-up receive the diagnosis of Briquet's syndrome initially. Most importantly, the diagnostic criteria select cases associated with a strong familial increase in the risk of Briquet's syndrome and in the risk of antisocial personality. Both are increased among first-degree female relatives, while only antisocial personality is increased among first-degree male relatives.

We showed that schizophrenia was a discrete disorder by using a quantitative clinical scale that discriminated schizophrenics from other subjects in a prospective follow-up and family study of 500 psychiatric outpatients. Four symptoms tended to occur together as a stable syndrome throughout the six- to 12-year follow-up: persecutory delusions, delusions of control, firmly fixed mood-incongruent delusions, and auditory hallucinations. Scale scores were computed as the number of these four symptoms that was present less one if there was a history of spending sprees with marked elation. More than 68% of the schizophrenics and fewer than 2% of nonschizophrenics had scores of +2 or greater. The distribution of scores was bimodal: persons with scores of +1 were relatively rare. Also, there was familial resemblance for the presence or absence of schizophrenia, but no additional resemblance for the number of schizophrenic symptoms. Despite this relative discreteness, scale scores were valuable for quantifying the certainty of diagnosis and predicting outcome.