Classification and short-term course of DSM-IV cannabis, hallucinogen, cocaine, and opioid disorders in treated adolescents.

This study examined the latent class structure of Diagnostic and Statistical Manual of Mental Disorders (text rev.; DSM-IV; American Psychiatric Association, 2000) symptoms used to diagnose cannabis, hallucinogen, cocaine, and opiate disorders among 501 adolescents recruited from addictions treatment. Latent class results were compared with the DSM-IV categories of abuse and dependence, and latent transition analysis (LTA) was used to examine changes in symptom severity over a 1-year follow-up. Although 2- and 3-class solutions provided the best fit to the data (2-class: hallucinogens, cocaine, opioids; 3-class: cannabis), 3-class solutions provided more substantive results and were emphasized in analyses. There was good agreement between latent classes and DSM-IV diagnosis. LTA suggested greater likelihood of transitioning to a less severe class at 1 year for all 4 drugs; in- and outpatients differed in pattern of change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group Comparisons of DSM-IV Subtypes of Chronic Depression: Validity of the Distinctions, Part 2.

The nosology of chronic depression in Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV, American Psychiatric Association, 1994) is highly complex and requires clinicians to differentiate among several chronic course subtypes. This study replicates an earlier investigation (J. McCullough et al., 2000; see record 2000-05424-007) that found few differences among Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.; DSM-III-R; American Psychiatric Association, 1987) categories of chronic depression. In the present study, 681 outpatients with chronic major depression, double depression, recurrent major depression without full interepisode recovery, and chronic major depression superimposed on antecedent dysthymia were compared. Few differences were observed on a broad range of demographic, clinical, psychosocial, family history, and treatment response variables. The authors suggest that chronic depression should be viewed as a single, broad condition that can assume a variety of clinical course configurations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Limitations in the Assessment of DSM-IV Cannabis Tolerance as an Indicator of Dependence in Adolescents.

The usefulness of the Diagnostic and Statistical Manual's (4th ed.; DSM-IV; American Psychiatric Association, 1994) tolerance criterion as an indicator of dependence has been debated. The authors of this study evaluated the performance of DSM's cannabis tolerance criterion, operationally defined as a percentage increase in quantity needed to get high, in distinguishing adolescents with and without cannabis dependence. Two samples of adolescent cannabis users (ages 12-19) provided data (ns = 417 and 380). Tolerance, defined as a percentage increase (median increase = 300% and 175%, respectively, in the samples), had only moderate overall sensitivity and specificity in distinguishing those with and without cannabis dependence. Results suggest limitations of the DSM-IV and change-based operational definition of tolerance in adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dimensional versus categorical classification of mental disorders in the fifth edition of the Diagnostic and statistical manual of mental disorders and beyond: Comment on the special section.

The value of including dimensional elements in the Diagnostic and Statistical Manual of Mental Disorders (DSM) has been recognized for decades. Nevertheless, no proposals have been made for introducing dimensional classification in the diagnostic system in a valid and feasible manner. As an initial step in this endeavor, the authors suggest introducing dimensional severity ratings to the extant diagnostic categories and criteria sets. Although not without difficulties, this would begin to determine the feasibility of dimensional classification and would address some limitations of the purely categorical approach (e.g., failure to capture individual differences in disorder severity, and clinically significant features subsumed by other disorders or falling below conventional DSM thresholds). The utility of incorporating broader dimensions of temperament and personality in diagnostic systems beyond the fifth edition of the DSM is also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relational disorders and relational processes in diagnostic practice: Introduction to the special section.

The special section addresses a number of salient issues that will arise as the revision process for the Diagnostic and Statistical Manual of Mental Disorders (DSM) unfolds and the role of relational processes in mental health is considered. This collection of articles, which emphasize historical, conceptual, and empirical contributions to the discussion, is intended to stimulate debate in the field and to serve as a resource for individuals charged with proposing new diagnostic guidelines. Jointly, the articles make it clear that the authors can improve on the current treatment of relational processes in the DSM and that there is a solid foundation of family research that can inform any discussion on this topic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to special section: Mental retardation and mental illness.

Historically, the perceived relation between mental illness and mental retardation has undergone substantial changes. During the past 2 centuries, clinical observations and systematic research addressing these 2 constructs have developed along separate lines. Consequently, the pathogenesis and treatment of psychopathology, emotional disorders, and behavior problems experienced by individuals with mental retardation have not been the purview of mainstream clinical psychology. This article initiates a special section on mental retardation and mental illness to provide up-to-date summaries of various key clinical and research issues regarding this population (i.e., individuals with "dual diagnoses"). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders.

The reliability of current and lifetime Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) anxiety and mood disorders was examined in 362 outpatients who underwent 2 independent administrations of the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV–L). Good to excellent reliability was obtained for the majority of DSM-IV categories. For many disorders, a common source of unreliability was disagreements on whether constituent symptoms were sufficient in number, severity, or duration to meet DSM-IV diagnostic criteria. These analyses also highlighted potential boundary problems for some disorders (e.g., generalized anxiety disorder and major depressive disorder). Analyses of ADIS-IV–L clinical ratings (0–8 scales) indicated favorable interrater agreement for the dimensional features of DSM-IV anxiety and mood disorders. The findings are discussed in regard to their implications for the classification of emotional disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical and translational research: Introduction to the special issue.

This special issue represents an effort by the journal Experimental and Clinical Psychopharmacology to emphasize its interdisciplinary mission by encouraging the writing of articles on clinical research and the interchange between basic and clinical research on mental illness and the addictions. This special issue opens with a commentary from A. I. Leshner (2002), retired director of the National Institute on Drug Abuse, which emphasizes the importance of translating research findings into clinical practice. Four review articles and 12 original research reports provide a broad sampling of contemporary clinical research, including behavioral therapy, pharmacotherapy, psychiatric comorbidity, and special populations, and also illustrate linkages between clinical research and basic fields of inquiry, including behavioral theory, neuropsychology, neuropharmacology, and statistics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment.

A wealth of evidence attests to the extensive current and lifetime diagnostic comorbidity of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM–IV) anxiety and mood disorders. Research has shown that the considerable cross-sectional covariation of DSM–IV emotional disorders is accounted for by common higher order dimensions such as neuroticism/behavioral inhibition (N/BI) and low positive affect/behavioral activation. Longitudinal studies indicate that the temporal covariation of these disorders can be explained by changes in N/BI and, in some cases, initial levels of N/BI are predictive of the temporal course of emotional disorders. The marked phenotypal overlap of the DSM–IV anxiety and mood disorders is a frequent source of diagnostic unreliability (e.g., temporal overlap in the shared features of generalized anxiety disorder and mood disorders, situation specificity of panic attacks in panic disorder and specific phobia). Although extant dimensional proposals may address some drawbacks associated with the DSM nosology (e.g., inadequate assessment of individual differences in disorder severity), these proposals do not reconcile key problems in current classification, such as modest reliability and high comorbidity. This article considers an alternative approach that emphasizes empirically supported common dimensions of emotional disorders over disorder-specific criteria sets. Selection and assessment of these dimensions are discussed along with how these methods could be implemented to promote more reliable and valid diagnosis, prognosis, and treatment planning. For instance, the advantages of this system are discussed in context of transdiagnostic treatment protocols that are efficaciously applied to a variety of disorders by targeting their shared features. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Mad travelers: Reflections on the reality of transient mental illness.

Reviews the book, Mad travelers: Reflections on the reality of transient mental illness by Ian Hacking (see record 1998-08112-000). The American Psychiatric Association produced its first Diagnostic and Statistic Manual (DSM) in 1952. It took 16 years to make the revisions that were published as DSM II, 12 years to produce DSM-III, 7 to produce DSM-III Revised, and a mere 7 more to create DSM-IV. It appears that the official accounts of mental, emotional, and behavioural problems change over the years. Moreover, some disorders change so drastically that they can assume epidemic proportions in one situation, while virtually non-existent in another. Such disorders are the focus of Hacking's book. The book is based on talks he gave in the Page-Barbour lecture series at the University of Virginia in 1997. Hacking's purpose is to explore what he calls "transient mental illnesses," those that seem to be confined to a particular time and place—an ecological niche that permits and even nourishes them. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An item response theory analysis of DSM-IV personality disorder criteria across younger and older age groups.

Many of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994) personality disorder (PD) diagnostic criteria focus on a younger social and occupational context. The absence of age-appropriate criteria for older adults forces researchers and clinicians to draw conclusions based on existing criteria, which are likely inadequate. To explore which DSM-IV PD criteria contain age group measurement bias, the authors report 2 analyses of data on nearly 37,000 participants, ages 18-98 years, taken from a public data set that includes 7 of the 10 PDs (antisocial, avoidant, dependent, histrionic, obsessive-compulsive, paranoid, and schizoid). The 1st analysis revealed that older age groups tend to endorse fewer PD criteria than younger age groups. The 2nd analysis revealed that 29% of the criteria contain measurement bias. Although the latent variable structure for each PD was quite similar across younger and older age groups, some individual criteria were differentially endorsed by younger and older adults with equivalent PD pathology. The presence of measurement bias for these criteria raises questions concerning the assessment of PDs in older adults and the interpretation of existing data. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction and overview of the special issue on Aristotle.

Aristotle's scientific legacy underlies much of what is currently considered mainstream psychology. Surprisingly, however, only a paucity of writings have elucidated this fact. To be sure, history of psychology texts register him as one of our intellectual ancestors, but unfortunately most psychologists appear to view Aristotle as an anachronism with little but the most indirect of influences upon modern theory and practice. The present issue of Theoretical and Philosophical Psychology is part of the effort begun by scholars such as Robinson to dispel this misconception. The six articles that follow not only show the continuing relevance of Aristotelian thinking, but they also employ Aristotelian conceptual tools to analyze and advance modern psychology still further. Each of the articles covers a unique aspect of Aristotle vis-a-vis psychology. Robinson delves into Aristotle's naturalism and ontology, and attempts to help readers find their way through some rather sticky theoretical issues for psychologists. Williams critically examines aspects of Aristotle's physics (or metaphysics) from a post-modernist's perspective. Silverstein, Howard, and Rychlak each discuss a different facet of Aristotle's teleology: Silverstein on developmental implications, Howard on philosophy of science ramifications, and Rychlak on cognitive considerations. Waterman then extends some of Aristotle's ethics through his empirical studies of happiness. Whereas the first four articles are primarily theoretical in nature, the final two (Waterman and Rychlak) demonstrate how theorizing compatible with Aristotle can be experimentally tested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An evaluation of the DSM-II classification of schizophrenia as a nomenclature.

Established 3 criteria by which the concepts of schizophrenia in Diagnostic and Statistical Manual of Mental Disorders, 2nd edition (DSM-II) could be analyzed: reliability, coverage, and overlap. 71 artificial patients were generated to uniformly represent a behavioral measurement space. 55 clinical psychologists and psychiatrists diagnosed the artificial patients using the DSM-II classificatory concepts of schizophrenia. Results concerning the criteria show that: (a) an empirical representation of overlap provided a new hierarchical representation of the DSM-II classification of schizophrenia; (b) reliability and coverage varied inversely; and (c) the DSM-II failed to serve as an adequate nomenclature. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing factor analytic models of the DSM-IV personality disorders.

There is little agreement about the latent factor structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM) personality disorders (PDs). Factor analytic studies over the past 2 decades have yielded different results, in part reflecting differences in factor analytic technique, the measure used to assess the PDs, and the changing DSM criteria. In this study, we explore the latent factor structure of the DSM (4th ed.; IV) PDs in a sample of 1200 psychiatric outpatients evaluated with the Structured Interview for DSM–IV PDs (B. Pfohl, N. Blum, & M. Zimmerman, 1997). We first evaluated 2 a priori models of the PDs with confirmatory factor analysis (CFA), reflecting their inherent organization in the DSM–IV: a 3-factor model and a 10-factor model. Fit statistics did not suggest that these models yielded an adequate fit. We then evaluated the latent structure with exploratory factor analysis (EFA). Multiple solutions produced more statistically and theoretically reasonable results, as well as providing clinically useful findings. On the basis of fit statistics and theory, 3 models were evaluated further—the 4-, 5-, and 10-factor models. The 10-factor model, which did not resemble the 10-factor model of the CFA, was determined to be the strongest of all 3 models. Future research should use contemporary methods of evaluating factor analytic results in order to more thoroughly compare various factor solutions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of Challenging the therapeutic state: Critical perspectives on psychiatry and the mental health system.

Reviews the special issue of The Journal of Mind and Behavior, Challenging the therapeutic state: Critical perspectives on psychiatry and the mental health system, edited by D. Cohen (1990). This special issue serves as an update on the critique of the medical model in psychiatry. In editing this volume, Cohen has assembled a collection of work from authors in many disciplines—including some laypersons—who are concerned with what they see as the frightening power of the "Therapeutic State." While the work of Thomas Szasz is a guiding light for several of these authors, they certainly are not all associated with his work. In fact, some of them explicitly disavow what they see as Szasz's overly simple stance toward madness. Moreover, the ideas in this volume expand the critique of the medical model far beyond the range of Szasz's work. Disagreements among authors are for the most part confined to a few footnotes in this volume. The book's purpose is to expose the problem before exploring solutions to it. When the volume is at its best, the papers are united by their contention that the medical model in psychiatry is disastrous both for individuals who are victimized by its institutions and practices, and for the society that embraces its disempowering philosophy. There is little, if any, brand new material in this book. Virtually all of the articles contain research and ideas tat the authors have already published elsewhere. The virtue of the book is in bringing together a diversity of work across disciplines that would not ordinarily appear between the same two covers. The common element running through all of these articles is one that the authors almost never state in so many words, but it gives a cumulative force to their very different treatments of psychiatry's problems. Each of these papers, in its own way, reveals aspects of the irrationality implicit in psychiatric orthodoxy. Psychiatry stands at the fringe of medical science, and the fringe of any science is where the inadequacies of its paradigm are most obvious. The attempt to make the medical model fit the problem of madness has not succeeded, but orthodox psychiatry continues to pursue it. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special issue: Psychology and AIDS.

From its beginnings in 1981, psychologists have been involved in worldwide efforts to meet the many challenges of the AIDS health crisis. As researchers and practitioners, as consultants and policy advisors, as educators and evaluators, and as activists and concerned members of the community--we psychologists have responded in many ways. We have attempted a broad perspective in approaching this special issue. We wanted coverage of the science, the practice, and the social issues that AIDS has brought into focus for psychology. Any attempt to cover all the issues is doomed to failure, however. The science changes too quickly, and the disease is spreading too rapidly, for any group of journal articles to ever claim currency and comprehensiveness. The issue has been divided into six major sections, each with an introduction. We begin with articles that overview the roles of psychology in the AIDS health crisis as seen in our own profession, and from various levels of science, health care, and legislative and government action. Then we present articles reviewing some of the primary issues AIDS commands us to examine: public health, antibody testing, AIDS and the communities of Black and Hispanic men, IV drug abuse, sexual behavior change, stigma, and psychoneuroimmunology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Egomania rageosis: A proposed new syndrome for the Diagnostic and Statistical Manual of Mental Disorders (V).

This paper describes a serious new disorder--Egomania Rageosis--which is approaching epidemic incidence in academia. The symptoms, epidemiology, and treatment of Egomania are described, and empirical work is reviewed. It is proposed that the syndrome be included in the Diagnostic and Statistical Manual of Mental Disorders (V). Those persons in whom a prolonged relationship with academia has given rise to deep-seated, unconscious feelings of irreverence will find the paper of both heuristic and therapeutic value. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding immigrant families from around the world: Introduction to the special issue.

Investigations of immigrant families enable researchers to trace family processes and children’s psychological adjustment in the presence of trenchant sociocultural change, cultural conflict, family dislocation, and the need for readjustment to new social environments. This special issue of 15 articles presents psychosocial research on immigrant families and children residing in Canada, Germany, Israel, the Netherlands, Portugal, and the United States. The articles focus on the psychosocial adaptation of immigrant families, parenting practices and their implications for child outcomes, and the importance of parent–adolescent relationships for adolescent mental health. Most of the articles are based on quantitative research methodologies. It is concluded that research on immigrant families is well suited to advance knowledge about the mutual dependence of dynamic sociocultural and family processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic Efficiency of DSM-IV Criteria for Borderline Personality Disorder: An Evaluation in Hispanic Men and Women With Substance Use Disorders.

This study examined diagnostic efficiency of Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), criteria for borderline personality disorder (BPD). One hundred thirty monolingual Hispanic adults (90 men, 40 women) at an outpatient psychiatric and substance abuse clinic were assessed with the Spanish-Language Version of the Diagnostic Interview for DSM-IV Personality Disorders (C. M. Grilo, L. M. Anez, & T. H. McGlashan, 2003). The BPD diagnosis was determined by the best-estimate method. Diagnostic efficiency indices were calculated for all BPD criteria, for the entire study group, and separately by gender. Overall, the best exclusion criterion was affective instability, whereas suicidality or self-injury was the best inclusion criterion and the best predictor overall. These findings did not differ by gender, are similar to those reported elsewhere in the literature, and have implications for the refinement of diagnostic systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinicians' judgments of clinical utility: A comparison of the DSM-IV and five-factor models.

Clinical utility, or the usefulness of a diagnostic system in clinical practice, has been identified as an important construct in proposed revisions to the diagnostic nomenclature and a significant limitation of dimensional models of personality disorder, such as the 5-factor model (FFM). Only 1 study to date has addressed explicitly the clinical utility of the FFM, and the findings suggested significant limitations. In the current study, 245 practicing psychologists described 3 historic cases using both the FFM and the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 2000) and then rated each model on 6 aspects of clinical utility. In contrast to prior research, the psychologists in this study considered the FFM to have greater clinical utility than the existing diagnostic categories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)