Relationship between the DSM-IV and the ICD-10..

The 10th revision of the International Classification of Diseases and Related Health Problems (ICD-10; World Health Organization, 1990) and the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) will both come into use in 1993 and be much more alike than the ICD-9 (World Health Organization, 1978) and the DSM-III (American Psychiatric Association, 1980). The American Psychiatric Association's controversial decision to publish a revision of the DSM-III in 1987 before setting up the Task Force to produce the DSM-IV impaired the association's ability to influence the format of the ICD-10, because by then major decisions had already been made by the World Health Organization. The DSM-IV will be more soundly based on a wider range of empirical data than any previous classification, national or international, and should not be revised again without compelling scientific reasons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of different diagnostic criteria on the prevalence of dementia

BACKGROUND: There are several widely used sets of criteria for the diagnosis of dementia, but little is known about their degree of agreement and their effects on estimates of the prevalence of dementia. METHODS: We examined 1879 men and women 65 years of age or older who were enrolled in the Canadian Study of Health and Aging and calculated the proportion given a diagnosis of dementia according to six commonly used classification systems: the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), third edition (DSM-III), the third edition, revised of the DSM (DSM-III-R), the fourth edition of the DSM (DSM-IV), the World Health Organization's International Classification of Diseases (ICD), 9th revision (ICD-9) and 10th revision (ICD-10), and the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). The degree of concordance among classification schemes and the importance of various factors in determining diagnostic agreement or disagreement were examined. RESULTS: The proportion of subjects with dementia varied from 3.1 percent when we used the criteria of the ICD-10 to 29.1 percent when the DSM-III criteria were used. The six classification systems identified different groups of subjects as having dementia; only 20 subjects were given a diagnosis of dementia according to all six systems. The classifications based on the various systems differed little according to the patients' age, sex, educational level, or status with respect to institutionalization. The factors that most often caused disagreement in diagnosis between DSM-III and ICD-10 were long-term memory, executive function, social activities, and duration of symptoms. CONCLUSIONS: The commonly used criteria for diagnosis can differ by a factor of 10 in the number of subjects classified as having dementia. Such disagreement has serious implications for research and treatment, as well as for the right of many older persons to drive, make a will, and handle financial affairs.     

Cross system agreement for substance use disorders: DSM-III-R, DSM-IV and ICD-10

This report presents results of a field trial of Substance Use Disorders as defined by DSM-III-R, DSM-IV (proposed) and ICD-10. Diagnoses based on the three systems were derived from interviews using the Composite International Diagnostic Interview (CIDI) in a heterogeneous sample of 521 adults drawn from clinical and community settings. Two issues are addressed: (1) cross system agreement; and (2) syndrome coherence of proposed criterion sets for Substance Dependence in each of the three systems. Findings were as follows: (1) Cross system agreement for Dependence was generally high, especially between DSM-III-R and DSM-IV. (2) Cross system agreement was lower for DSM-III-R and DSM-IV Abuse and very low for DSM-IV Abuse and ICD-10 Harmful Use. (3) Agreement varied across drug categories with lowest DSM-III-R/DSM-IV agreement for alcohol abuse and DSM-IV/ICD-10 agreement for marijuana use disorders. (4) Overall prevalence differed for the three systems with DSM-IV yielding highest rates followed by DSM-III-R and ICD-10 in that order. (5) Factor analysis of Dependence criteria showed high loadings of all items on a single factor across the three diagnostic systems and for all categories of drugs. Implications for validity of the dependence syndrome construct and for revisions in DSM-IV are discussed.     

Measuring diagnostic agreement.

Diagnostic agreement tests the reliability and concordance of diagnostic systems. The introduction of measures of agreement with reputations for baserate independence (e.g., Yule's Y and Q), and new studies occasioned by the publication of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) and the International Classification of Diseases—10 (ICD-10, World Health Organization, 1992) make it necessary to study the relationship of illness baserates to measures of agreement. Testing diagnostic concordance for diagnoses of drug dependence from the third edition of the DSM (American Psychiatric Association, 1980) versus DSM-IV diagnoses of drug dependence under 3 baserate conditions, it was found that Yule's Y and Q proved as vulnerable to differences in baserates as kappa or percent agreement and that specificity covaried with baserate rather than being fixed, as most theoretical discussions assume. The uncritical use of Y and Q, therefore, is likely to lead to optimistic interpretations of agreement. Kappa should be preferred for most purposes, although an adjustment to the computational formulas for Y and Q is presented that can diminish their positive bias. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changing criteria of autistic disorders: a comparison of the ICD-10 research criteria and DSM-IV with DSM-III-R, CARS, and ABC

Revised versions of diagnostic manuals, the International Classification of Diseases (ICD-10), and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) all operate with several subgroups in the autistic spectrum. Five of the subgroups are identical in the two manuals, but ICD-10 contains five in addition. 132 children were diagnosed using ICD-10, DSM-IV, DSM-III-R, the Childhood Autism Rating Scale (CARS), and the Autistic Behavior Checklist (ABC). Five out of ten alternative subgroups of Pervasive Developmental Disorders (PDD) were identified in a population of developmentally impaired children. These subgroups were the same in the two manuals; the additional ones in ICD-10 were not identified. With the exception of the groups Disintegrative Disorder and Rett syndrome, significant differences were found between all the subgroups within the PDD spectrum and between the PDD group and the non-PDD group. Some problems connected with the guidelines in the ICD-10 manual are discussed.     

DSM-III, DSM-IV and ICD-10 as severity scales for drug dependence

The construct of illness severity serves many scientific and clinical functions. This study tested the performance as severity scales of three systems for diagnosing drug dependence--DSM-III, DSM-IV and ICD-10--in a multisite regional sample of 370 clinical subjects. Both lifetime and current severity of four drug problems--alcohol, cannabis, cocaine and opiate dependence--was studied in three stages: (a) item difficulty and internal consistency analysis; (b) probabilistic modeling of distribution behavior; and (c) concurrent validation against a set of independent measures. All three systems, for most drugs correlated with most test variables, had good to excellent concurrent validity. Unexpectedly, DSM-III showed in some instances better item behavior, composite score behavior and concurrent validity than the other systems, though DSM-IV and ICD-10 are based on slimmer generic algorithms, and may represent a good balance between simplicity and concurrent validity. Results suggest that the design of future diagnostic algorithms start at the item level and strive for moderate levels of both internal consistency and difficulty. Composite score distributions can then be modeled in field research, and necessary item corrections can be made before the algorithm is widely promulgated.     

Salivary duct carcinoma: clinicopathological and immunohistochemical studies

The SCID-II Personality Questionnaire, modified for DSM-IV and ICD-10 Diagnostic Criteria for Research (ICD-10-DCR), was administered to 58 consecutive patients with agoraphobia with panic disorder in order to screen for personality disorders (PDs) and assess diagnostic agreement between DSM-IV and ICD-10-DCR. The diagnostic agreement, as expressed by kappa values, was 0.78 for the presence of any personality disorder (PD), but it ranged from 0.51 for schizoid PD to 0.83 for dependent PD. There was a tendency for ICD-10-DCR to overdiagnose PDs, except for borderline and dependent PDs. The sources of disagreement can be traced to differences in the conceptualization of some PDs and differences in diagnostic criteria and diagnostic thresholds; these are further examined in an effort to improve diagnostic criteria and attain greater compatibility between the two diagnostic systems.     

Effects of a community intervention to change smoking behavior among Hispanics

The American Psychiatric Association published the fourth edition of the Diagnostic and Statistical Manual (DSM-IV) in May 1994. Referred to by some in the popular media as the mental health profession's diagnostic bible, the decisions reflected in this fourth edition are likely to shape diagnostic practice and education and may impact on treatment approaches as well. This article describes the goals and process involved in preparing this document, examines the major changes from DSM-III-R to DSM-IV and comments on the relevance of DSM-IV to psychiatric/mental health nursing.     

Clinical psychologists' theory-based representations of mental disorders predict their diagnostic reasoning and memory.

The theory-based model of categorization posits that concepts are represented as theories, not feature lists. Thus, it is interesting that the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV, American Psychiatric Association, 1994) established atheoretical guidelines for mental disorder diagnosis. Five experiments investigated how clinicians handled an atheoretical nosology. Clinicians' causal theories of disorders and their responses on diagnostic and memory tasks were measured. Participants were more likely to diagnose a hypothetical patient with a disorder if that patient had causally central rather than causally peripheral symptoms according to their theory of the disorder. Their memory for causally central symptoms was also biased. Clinicians are cognitively driven to use theories despite decades of practice with the atheoretical DSM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Culture and classification: the cross-cultural application of the DSM-IV

Changes incorporated into the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) include a number of features designed to enhance its cross-cultural applicability. However, the overt move toward a culture-sensitive nosology is undermined by an implicit assumption of the universality of its primary syndromes. In this review we argue that the DSM-IV's underlying thesis of universality based on Western-delineated mental disorders is problematic and has limited cross-cultural applicability. Research on the cross-cultural manifestation of schizophrenia and depression shows that presentation of these disorders varies significantly across cultures. We conclude by discussing the research and clinical implications of these findings.     

Number of symptoms, quantification, and qualification of depression

Current classification systems (ICD-10 and DSM-IV) require a quantitative criterion for differentiating depressive states, suggesting a correlation between the number of symptoms, i.e., the pervasiveness of the syndrome, and the subtype of the illness. All the symptoms (within those contained in the diagnostic lists) are assumed to have comparable value. To investigate the relevance of the number and the type of symptoms reported by 196 patients suffering from depression, we compared the symptoms using independent indicators of severity such as the Clinical Global Index (CGI) and the social functioning subscale of the Global Assessment of Functioning (GAF). A second comparison using the same indicators was made between qualitatively distinct categories of DSM-IV and ICD-10 (i.e., melancholic v nonmelancholic, somatic v nonsomatic, and psychotic v nonpsychotic). There was evidence that increasing numbers of symptoms actually reflect higher levels of severity, but the categorizations that were mainly based on qualitative criteria (e.g., melancholia, somatic syndrome, etc.) usually attained better discrimination compared with those based on the number of symptoms. Moreover, certain symptoms (usually those indicated as endogenous) were more likely to be associated with greater severity and pervasiveness. Finally, the results clearly showed that different symptoms had different weight in establishing the gradient of severity.     

Entorhinal cortex of aged subjects with Down''s syndrome shows severe neuronal loss caused by neurofibrillary pathology

OBJECTIVE: To examine directly the extent to which ICD-10 hyperkinetic disorder and DSM-IV attention-deficit/hyperactivity disorder (ADHD) identify the same children with the same difficulties. METHOD: Participants were children referred for symptoms of overactivity, inattention, and impulsivity, and a normal control group. Diagnostic criteria for ICD-10 hyperkinetic disorder and DSM-IV ADHD were applied retrospectively. Four groups were identified: hyperkinetic disorder and ADHD (n = 21), ADHD only (n = 22), clinic control (n = 15), and normal control (n = 19). The groups were compared on measures reflecting the central characteristics of ADHD, neurodevelopmental functioning, academic and cognitive functioning, and the presence of conduct problems. RESULTS: There is some evidence of increased symptom severity in the combined diagnostic group. Few differences emerged on measures of neurodevelopmental, academic, and cognitive functioning. Rates of conduct disturbance were similar in both ADHD groups. CONCLUSIONS: DSM-IV criteria identify a broader group of children than those identified by ICD-10. However, there is substantial overlap between the groups formed with these different criteria.     

Review of The science game: An introduction to research in the behavioral and social sciences, seventh edition.

Reviews the book, The science game: An introduction to research in the behavioral and social sciences, seventh edition by Neil McKinnon Agnew and Sandra W. Pyke (2007). In 1969, Neil Agnew and Sandra Pyke published the first edition of The Science Game, a 182-page survey of the major components of what they call the game of "sciencing," a game, they claim, that "like all other games of consequence, is a mixture of art, enterprise, and invention held loosely together by man-made rules." Using the same quirky but engaging style as in the original, in the seventh and latest edition, Agnew and Pyke dedicate a full 471 pages to the task, tackling a host of topics bearing on the activities of science, ranging from the strengths and weaknesses of humans' cognitive capacity for problem solving to debates in the philosophy of science regarding the nature of knowledge. Although this most recent edition elaborates on many of the same themes presented in earlier versions, it is much grander in scope and includes a number of new features, including the introduction of a central theme and memory aid throughout the book (i.e., a puzzle-solving theme), the inclusion of statements of chapter goals, and chapter-end summaries and self-test quizzes. The Science Game provides a fairly comprehensive set of "sound bites" pertaining to the techniques, procedures, and conventions adopted by social science researchers and is accessible to either students encountering these topics for the first time or more advanced students in need of a refresher. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Structure of Child and Adolescent Psychopathology: Generating New Hypotheses.

To begin to resolve conflicts among current competing taxonomies of child and adolescent psychopathology, the authors developed an interview covering the symptoms of anxiety, depression, inattention, and disruptive behavior used in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994), the International Statistical Classification of Diseases and Related Health Problems (ICD-10; World Health Organization, 1992), and several implicit taxonomies. This interview will be used in the future to compare the internal and external validity of alternative taxonomies. To provide an informative framework for future hypothesis-testing studies, the authors used principal factor analysis to induce new testable hypotheses regarding the structure of this item pool in a representative sample of 1,358 children and adolescents ranging in age from 4 to 17 years. The resulting hypotheses differed from the DSM-IV, particularly in suggesting that some anxiety symptoms are part of the same syndrome as depression, whereas separation anxiety, fears, and compulsions constitute a separate anxiety dimension. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The psychology of eating & drinking: An introduction, Vol. 2.

Reviews the book, The psychology of eating & drinking: An introduction, Vol. 2 by A. W. Logue (1991). The second edition of The psychology of eating and drinking expands the first by three chapters. These discuss, as the author says, the psychology of eating and drinking as it applies to everyday issues. New topics address female reproduction, cigarette smoking, and cuisine and wine tasting. Following 296 pages of text, the book lists several clinics and self-help agencies dealing with disorders of taste and smell, eating, and alcohol (only one resource offered for alcohol abuse). Also, the book provides chapter-by chapter references as well as name and subject indexes. Furthermore, as the author says, the second edition updates the research-base of the original edition. Logue organizes her book into five parts, each preceded by a précis. The first three parts, which follow an introductory chapter that maps what is to come and that justifies the large number of animal (rat) studies to be presented, describe the basics of eating and drinking. Part One comprises two chapters on starting and stopping eating and drinking. Here, as elsewhere, Logue informs the reader well; by this time, one wants to work through the book. Equally as interesting, Part Two (four chapters) looks at what we select to drink and cat, and why we make such choices. Part Three (one chapter) talks about nutritive and nonnutritive substances. It concerns the interplay of what we eat and what we subsequently do. Part Four (three chapters) gets directly at the clinical issues. It explains and discusses eating disorders (anorexia, bulimia), obesity, and alcoholism. Lastly, Part Five (three chapters) addresses everyday concerns. Logue intends that the book be read by lay persons and psychologists, but I doubt that those devoid of psychology background will fully appreciate all she has to say. She also intends that the reader will come away from the book appreciating the value of the scientific method in phrasing and answering questions about why we do what we do. Here Logue clearly achieves her goal, for the reader cannot help but see what scientific thinking can bring to the understanding of the psychology of eating and drinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An outsider-insider's views about revising the DSMs.

After having a leadership role in the development of the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) and its revision (DSM-III—R; American Psychiatric Association, 1987), R. L. Spitzer comments as an outsider-insider on the development of DSM-IV. Many features of the DSM-IV process, such as systematic literature reviews and focused field trials, represent significant advances that will increase the role of empirical findings in the decision-making process in this latest edition of the DSM. However, it is likely that when final decisions are made about DSM-IV, the decisions will still be based primarily on expert consensus, rather than on data, as was the case with DSM-III and DSM-III—R. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Occurrence of free D-aspartate and aspartate racemase in the blood shell Scapharca broughtonii

In spite of the high prevalence of tuberculosis worldwide, there are few studies on its psychiatric complications. The mental state of 53 patients with pulmonary tuberculosis seen in a Nigerian chest clinic was examined using the 30-item General Health Questionnaire (GHQ-30), the Present State Examination (PSE), and a clinical evaluation based on the International Classification of Disease, tenth edition (ICD-10). Results were compared with two comparison groups: (1) a group of 20 long-stay orthopedic patients with lower limb fractures; and (2) a group of 20 apparently healthy controls. The sociodemographic characteristics of the groups were also compared. A significantly higher prevalence of psychiatric disorders was found in the tuberculosis group (30.2%) than in the orthopedic group (15%) and the apparently healthy controls (5%). The types of psychiatric disorders encountered included mild depressive episode, generalized anxiety disorder, and adjustment disorder (ICD-10). Psychiatric morbidity was higher in tuberculosis patients with low educational attainment, and did not show a statistically significant relationship with other sociodemographic parameters. Ways of improving the mental health of tuberculosis patients are discussed.     

Proceedings à la Russe.

Notes that the December issue of the American Psychologist (1964, 19, 972-973) contains the announcement of an experimental edition of the proceedings of the 1965 American Psychological Association convention. The author suggests that this venture should be applauded and supported as a measure designed to make the communication of scientific information in psychology more effective. Furthermore, it is argued that in considering the matter of extending beyond 100-word abstracts the information concerning the papers presented at the annual meetings of the APA (and perhaps at the regional meetings as well), the Soviet approach and experience may be of interest. The author elucidates the advantages and disadvantages of both the Soviet and APA approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Causes and consequences: Individual distress in the context of couple interactions.

The covarying relationship between individual distress and couple interactions provides justification for developing a system to classify couple interactional behaviors. This system is proposed as an alternative to the Diagnostic and Statistical Manual of Mental Disorders (e.g., 4th edition; DSM-IV; American Psychiatric Association, 1994) system, whose problems include reliance on linear models of causality, atheoretical classification of individual syndromes, and poor predictive validity and treatment utility. These difficulties may be resolved by using an alternative classification model of couple interactions, at least for many distressed individuals and couples. An example of a model for classifying couple interactions (including distressed individual behavior) is presented. The potential benefits of theoretical consistency, implied treatment-matching strategies, increased predictive validity and enhanced treatment utility of such an alternative classification system are discussed, along with guidelines for the further development and testing of couple interaction classification alternatives to the DSM nosology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)