The DSM-IV construct of cocaine dependence in a treatment sample of Black, Mexican American, and White men.

The unidimensionality of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-lV) construct of cocaine dependence was examined among 263 Black, 212 Mexican American, and 256 White men admitted consecutively to 5 substance abuse treatment programs in the Bay Area of northern California. Interviews of about 1 hr were conducted in the programs' facilities by trained interviewers who used a standardized questionnaire. Results of the confirmatory factor analysis (CFA) generally supported a unidimensional model of the 7 indicators of DSM-IV cocaine dependence across the men in all 3 ethnic groups. The results of the CFA, latent trait analysis, and latent class analysis suggested that the indicator representing health problems from cocaine use may not be as useful as the other criteria for identifying cocaine dependence. Limitations and suggestions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of DSM-IV cluster B personality disorder symptoms on the termination and continuation of psychotherapy.

This study investigates the relationship between therapy attendance with DSM-IV criteria for the cluster B personality disorders (antisocial [ANPD]; borderline [BPD]; histrionic [HPD]; and narcissistic [NPD]). Ninety patients who were found to meet DSM-IV criteria for an Axis II disorder (cluster A personality disorders?=?10; ANPD?=?20, BPD?=?25, HPD?=?5, NPD?=?14; cluster C personality disorders?=?16). Total number of DSM-IV criteria for BPD (r?=?.33, p?=?.001) and ANPD (r?=?–.22, p?=?.04) were significantly related to the number of psychotherapy sessions attended by a patient. Stepwise regression indicated that the 5 individual criteria BPD-1, NPD-4, BPD-8, HPD-8, and ANPD-7 (in order of entry into the regression equation) were independent and nonredundant predictors that explained 31% of variance found in the number of psychotherapy sessions attended by patients. The presence or absence of 3 of these individual criteria provided a good balance of positive predictive power (.78–.95) and overall correct classification rate (.53–.69) for therapy continuation. Clinical and research implications of personality characteristics are discussed in relation to the termination and continuation of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Categorical versus dimensional status of borderline personality disorder.

One of the many controversies concerning the borderline personality disorder (BPD) diagnosis is whether the construct refers to a categorical or dimensional variable. The current study used P. E. Meehl's (1973) maximum covariance analysis to investigate this issue. The charts of 409 psychiatric inpatients were systematically reviewed for the presence of BPD and dysthymic symptoms. Charts of 244 inpatients were also reviewed to assess the presence of indicators of male sex, a categorical variable. The results for BPD and dysthymia were consistent with a dimensional model, whereas those for male sex were consistent with a categorical model. A dimensional model of classification of BPD is recommended, and suggestions for future research are provided. (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)     

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)     

Is Depression Best Viewed as a Continuum or Discrete Category? A Taxometric Analysis of Childhood and Adolescent Depression in a Population-Based Sample.

The authors examined the latent structure of depression in a population-based sample of children and adolescents. Youth's self-reports and parents' reports of the youth's Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) major depressive symptoms were assessed via a structured clinical interview. The authors used Meehl's (1995) taxometric procedures to discern whether youth depression is dimensional or categorical. Taxometric analyses that explicitly took into account the skewness of depressive symptoms suggested that depression is a dimensional, not categorical, construct. The dimensional structure of depression was obtained for all of the DSM-IV major depressive symptoms as well as for different domains of depression (emotional distress symptoms and vegetative, involuntary defeat symptoms), youth and parent reports, and different subsamples (i.e., boys vs. girls and younger vs. older youth). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The latent dimensionality of DIS/DSM-III-R nicotine dependence: exploratory analyses

Decisions on DSM-IV criteria for alcohol dependence were based in part on latent structure analyses of field survey data on alcohol problems. Analogously, to investigate the latent structure of nicotine dependence in an epidemiological sample, we carried out a dichotomous item factor analysis of DSM-III-R symptom data gathered from 394 young adults who reported a history of sustained daily smoking. Smokers and their dependence symptoms were identified by means of the NIMH Diagnostic Interview Schedule version III revised, administered to a random sample of 1007 21-30-year-olds who were members of a health maintenance organization in the Detroit area. Comparing different latent structure models using LISCOMP software with bootstrap re-sampling, followed by multiple logistic regression, we found that a two-factor model indicating a 'general dependence' and a 'failed cessation' dimension best accounted for the observed data. Current smoking status (persistent vs. past smoking) was associated with the two factors independently. Replication and additional research on construct, discriminant and convergent validity are needed.     

"Silent" patent ductus arteriosus and bronchopulmonary dysplasia in low birth weight infants

We conducted a clinical study on the antecedents of bronchopulmonary dysplasia (BPD) in 290 premature RDS infants with < or = 1.75 kg birth weight (BW). They were enrolled in a prospective trial of indomethacin treatment for "silent" patent ductus arteriosus (PDA), screened by 2-D echocardiographic and pulsed Doppler evaluation on the third day of life. The trial took place at the NICU of the Pediatric Department of Padua University between January 1987 and December 1991. Out of 290 infants screened, 96 had evidence of "silent" PDA (33%) and 77 responded to indomethacin treatment (80%). Comprehensively 79 (27%) developed BPD, and from these the incidence of BPD was statistically increased in infants with "silent" PDA, 47 out of 96 (49 +/- 9%), with respect to 32 out of 194 (16 +/- 3%) preterm infants without PDA. Statistical analysis showed that in preterm infants with "silent" PDA the development of BPD was correlated at 99% C.L. to their low BWs (mean BW = 1.13 kg): in fact the mean and the mode of BW distributions were statistically lower in the presence of BPD, 1.03 kg versus 1.24 kg, and 0.88 kg versus 1.65 kg respectively. Moreover, the preterm infants with "silent" PDA unresponsive to the first course of indomethacin and/or submitted later to surgical closure, presented a statistically lower BW with respect to the early responders, 1.06 kg versus 1.18 kg, and at the same time a statistically higher incidence of BPD (63 +/- 20% versus 43 +/- 9%). From these data we conclude that, although "silent", PDA increase per se the incidence of BPD, even if benefits from an early induced closure. Furthermore, a lower BW of infants affected by "silent" PDA represents a contributing factor to the development of BPD.     

On the nature of nicotine addiction: A taxometric analysis.

Taxometric procedures were used to determine whether nicotine addiction is best conceptualized as a dimensional or a categorical (i.e., taxonic) phenomenon. Using data from the 2003 National Survey on Drug Use and Health (NSDUH; N = 12,467), results from MAMBAC, MAXEIG, and LMODE taxometric analyses provided strong evidence that nicotine addiction has a taxonic latent structure. Members of the addiction taxon, which constituted approximately 48% of those who reported smoking in the past 30 days, consumed a higher number of cigarettes per day, had stronger craving, higher levels of nicotine tolerance, more inflexible smoking patterns, and shorter latencies to smoking their first cigarette on waking compared with nontaxon members. These findings of a distinct addiction taxonic structure were replicated using a 2002 NSDUH sample (N = 12,224). Finally, the predictive validity of the taxon variable was compared with a continuous indicator sum. The taxon accounted for most of the predictive variance in the indicator sum, but the latter generally showed significant predictive power even after controlling for the former. Thus, these smoking variables may have both a categorical and a dimensional structure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing the degree of cross-sectional and longitudinal dependence between two discrete dynamic processes.

Developmental research often involves studying change across 2 or more processes or constructs simultaneously. A natural question in this work is whether change in these 2 processes is related or independent. Associative latent transition analysis (ALTA) was designed to test hypotheses about the degree to which change in 2 discrete latent variables is related. The ALTA model is a type of latent class model, which is a categorical latent variable model based on categorical indicators. In the ALTA approach, level and change on 1 variable is predicted by level and change in another. Two types of hypotheses are discussed: (a) broad hypotheses of dependence between the 2 discrete latent variables and (b) targeted hypotheses comparing specific patterns of change between levels of the discrete variables. Both types of hypotheses are tested via nested model comparisons. Analyses of relations between psychological state and substance use illustrate the model. Recent psychological state and recent substance use were found to be associated cross-sectionally and longitudinally, implying that change in recent substance use was related to change in recent psychological state. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adenoid cystic carcinomas of the maxillary sinus with intracranial invasion. Review of the literature, apropos of a case

The aims of this study were to analyze and assess dimensions of the Dental Fear Survey (DFS), which has been developed to measure dental fears and phobias. The present study of 313 dental-phobic individuals analyzed the DFS in a factor analysis using an exploratory (EFA) and a confirmatory (CFA) factor analysis to show dimensions and latent variables. The EFA showed a five-factor structure, with dimensions including items characterizing 'Avoidance of dental care', 'Physiologic arousal during dental treatment', 'Anticipatory anxiety while waiting for dental treatment', 'Fear of the injection needle', and 'Fear of the drill'. The total explained variance of the EFA was 63%. Although statistically significant, the CFA model showed a factor structure with 6 latent variables including a general dental fear factor loading on all 20 items together with the aforementioned 5 factors. In spite of the limitation in sample size and the significant test statistic for this 6-factor structure, the model was interpretable in its dimensionality. In conclusion, these factor analyses have shown a different factor structure of the DFS in this sample of dental-phobic individuals as compared with the dimensions reported from previous research in samples representing nonclinical populations.     

Tobacco and ectopic pregnancy. Arguments in favor of a causal relation]

The aim of this paper was to study gender differences in the percept-genetic method Defense Mechanism Test (DMT) among a group of 60 adolescent subjects. Three subgroups were used: patients with psychotic disorders (Axis 1); borderline personality disorder (Axis 2) according to the DSM-IV classification system, and a non-patient group. The test protocols were scored with respect to 124 DMT variables and analyzed by means of the multivariate projection method Partial Least Squares (PLS) in latent structures. The overall results showed considerable gender differences in the whole group as well as in the subgroups. The most striking finding was that girls compared to boys were characterized by the perceptual defense identification with the opposite sex, which means that they perceived male gestalts instead of females in the stimulus picture. When both gender and diagnostic group membership were considered simultaneously, the influence of diagnostic group membership seemed to be stronger than gender even if there was an interaction between diagnoses and gender. It was concluded that gender must be considered when the DMT is used on adolescent populations.     

Latent structure and factorial invariance of a neuropsychological test battery for the study of preclinical Alzheimer's disease.

Objective: To examine the latent structure of a test battery currently being used in a longitudinal study of asymptomatic middle-aged adults with a parental history of Alzheimer's disease (AD) and test the invariance of the factor solution across subgroups defined by selected demographic variables and known genetic risk factors for AD. Method: An exploratory factor analysis (EFA) and a sequence of confirmatory factor analyses (CFA) were conducted on 24 neuropsychological measures selected to provide a comprehensive estimate of cognitive abilities most likely to be affected in preclinical AD. Once the underlying latent model was defined and the structural validity established through model comparisons, a multigroup confirmatory factor analysis model was used to test for factorial invariance across groups. Results: The EFA solution revealed a factor structure consisting of five constructs: verbal ability, visuospatial ability, speed & executive function, working memory, and verbal learning & memory. The CFA models provided support for the hypothesized 5-factor structure. Results indicated factorial invariance of the model across all groups examined. Conclusions: Collectively, the results suggested a relatively strong psychometric basis for using the factor structure in clinical samples that match the characteristics of this cohort. This confirmed an invariant factor structure should prove useful in research aimed to detect the earliest cognitive signature of preclinical AD in similar middle aged cohorts. (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)     

Inhibition of triazolam clearance by macrolide antimicrobial agents: in vitro correlates and dynamic consequences

OBJECTIVE: To evaluate the ability of the DSM-IV criteria for the pervasive developmental disorders (PDD) to reliably and accurately differentiate PDD subtypes. METHOD: The sample consisted of 143 children with various types of developmental disabilities. A diagnosis of PDD and PDD subtype was made by one clinician using information obtained from the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule. The raw data from the Autism Diagnostic Interview-Revised, clinical notes (excluding diagnostic opinion), Autism Diagnostic Observation Schedule, IQ, and other available data were independently assessed by three experienced raters, each of whom then made a separate, blind diagnosis. If there was any disagreement, a consensus best-estimate (CBE) diagnosis was made after discussion. To assess reliability, the agreement between the three raters was calculated using k. Accuracy was assessed by calculating the agreement between the clinician's diagnosis and the CBE and by calculating the error rates associated with the three raters using latent class analysis. RESULTS: The current DSM-IV criteria show good to excellent reliability for the diagnosis of PDD, Asperger's disorder (AsD), and autism, but they show poor reliability for the diagnosis of atypical autism. The clinician (compared to the CBE) had little difficulty differentiating PDD from non-PDD children and autism from AsD but had more difficulty identifying children with atypical autism. The latent class analysis also showed that the average error rates of the three raters for a differentiation of atypical autism from autism were unacceptably high. CONCLUSIONS: Although the psychometric properties of the current DSM-IV criteria for autism and AsD appear quite acceptable, there is likely to be a high rate of misclassification of children given a diagnosis of atypical autism.     

Item response theory analysis of diagnostic criteria for alcohol and cannabis use disorders in adolescents: Implications for DSM-V.

Item response theory (IRT) has advantages over classical test theory in evaluating diagnostic criteria. In this study, the authors used IRT to characterize the psychometric properties of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994) alcohol and cannabis use disorder symptoms among 472 clinical adolescents. For both substances, DSM-IV symptoms fit a model specifying a unidimensional latent trait of problem severity. Threshold (severity) parameters did not distinguish abuse and dependence symptoms. Abuse symptoms of legal problems and hazardous use, and dependence symptoms of tolerance, unsuccessful attempts to quit, and physical-psychological problems, showed relatively poor discrimination of problem severity. There were gender differences in thresholds for hazardous use, legal problems, and physical-psychological problems. The results illustrate limitations of DSM-IV criteria for alcohol and cannabis use disorders when applied to adolescents. The development process for the fifth edition (DSM-V) should be informed by statistical models such as those used in this study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Latent class and factor analysis of DSM-IV ADHD: a twin study of female adolescents

OBJECTIVE: In an attempt to validate the current DSM-IV criteria for attention-deficit/hyperactivity disorder (ADHD) in females and to determine whether symptoms are continuously distributed or categorically discrete, the authors performed factor and latent class analysis on ADHD symptom data from a large general population of adolescent female twins (1,629 pairs). METHOD: A structured diagnostic assessment of DSM-IV ADHD was completed with at least one parent of 1,629 pairs by telephone. ADHD symptoms from 1,549 pairs were subjected to latent class and factor analysis. RESULTS: Latent class and factor analyses were consistent with the presence of separate continuous domains of inattention (ATT), hyperactivity-impulsivity (H-I), and combined ATT with H-I problems. Severe latent classes corresponding to the predominantly inattentive, predominantly hyperactive-impulsive, and combined types were identified with lifetime prevalence estimates of 4.0%, 2.2%, and 3.7%, respectively. Membership in the severe ATT class predicted academic problems, family problems, and referral to health care providers. Membership in the H-I and combined classes also predicted impaired social relationships. CONCLUSIONS: These results suggest that DSM-IV ADHD subtypes can be thought of as existing on separate continua of inattention, hyperactivity-impulsivity, and combined type problems. Membership in any of there severe ADHD latent classes did not preclude academic excellence, but it was associated with different types of impairment and health care-seeking behavior. These data have implications in the areas of diagnosis, classification, treatment, and research.     

Does comorbid substance use disorder exacerbate borderline personality features? A comparison of borderline personality disorder individuals with vs. without current substance dependence.

There is compelling evidence that comorbid borderline personality disorder (BPD) negatively impact the clinical courses and outcomes of substance use disorders (SUD). Conversely, there is little evidence that concurrent SUD exacerbates the clinical characteristics of BPD. Thus, this study sought to examine whether the presence of current substance dependence among BPD patients would be associated with stronger BPD-relevant personality traits and behavioral characteristics. Female BPD patients without (BOR; n = 37) or with current substance dependence (BSUD; n = 19), and female non-BPD/SUD controls (CON; n = 48) were compared with respect to impulsivity, affective lability, affective intensity, externalizing behaviors, and self-harming/suicidal tendencies, taking into consideration their comorbid mood disorders, anxiety disorders, and antisocial personality disorder. Results indicated that both BOR and BSUD groups scored higher than CON in most of the measures, but BOR and BSUD failed to reveal significant group differences especially when the influence of comorbid psychopathology was removed. The overall pattern of findings remained identical even when comparing BPD patients with versus without the diagnosis of lifetime substance dependence. Our results do not support the notion that BPD individuals with SUD display more severe BPD features than individuals with BPD alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding the heterogeneity of BPD symptoms through latent class analysis: Initial results and clinical correlates among inner-city substance users.

The current study investigated the heterogeneity of borderline personality disorder (BPD) symptoms in a sample of 382 inner-city, predominantly African American male substance users through the use of latent class analysis. A 4-class model was statistically preferred, with 1 class interpreted to be a baseline class, 1 class interpreted to be a high-BPD class, and 2 classes interpreted as intermediate classes. As a secondary goal, we examined the resulting BPD classes with respect to relevant clinical correlates, including temperamental vulnerabilities (affective instability, impulsivity, and interpersonal instability), childhood emotional abuse, drug choice, and co-occurring mood and anxiety disorders. The high-BPD class evidenced the highest levels of the temperamental vulnerabilities and environmental stressors, the baseline class evidenced the lowest levels, and the 2 intermediate classes fell in between. In addition, the high-BPD class had a higher probability of cocaine and alcohol dependence, as well as mood and anxiety disorders, than did the baseline class. Rates of alcohol use and mood disorders for the intermediate classes fell in between the high-BPD and the baseline classes. Results are discussed in relation to the current diagnostic conceptualization of BPD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)