Decision rules for phenomenological classification of psychiatric patients.

Used cluster analysis and related numerical taxonomy methods to identify 8 distinct phenomenological types in the psychiatric population, and prototype patterns for the types are described in terms of the Brief Psychiatric Rating Scale (BPRS) profiles. Numerical methods are provided for classifying individual patients based on similarity to the prototype patterns. Patients can also be classified operationally by simple decision rules involving 2-point code typing of BPRS profile patterns. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

New classification and diagnostic criteria for diabetes mellitus

The new Classification and Diagnostic Criteria for Diabetes Mellitus (DM), prepared by a group of experts from the American Diabetes Association is presented and analyzed. On an etiopathogenic basis, it designates Insulin Dependent and Non Insulin Dependent as Type 1 and Type 2 respectively. It specifies DM having specific known causes. It maintains Gestational Diabetes and Glucose Intolerance and adds the Impaired Fasting Glucose Condition. It recommends fasting plasma glucose for search and diagnosis, and lowers the level to > or = 126 mg/dl instead of > or = 140 mg/dl, due to its association with chronical complications of DM. It maintains the diagnostic criteria of random and post charge glycemia > or 200 mg/dl. It does not alter the glucose intolerance figure (140-200 mg/dl in OGTT) and introduces fasting abnormality > or = 110 and < 126 mg/dl. It encourages the search with fasting glucose every 3 years in individuals aged over 45, and at more frequent intervals in younger individuals with high risk factors. Analysis of the report allows to conclude that, although the classification does not introduce any significant change in daily clinical use, its pathogenic orientation makes future innovations possible. The preferential use of fasting glucose > or = 126 mg/dl for diagnosis of DM has theoretical basis and practical advantages. Identification of individuals with impaired fasting glucose allows to detect, in a simple manner, a high risk group in which to start preventive measures. However, there is a percentage of cases which are not diagnosed by fasting glycemia, but are diagnosed by OGTT, therefore the latter should not be discarded.     

Attention deficit/hyperactivity. Diagnostic criteria and classification]

Following several reports on treatment of adults with attention deficit/hyperactivity disorder, diagnostic problems regarding the diagnosis are discussed. Symptoms and criteria have changed considerably over the years. Many of those who were given this diagnosis earlier would probably be given a different diagnosis today. Patients should be diagnosed according to the latest diagnostic criteria, but these are developed for children, and are not always adequate for adults. Knowledge regarding the manifestation of the disorder in adults is not sufficient. In order to make this diagnosis in an adult, there must be evidence of the symptoms at the time of examination and also in childhood. The latter may be difficult or impossible to demonstrate. Reliable information on the symptomatology of attention deficit/hyperactivity disorder in adulthood will not be available until children who are given the diagnosis today according to DSM-IV or the research criteria of ICD-10 have been followed up in adulthood.     

Metaphorical analysis of psychiatric classification as a psychological test.

In this taxonomic article we explore the metaphor of comparing a psychiatric classification to a psychological test. Structurally, diagnostic criteria are like test items; diagnostic categories are like scales; and classifications are like tests. Analytically, the ideas of reliability and validity are the primary concepts invoked in the empirical evaluation of both classifications and tests. However, when the metaphor is explored in more detail, the differences between classifications and tests become clear. These differences are discussed in terms of the structural and analytical relations between tests and classifications. This metaphorical analysis of classifications as tests suggests that certain issues that have been discussed in regard to psychological tests, particularly reliability and validity, may require modification when applied to psychiatric classification. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examining classification criteria: A comparison of three cut score methods.

This study compared 3 different methods of creating cut scores for a screening instrument, T scores, receiver operating characteristic curve (ROC) analysis, and the Rasch rating scale method (RSM), for use with the Behavioral and Emotional Screening System (BESS) Teacher Rating Scale for Children and Adolescents (Kamphaus & Reynolds, 2007). Using the BESS norm data set, we compared the methods across 7 classification indices. Additional information about accuracy was used with a subset of children who had been given a prior diagnosis for selected disorders. The results showed that the methods were generally in concordance, with similarities identified across methods. RSM and ROC analysis methods performed similarly, with both methods identifying the same optimal cut-point. The method based on T scores appeared to be more conservative, identifying a lower cut score as optimal. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The effects of employing different termination classification criteria in dropout research.

Compared differences between therapy terminations categorized by duration and those categorized by therapist judgment in 152 consecutive mental health center outpatient (average age 27 yrs) treatment terminations, in order to demonstrate distinctions between early dropouts and early completers. The sample was first divided based on treatment duration. Terminated Ss who had made 1–5 visits (early terminators) were compared to those with 6 or more visits (late terminators). Early dropouts were then compared to early completers by comparing therapist-classified dropouts who attended 1–2 visits with therapist-classified completers who attended 1–3 visits. Significant differences were found between dropouts and completers on 11 of 18 client and therapist variables when classified by therapist judgments; no differences were found when the groups were classified using duration criteria. Within the therapist-classified groups, low-visit dropouts were found to differ from low-visit completers on 8 of 18 variables. The pattern of results strongly supports the superiority of the therapist classification procedure. It is recommended that duration-based classification not be employed in future investigations of continuance unless investigators explain why such a classification is appropriate for specific variables being investigated and acknowledge the limitations of the approach. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurobehavioral approach to classification of psychiatric patients using a competency model.

Performed Q-type factor analyses on 25 neuropsychological variables for 3 samples of right-handed adult psychiatric patients to test the hypothesis that degree and type of impairment are substantially independent of psychiatric status. Ss included an initial sample of 218 Ss, a within-laboratory replication sample of 175 Ss, and a cross-laboratory, cross-national replication sample of 102 Ss. Each S was administered a battery of tests, including the WAIS, MMPI, Halstead-Reitan Neuropsychological Test Battery, and Wechsler Memory Scale. Factor analysis classified 71% of Ss into 6 groups with strong within- and across-laboratory replications. Each group had a unique profile of competencies and deficits that was independent of psychiatric status with the exception of a group comprised primarily of young, poorly educated males with histories of learning disability and drug abuse. It is concluded that a classification system with associated treatment interventions based on patient's profile of competencies and deficits would be more useful in treatment planning than a system based on traditional nosology. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Criteria for criteria.

"When one selects a criterion to evaluate the effectiveness of some independent variable, the choice is frequently made… . [on the basis of] relevance, expedience, or precedence." Among the criterion dimensions which might be studied are: (a) Time. (When is the measurement taken?) (b) Type. (What performance measure is selected and why that one?) (c) Level. (What level of performance is considered success or failure?) "If we knew more about the functioning of criterional variables, we should be able to predict which criteria are relevant for assessing effects of independent variables and with this knowledge, be able to state more concerning the operations of the independent and the intervening variables." From Psyc Abstracts 36:02:2AF28W. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluative conditioning may incur attentional costs.

Evaluative conditioning (EC) refers to changes in the liking of an affectively neutral stimulus (conditioned stimulus, or CS) after pairing this stimulus with an affect-laden stimulus (unconditioned stimulus, or US). Several authors proposed that EC incurs little or no attentional cost. Using a rigorous design, we provide evidence that a reduction in attentional resources may have a negative impact on EC. Additional analyses also revealed that participants correctly encoded fewer CS–US pairings when their attentional resources were depleted. Replicating Pleyers, Corneille, Luminet, and Yzerbyt’s (2007) findings, EC was also obtained only for CSs that could be correctly linked to their associated US in the context of an identification task. This research clarifies the role of higher order processes in EC and has significant practical implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fundamental neuroscience and the classification of psychiatric disorders

Non-Darwinian views of evolution of nervous systems (e.g., Jacksonian evolution) conceive the present structure of the human brain as composed of a series of additive layers representing successive phylogenetic stages in evolution, layers which remain static after their emergence. In contrast to this view, recent allometric studies clearly show that limbic structures scale with the growth of the human brain (i.e., they do not remain stable but reach the size expected for the brain of a primate with the weight of a human brain). Data also show that limbic structures are significantly involved in cognitive functions such as memory and attention. Hence overlap of lesions in similar brain loci, especially in limbic regions, in both manic-depression and schizophrenia should come as no surprise. In the psychobiological sphere, the need for cognitive perceptual evaluation of the external world and internal state for emotional experience, further to the necessary visceral arousal, leads to a breakdown of the platonic, essentialist position, emotion vs. cognition at the psychological level, a problematic issue for the Kraepelinean view. Neural networks operation depend upon multiple nonlinear processes at the cellular, synaptic and network levels. Afferent input may serve not only to activate, but also to configure them into one of several circuit modes. These networks have been named polymorphic and can, at least to a measure, account for commonalities in lesion sites, in both affective and schizophrenic diseases. It is proposed that fundamental neuroscience should serve as one of the bases for the classification of psychiatric disorders.     

Differential criteria and classification of traumatisms at home

Communal traumatism represents a heterogeneous phenomenon in whose structure latent, outpatient, hospital, invalidating, and lethal communal traumatism should be distinguished. The said types of traumatism differ by the incidence, share, mean age of the victims, predominating type of injuries, share of multiple injuries, time of application for primary health care, share of ambulance calls, percent share of invalidity, type and duration of invalidity, and outcome of injury. The severity of communal traumatism gradually increases from the first to the last named type and depends on the type of injury and development of complications.     

Increasing the impact of cluster analysis research: The case of psychiatric classification.

The publication of the DSM-III by the American Psychiatric Association has fueled interest among psychologists in developing alternative classifications. A popular approach is to use multivariate methods known as cluster analysis to identify clinical syndromes. Empirical clustering techniques offer potential for making diagnoses more objective, reliable, and predictive of outcome from differential treatment. However, problems exist at the interface between this statistical technology and psychiatric classification. To date, cluster-analytic studies have had limited impact on psychiatric nomenclature, and clinicians have not found the cluster-derived syndromes to be relevant to everyday practice. The present authors discuss reasons that underlie the lack of impact and describe directions for upgrading both the scientific quality and clinical acceptance of cluster-analysis research. It is concluded that more emphasis must be placed on fostering the clinical use of empirically derived classifications. (69 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnosis and classification of diabetes mellitus: new criteria

New recommendations for the classification and diagnosis of diabetes mellitus include the preferred use of the terms "type 1" and "type 2" instead of "IDDM" and "NIDDM" to designate the two major types of diabetes mellitus; simplification of the diagnostic criteria for diabetes mellitus to two abnormal fasting plasma determinations; and a lower cutoff for fasting plasma glucose (126 mg per dL [7 mmol per L] or higher) to confirm the diagnosis of diabetes mellitus. These changes provide an easier and more reliable means of diagnosing persons at risk of complications from hyperglycemia. Currently, only one half of the people who have diabetes mellitus have been diagnosed. Screening for diabetes mellitus should begin at 45 years of age and should be repeated every three years in persons without risk factors, and should begin earlier and be repeated more often in those with risk factors. Risk factors include obesity, first-degree relatives with diabetes mellitus, hypertension, hypertriglyceridemia or previous evidence of impaired glucose homeostasis. Earlier detection of diabetes mellitus may lead to tighter control of blood glucose levels and a reduction in the severity of complications associated with this disease.     

Evaluative conditioning in humans: A meta-analysis.

This article presents a meta-analysis of research on evaluative conditioning (EC), defined as a change in the liking of a stimulus (conditioned stimulus; CS) that results from pairing that stimulus with other positive or negative stimuli (unconditioned stimulus; US). Across a total of 214 studies included in the main sample, the mean EC effect was d = .52, with a 95% confidence interval of .466–.582. As estimated from a random-effects model, about 70% of the variance in effect sizes were attributable to true systematic variation rather than sampling error. Moderator analyses were conducted to partially explain this variation, both as a function of concrete aspects of the procedural implementation and as a function of the abstract aspects of the relation between CS and US. Among a range of other findings, EC effects were stronger for high than for low contingency awareness, for supraliminal than for subliminal US presentation, for postacquisition than for postextinction effects, and for self-report than for implicit measures. These findings are discussed with regard to the procedural boundary conditions of EC and theoretical accounts about the mental processes underlying EC. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Information criteria for pairwise comparisons.

A new approach is presented for the interpretation of differences among means and proportions. Post hoc techniques, such as Tukey's honestly significant difference procedure, have interpretive problems related to intransitive decisions and technical issues arising from unequal sample sizes or heterogeneity of variance. These concerns can be avoided by considering ordered subsets of means and by using information criterion to select among competing models. This paired-comparisons information-criterion (PCIC) approach is wholistic in nature and does not depend on interpreting a series of statistical tests. Simulation results suggest that a protected version of the PCIC procedure is desirable to minimize failures to detect the null case. This technique is illustrated for independent means, proportions, and means from repeated measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A rationale for psychiatric selection.

Psychiatric selection procedures are assumed to aid efficient performance and to protect the individual from the consequences of failure. Despite difficulties and shortcomings, "… psychiatric selection is a demonstrably valid and socially useful procedure." Several studies are cited which "… have substantiated the validity of psychiatric selection, demonstrated its value in the military services, shown that it can be established on a sound scientific basis, and indicated that future experimental investigation can hope to increase the range of its application and raise its present level of efficiency." 22 references. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluative reaction to interpersonal touch in a counseling interview.

Investigated the effects of the use of touch gestures by counselors on client evaluative responses to the counseling experience, using a 2 (touch vs no touch)?×?2 (male vs female client)?×?2 (male vs female counselor) between-Ss design. Clients who were touched evaluated the counseling experience more positively than no-touch control Ss. However, the magnitude of the effect of touch was affected by the sex composition of the counseling dyad, with stronger effects occurring when clients were touched by an opposite-sex counselor. Results are discussed in terms of conceptual implications and with respect to applied relevance for therapeutic practice and the training of counselors. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)