Role orientation, sphere dominance, and social competence as bases of psychiatric diagnosis in Japan: A replication and extension of American findings.

Replicated the american study by L. Phillips, I. Broverman, and E. Zigler (see pa, vol. 42:17396) in 412 hospitalized japanese psychiatric patients. Results substantiate the existence of significant relationships between diagnosis and the symptom styles of role orientation (turning against self or others and avoidance of others) and sphere dominance (thought, affect, and action). These relationships, however, differed in many specific respects from those established in the united states. Social competence and symptom styles, both singly and jointly, were significantly associated with diagnosis. Results indicate the extent and the limits of comparability of the empirical bases of psychiatric diagnosis in the 2 countries. (15 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathology in pediatric complex partial and primary generalized epilepsy

Structured psychiatric interviews were administered to 60 children with complex partial seizure disorder (CPS), 40 children with primary generalized epilepsy with absences (PGE), and 48 control children, aged 5 to 16 years. Significantly more patients with epilepsy had psychiatric diagnoses compared with the control children. There were no statistically significant differences, however, in the number of patients with CPS and PGE with psychiatric diagnoses. Other than a schizophrenia-like psychosis found only in the patients with CPS, the two groups of patients had similar psychiatric diagnoses. The presence of psychopathology was related to significantly lower IQ scores and socioeconomic status, but not to seizure-related factors. These findings suggest that the psychopathology of children with CPS and PGE reflects different subtle neuropsychological deficits.     

Diagnostic accuracy of a rural live video telepathology system

Accuracy of diagnoses rendered using a live video telepathology network was assessed for permanent sections of surgical pathology specimens. To determine accuracy, telepathology diagnoses were compared with those obtained by directly viewing the glass slide using a standard microscope. A total of 294 cases were read via both telepathology and glass slide by attending pathologists at a tertiary care medical center. Overall accuracy was defined as exact concordance between diagnoses. Clinically insignificant differences in diagnoses were excluded to determine clinically significant accuracy. For the 285 cases with complete data, the overall accuracy for telepathology was 0.912 (95% confidence interval [CI], 0.872-0.941), whereas the overall accuracy for glass slide readings was 0.968 (95% CI, 0.939-0.985). This difference is statistically significant (p = 0.009). When focusing on clinically significant discrepancies, where the difference in diagnosis might affect therapeutic decisions, the video accuracy was only slightly less than the glass slide accuracy (0.965 [95% CI, 0.934-0.982] vs. 0.982 [95% CI, 0.957-0.994], respectively), but this difference is not statistically significant (p = 0.302). Most of the cases with clinically significant differences involved lesions with inherently high interobserver variation. Certainty of diagnosis did not differ between video and glass slide readings (p = 0.911), but there was an association between certainty of diagnosis and diagnostic accuracy for video (p = 0.003 for clinically significant accuracies). Based on these findings, we recommend when using this telepathology system that only preliminary diagnoses should be given in the following situations: for diagnostic areas with known high interobserver variability; when the consultant has any degree of uncertainty about the presence or absence of the lesion in question; and when there is insufficient experience using telepathology as a diagnostic medium.     

Do substance abuse patients with more psychopathology receive more treatment?

The association between psychopathology at treatment entry and the amount of treatment services received was evaluated in 104 alcohol-dependent and 100 cocaine-dependent male veterans treated for 1 month in either a day hospital or inpatient program. Measures of psychopathology included the Addiction Severity Index psychiatric composite score, the presence or absence of an antisocial personality disorder diagnosis, and the total number of additional lifetime or current psychiatric diagnoses. Patients with higher admission Addiction Severity Index psychiatric composite scores received more medical, alcohol, family/social, and psychiatric services. There was also preliminary evidence that patients who received more treatment showed greater improvement 7 months after admission. The relationships between the other measures of psychopathology and treatment services failed to achieve overall statistical significance, although significant relationships were found in several individual areas.     

Coronary reserve of high- and low-flow regions in the dog heart left ventricle

OBJECTIVE: To examine the relationship between psychopathology and health care utilization beginning in the preschool (ages 2 to 5) years. METHOD: Five hundred ten preschool children were enrolled through 68 primary care physicians. The test battery used for diagnoses included the Child Behavior Checklist, a developmental evaluation, the Rochester Adaptive Behavior Inventory, and a videotaped play session. Consensus DSM-III-R diagnoses were assigned using best-estimate procedures. Frequency of primary care visits was established through 1-year retrospective record review; mothers estimated total visits and emergency department (ED) use. RESULTS: Logistic regression models showed that a DSM-III-R diagnosis was related to increased ED use but not primary care or total visits. Greater functional impairment was associated with fewer primary care visits and more ED visits. Total, internalizing, and externalizing behavior problem scores were associated with increased primary care and total visits; ED visits were associated with increased total and internalizing problems. Child's health status consistently correlated with utilization. CONCLUSION: There is a consistent relationship between health care use and child psychopathology beginning in the preschool years.     

The role of clinical autopsy in monitoring the quality of the clinical diagnosis in an emergency department

OBJECTIVE: A total of 61 autopsies performed in patients died in emergency department of a university hospital were retrospectively analysed and the findings were compared with clinical diagnoses. METHODS: Sensitivity and specificity of the clinical diagnoses and the correction of medical procedures were measured. The influence of age and sex of patients was analyzed using Fisher's exact test and chi-square-test. RESULTS: The most common causes of death were cardiovascular diseases (52.46%). Autopsy showed unexpected major findings in 44.26% of cases. Major discrepancies between the autopsy reports and the clinical diagnoses, were present in 26.22% of all cases. Absolute concordance between clinical and autopsy diagnoses was obtained in 44.26% of cases. The major sensitivity of clinical diagnosis was found in cerebrovascular disorders (100%), upper digestive hemorrhage (100%), and acute myocardial infarction (82.35%). The lowest sensitivity was found in malignant tumors (16.66%), hemorrhagic pancreatitis (0%) and bowel infarction (0%). The patient cares were correct in 68.85% of cases. No statistically significant differences were observed in relation to age and sex. CONCLUSIONS: We concluded that autopsy is a useful method for evaluate diagnostic procedures and quality of medical cares in emergency departments.     

Thirty-six cases of obturator hernia: does computed tomography contribute to postoperative outcome?

Obturator hernia is relatively rare and occurs mostly in elderly, thin, multiparous women. Recent reports have highlighted the importance of pelvic computed tomography (CT) for the preoperative diagnosis. Thirty-six patients with an obturator hernia operated in our hospital were divided retrospectively into two groups (group A: 18 operations from 1973 to 1986, before we used CT; group B: 18 CT cases from 1987 to 1995). Preoperative diagnoses, operative procedures, and postoperative course were reviewed. No statistically significant differences were found between groups A and B in terms of patient characteristics. Rates of accurate preoperative diagnoses were significantly higher in group B: 39% (7/18) in group A and 78% (14/18) in group B (p = 0.018). The intraoperative findings, occurrence of postoperative complications, and overall mortality rates were similar between the two groups. There were four postoperative deaths (mortality rate 11%). Three of four patients who died had panperitonitis because of small bowel perforation. The correct preoperative diagnosis of obturator hernia was facilitated by CT of the pelvis, but it has no impact on patient outcome. Early diagnosis and surgical intervention are essential for this rare entity.     

Osteoarthritis and synovitis as major pathoses of the temporomandibular joint: comparison of clinical diagnosis with arthroscopic morphology

PURPOSE: The purposes of this investigation were to determine how common osteoarthritis and synovitis are in patients with severe, recalcitrant temporomandibular joint (TMJ) symptoms using clinical diagnostic criteria as well as arthroscopic examination, and to compare the accuracy of the clinical and arthroscopic diagnoses with respect to specificity and sensitivity. PATIENTS AND METHODS: Clinical and arthroscopic diagnoses were established in 126 joints of 84 patients with severe TMJ symptoms recalcitrant to conservative therapy. All joints were classified as having osteoarthritis (OA) or no osteoarthritis (non-OA) and synovitis (syn) or no synovitis (non-syn) using clinical and arthroscopic criteria. Chi-squared analysis was used to determine whether there was a relationship between the clinical and arthroscopic diagnoses. Preoperative clinical diagnoses were compared with arthroscopic morphologic diagnoses to determine the specificity and sensitivity of the clinical diagnostic criteria for synovitis and osteoarthritis. RESULTS: A preoperative clinical diagnosis of OA was established in 59 of 126 joints (47%) compared with an arthroscopic diagnoses of OA in 82 of 126 joints (65%). Chi-squared analysis showed a significant relationship between the clinical and arthroscopic diagnosis of OA. A clinical diagnosis of OA was associated with a high specificity (.977); however, there were 23 of 82 (.293) false-negative findings and a sensitivity of only .707. A preoperative clinical diagnosis of synovitis was established in 114 of 126 joints (90%), compared with an arthroscopic diagnosis of synovitis in 112 of 126 (89%). Chi-squared analysis did not show a significant relationship between the clinical and arthroscopic diagnosis of synovitis. A clinical diagnosis of synovitis was associated with a high sensitivity (.920); however, there were 11 of 14 false-positive findings (.786) associated with a low specificity (.214). CONCLUSIONS: Although there was high specificity for the clinical diagnosis of OA, the sensitivity was very low. (Comparison of clinical and arthroscopic diagnoses showed that osteoarthritis frequently escapes clinical detection. The clinical diagnosis of synovitis showed that low specificity and symptoms may be caused by other pathoses.     

Reducing the threat: an experiential exercise to introduce role play to student nurses

OBJECTIVE: To determine if cervical smears obtained with an Ayre spatula and a cytobrush are better detectors of atypia and dysplasia than the modified Ayre spatula alone, as determined by a 2-year clinical follow-up study. METHOD: Paired cervical samples were obtained, one using a modified Ayre spatula and the other a cytobrush. In those smears with any abnormality, follow-up after 2 years documented subsequent cytologic and/or histologic diagnosis. The statistical relationship between the screening tests and follow-up cytologic diagnosis was investigated. SETTING: Seven hundred ninety-two women, aged 18 years and older, who presented to a family practice residency clinic for Papanicolaou tests. RESULTS: The correlation coefficient for the diagnoses obtained using the modified Ayre spatula and the clinical follow-up was .40 (P = .0008), while the correlation coefficient between the cytobrush samples and the clinical follow-up diagnoses was .25 (P = .04). The kappa statistics indicate statistically significant concordance only between the spatula and the follow-up diagnoses. CONCLUSIONS: Cervical smears obtained with a modified Ayre spatula correlated significantly with the follow-up diagnoses. As cervical sampling tools emerge, they need to be evaluated on the basis of accurate identification of significant clinical disease, not only on the basis of obtaining endocervical cells to avoid unnecessary repetition of screening tests and diagnostic workups.     

Multivariate structure of associations between verbal and nonverbal intelligence among brain-damaged, schizophrenic, neurotic, and alcoholic patients.

The scores of 380 male Ss—brain-damaged, process schizophrenic, reactive schizophrenic, neurotic, and alcoholic patients—on the Verbal and Performance subtests of the WAIS were subjected to canonical correlational and multiple discriminant analyses. Substantial associations between verbal and nonverbal abilities were found for all groups, although these correlations were sufficiently imperfect that each set of subtests contributed independently to group discrimination when combined with the other set. Results support C. Spearman's (1927) view that measures of intelligence contain both general and specific components of variance and not the high degree of differentiation that is sometimes postulated. It is concluded that major forms of psychopathology are characterized more by differences in intellectual profile patterns than by changes in the basic organization of abilities. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health treatment outcome by sex, diagnosis, and treatment agency.

Analyzed the effect of client characteristics and treatment on 9 dimensions of functioning (e.g., sociolegal, thought processes, and interpersonal relations) among 1,519 male and 1,877 female patients. MANOVA yielded consistent and significant differences in levels of functioning at admission as a function of sex, treatment setting, and diagnosis. Women with transient disorders showed the most adequate functioning. A Diagnosis?×?Agency interaction was also significant and indicated greater differences in functioning at admission between hospitalized and nonhospitalized Ss with "less severe" diagnoses than for Ss with schizophrenia or personality disorders. Subsequently, MANCOVA was used to partial out the effects of admission level of functioning on terminal level of functioning. Several significant differential effects of treatment and client characteristics were noted. There were fewer differences at termination than at admission, and significant differences in terminal level of functioning were observed by sex, diagnosis, and treatment agency. The interaction of sex and diagnosis was significant as was the interaction between agency and diagnosis. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Focal calvarial bone lesions. Comparison of logistic regression and neural network models

RATIONALE AND OBJECTIVES: To assess the accuracy of logistic regression (LR) and artificial neural networks (NN) in the diagnosis of calvarial lesions using computed tomography (CT) and to establish the importance of the different features needed for the diagnosis. METHODS: One hundred sixty-seven patients with calvarial lesions as the only known disease were enrolled. The clinical and CT data were used for LR and NN models. Both models were tested with the leave-one-out method. The final results of each model were compared using the area under receiver operating characteristic curves (Az). RESULTS: Of the lesions, 73.1%, were benign and 26.9% were malignant. There was no statistically significant difference between LR and NN in differentiating malignancy. In characterizing the histologic diagnoses, NN was statistically superior to LR. Important NN features needed for malignancy classification were age and edge definition, and for the histologic diagnoses matrix, marginal sclerosis, and age. CONCLUSION: NNs offer wide possibilities over statistics for the study of calvarial lesions other than their superior diagnostic performance.     

Validity of the distinction between generalized social phobia and avoidant personality disorder.

Disorders of pervasive social anxiety and inhibition are divided into 2 categories: generalized social phobia (GSP) and avoidant personality disorder (APD). The authors explored the discriminative validity of this categorization by examining the comorbidity of GSP and APD and by comparing these groups on anxiety level, social skills, dysfunctional cognitions, impairment in functioning, and presence of concurrent disorders. Results from 23 Ss showed high comorbidity of the 2 diagnoses: All Ss who met criteria for APD also met criteria for GSP. APD was associated with greater social anxiety, impairment in functioning, and comorbidity with other psychopathology, but no differences in social skills or performance on an impromptu speech. GSP and APD seem to represent quantitatively different variants of the same spectrum of psychopathology rather than qualitatively distinct disorders. The authors also investigated a proposed social phobia subtyping scheme. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A seven-year follow-up of intelligence test scores of foster grandparents

After 7 years, a group of originally nonemployed poverty-level older people (over 60) who had been employed as foster grandparents were retested with the WAIS. Four WAIS subtests - Vocabulary Similarities, Digit Span, and Block Design - were employed. Of the original group of 39, complete data were available for 28; 18 of these were still working on the project, and the other 10 had dropped out. Dropouts as a group tested lower originally and also showed more deterioration in functional health ratings over time. For the total group of 32 foster grandparents, three subtest scores showed stability over the 7 years. Only Digit Span showed a statistically significant drop. Neither age nor the initial level of health or WAIS scores was related to test-score changes over time.     

Wechsler comprehension and picture arrangement subtests and social adjustment.

Despite their widespread application, many of the D. Rapaport et al (1968) hypotheses regarding the Wechsler intelligence tests have not achieved empirical support. To test the assumption that the Comprehension and Picture Arrangement subtests are socially sensitive components of the Wechsler scales, individual subtest scores of the Wechsler Adult Intelligence Scale (WAIS) and Wechsler Intelligence Scale for Children (WISC) were correlated with clinician ratings of social competence and hostility. In these analyses, 175 normal Ss and 206 Ss at risk for psychopathology were examined during both childhood and adolescence. Although some support for the hypothesized relationship regarding the Comprehension subtest was found for normal Ss in childhood, overall, the results did not support the assumption that the Comprehension or Picture Arrangement subtests are generally sensitive to social functioning. Implications of differences in patterns between at-risk and normal groups across ages are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Safety and tolerability of intravenous cibenzoline for acute termination of spontaneous sustained ventricular tachycardia. Cibenzoline and spontaneous VT

OBJECTIVE: To examine the rate of persistence of borderline personality disorder (BPD), the existence of concomitant personality disorders on follow-up, and the predictors of outcome in patients who met criteria for BPD compared with patients with borderline features who failed to meet all of the criteria. METHOD: This prospective cohort study reassessed subjects for BPD diagnosis and cooccurring personality pathology at 7 years follow-up. Initial measures of borderline and comorbid personality psychopathology were used to predict levels of borderline or other personality disorder psychopathology at follow-up. RESULTS: Of the 57 subjects who initially met the criteria for BPD, 30 (52.6%) were found to have remitted BPD, and 27 (47.4%) were characterized as having persistent BPD. The remitted group met significantly fewer comorbid personality disorder diagnoses than the persistent group (mean = 0.8, mean = 3.5 respectively; P < 0.05). Results also indicated that the initial level of borderline psychopathology was predictive of borderline psychopathology at follow-up, which explained 17% of the variance. CONCLUSIONS: This prospective follow-up study found that almost 50% of former inpatients with BPD continue to test positive for BPD at 7 years follow-up, and these persistent BPD patients also had significantly more comorbid personality psychopathology. Borderline psychopathology at follow-up was primarily predicted by the level of borderline psychopathology recorded at the initial assessment.     

Alcohol use disorders and neuropsychological functioning in first-year undergraduates

The relation between alcohol use disorders and neuropsychological functioning was examined in 489 first-year undergraduates, approximately half of whom had a history of alcoholism in their biological fathers. Factor analyses of 17 neuropsychological tests and subtests produced the following 5 factors that were the basis of subsequent analyses: Language/Verbal Memory, Visuospatial Ability, Motor Speed, Booklet Category Performance, and Attention. Participants with alcohol use disorders showed deficits in visuospatial ability. Those who had alcohol dependence showed deficits in both visuospatial ability and motor speed relative to participants who abused alcohol. The differences in neuropsychological functioning remained even after several potential confounding variables were controlled statistically. Results suggest that alcohol use disorders in first-year college students are associated with deficits in neuropsychological measures that are not attributable to several potential third-variable explanations.     

Culture and youth psychopathology: Testing the syndromal sensitivity model in Thai and American adolescents.

Current widespread use of the same youth assessment measures and scales across different nations assumes that youth psychopathology syndromes do not differ meaningfully across nations. By contrast, the authors' syndromal sensitivity model posits 3 processes through which cultural differences can lead to cross-national differences in psychopathology syndromes. The authors tested this model in a comparison of Child Behavior Checklist syndromes for adolescents in Thailand and the United States. In support of the model, about half of the Thai-U.S. syndrome comparisons showed poor agreement (kappa = .40), and distinctive Thai syndromes emerged reflecting 3 prominent themes in Thai research literature: delayed maturation, indirect aggression and/or delinquency, and sex problems in boys. Such syndromal dissimilarity carries significant implications for assessment, diagnosis, epidemiology, and intervention across national boundaries. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trends in students'' knowledge, opinions, and experience regarding dental informatics and computer applications

OBJECTIVE: To analyze the discriminative capability of morphometric assessment of nuclear morphology in the differential diagnosis of small round blue cell tumors (SRCTs) of bone and soft tissue. STUDY DESIGN: The study material consisted of glutaraldehyde-fixed, resin-embedded, semithin sections from 119 human tumors. Nuclear area, perimeter, maximum diameter, form factors and nuclear density were measured in at least 300 nuclei per case. RESULTS: Neuroblastoma (NB) (10 cases) showed the most regular pattern. Ewing's sarcoma (ES) (35 cases); atypical Ewing's sarcoma (AEs) (15 cases) and peripheral neuroectodermal tumors (PNET) (30 cases) showed no significant differences regarding area, perimeter or form factors, but AEs showed a lower mean nuclear density that was statistically significant. Rhabdomyosarcomas (6 cases) and osteosarcomas (OS) (11 cases) were used as controls and showed several morphometric and stereometric differences with other SRCTs, whereas microcellular OSs (6 cases) shared features of SRCTs and conventional osteosarcomas. CONCLUSION: Morphometric characterization of nuclear features reveals differences between the distinct groups of SRCTs. Although overlapping occurred between all these groups at the individual case level, this study provides new support for the existence of morphologic links within the family of ES and PNET.