Developmentally sensitive diagnostic criteria for mental health disorders in early childhood: The diagnostic and statistical manual of mental disorders—IV, the research diagnostic criteria—preschool age, and the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood—Revised.

As the infant mental health field has turned its focus to the presentation, course, and treatment of clinically significant mental health disorders, the need for reliable and valid criteria for identifying and assessing mental health symptoms and disorders in early childhood has become urgent. In this article we offer a critical perspective on diagnostic classification of mental health disorders in young children. We place the issue of early childhood diagnosis within the context of classification of psychopathology at other ages and describe, in some detail, diagnostic classifications that have been developed specifically for young children, including the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–3R; ZERO TO THREE, 2005), a diagnostic classification for mental health symptoms and disorders in infants, toddlers, and preschoolers. We briefly outline the role of diagnostic classification in clinical assessment and treatment planning. Last, we review the limitations of current approaches to the diagnostic classification of mental health disorders in young children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for trauma histories, posttraumatic stress disorders (PTSD) and subthreshold PTSD in psychiatric outpatients.

The ability of the Structured Clinical Interview for DSM-IV (SCID) posttraumatic stress disorder (PTSD) module's screening question to identify individuals with PTSD or subthreshold PTSD was examined. First, the screen's sensitivity for detecting a trauma history was determined. Second, the incremental validity of a more thorough trauma assessment was examined by determining how many individuals responded negatively to the screen but then were diagnosed with PTSD or subthreshold PTSD. Last, the optimal SCID termination point for assessing subthreshold PTSD was determined. Using a trauma list increased the number of participants reporting a trauma; however, the SCID screen captured almost all individuals who had PTSD or subthreshold PTSD. When one screens for subthreshold PTSD, the SCID can be terminated on failure to meet Criterion B. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Shedler-Westen Assessment Procedure-200 as a basis for modifying DSM personality disorder categories.

The Shedler-Westen Assessment Procedure-200 (SWAP) is a Q-sort instrument designed to assess personality pathology on the basis of clinician ratings. On the basis of research with the SWAP, its creators have proposed a group of 12 personality disorder (PD) diagnoses that can be used to replace or modify current Axis II categories of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The authors discuss conceptual and empirical issues that require clarification before this proposal can be properly evaluated. They identify problematic psychometric features of the SWAP, including its unrepresentative normative sample, its reliance on a fixed skewed distribution, and anomalies in its T-score approach to diagnoses. In addition, a review of research on SWAP-based PD categories indicates that important information regarding diagnostic coverage, validity, and temporal stability is presently lacking. The authors conclude that research evidence is currently insufficient to justify the use of SWAP-based PD categories to guide revision of the DSM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating disorder diagnoses: Empirical approaches to classification.

Decisions about the classification of eating disorders have significant scientific and clinical implications. The eating disorder diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) reflect the collective wisdom of experts in the field but are frequently not supported in empirical studies and do not capture the disorders of eating experienced by most people with an eating disorder. Statistical approaches to classification such as latent class analysis and taxometrics can help to create a classification system with greater scientific validity and clinical utility. The field would benefit from direct empirical comparisons of different classification schemes with various clinical and scientific validators. Such studies would enable the creators of the next DSM eating disorder classification to increase understanding of the advantages and disadvantages associated with choosing various diagnostic criteria sets for the eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ten-year stability and latent structure of the DSM–IV schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders.

Evaluation of the validity of personality disorder (PD) diagnostic constructs is important for the impending revision of the Diagnostic and Statistical Manual of Mental Disorders. Prior factor analytic studies have tested these constructs in cross-sectional studies, and models have been replicated longitudinally, but no study has tested a constrained longitudinal model. The authors examined 4 PDs in the Collaborative Longitudinal Personality Disorders study (schizotypal, borderline, avoidant, and obsessive-compulsive) over 7 time points (baseline, 6 months, 1 year, 2 years, 4 years, 6 years, and 10 years). Data for 2-, 4-, 6- and 10-year assessments were obtained in semistructured interviews by raters blind to prior PD diagnoses at each assessment. The latent structure of the 4 constructs was differentiated during the initial time points but became less differentiated over time as the mean levels of the constructs dropped and stability increased. Obsessive-compulsive PD became more correlated with schizotypal and borderline PD than with avoidant PD. The higher correlation among the constructs in later years may reflect greater shared base of pathology for chronic personality disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of survival analyses to examine onset and staging of DSM-IV alcohol symptoms in women.

Despite their implications for diagnostic validity. few studies have examined patterns of alcohol symptom onset in women. Using Structured Clinical Interview for the DSM-lV (M. B. First, M. Gibbon, R. L. Spitzer, & J. B. W. Williams, 1995) data, the authors applied survival analysis to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) alcohol symptoms in 87 women in treatment. Legal problems occurred rarely and did not fit a staging model. Compared with men previously studied, women showed a later onset of symptoms, which developed in 4 stages: abuse, consequation, accommodation to the illness, and physiological dependence. Three symptoms-hazardous use, larger/longer use than intended, and lots of time spent using-occurred early and may be useful for screening purposes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association between blood lead levels (< 5 μg/dL) and inattention-hyperactivity and neurocognitive profiles in school-aged Korean children

Objectives

The association between low blood lead levels (< 5 μg/dL) and the inattention-hyperactivity symptoms and neurocognitive profiles of school-aged Korean children was investigated.

Methods

We measured blood lead levels in 256 Korean children aged 8-10 years. Teachers completed the Attention-Deficit Hyperactivity Disorder Rating Scale (T-ARS)-IV to assess inattentive and hyperactive symptoms. Parents completed the Korean version of the Learning Disability Evaluation Scale (K-LDES). Children performed neurocognitive tests [The Continuous Performance Test (CPT), the Children's Color Trails Test, and the Stroop Color and Word Test (SCWT)].

Results

A linear regression analysis indicated that the blood lead concentrations were associated with the inattention scores [B = 4.8, S.E. = 1.6, 95% confidence interval (CI): 1.5-8.0], the hyperactivity subscores (3.1, 1.4, 0.3-5.9), and the total score (7.9, 2.9, 2.1-13.6) on the T-ARS; the number of omission errors on the CPT (20.6, 7.1, 6.5-34.6); the listening (−1.4, 0.7, −2.8 to −0.1), reading (−2.1, 0.7, −3.4 to −0.7), writing (−2.0, 0.7, −3.4 to −0.6), spelling (−2.2, 0.7, −3.7 to −0.7), and calculating (−1.8, 0.7, −3.1 to −0.4) scores on the K-LDES; and the color-word score on the SCWT (−6.7, 3.4, −13.3 to −0.1). A logistic regression analysis indicated that the probability of inattentive and hyperactive symptoms was increased with higher blood lead levels in boys with an odds ratio of 2.768 [B = 1.018, S.E. = 0.487, p = 0.036, 95% CI: 1.066-7.187].

Conclusion

This study suggests that even low blood lead levels (< 5 μg/dL) are associated with inattentive and hyperactivity symptoms and learning difficulties in school-aged children.     

An Application of Item Response Theory Analysis to Alcohol, Cannabis, and Cocaine Criteria in DSM-IV.

Item response theory (IRT) is supplanting classical test theory as the basis for measures development. This study demonstrated the utility of IRT for evaluating DSM-IV diagnostic criteria. Data on alcohol, cannabis, and cocaine symptoms from 372 adult clinical participants interviewed with the Composite International Diagnostic Interview--Expanded Substance Abuse Module (CIDI-SAM) were analyzed with Mplus (B. Muthen & L. Muthen, 1998) and MULTILOG (D. Thissen, 1991) software. Tolerance and legal problems criteria were dropped because of poor fit with a unidimensional model. Item response curves, test information curves, and testing of variously constrained models suggested that DSM-IV criteria in the CIDI-SAM discriminate between only impaired and less impaired cases and may not be useful to scale case severity. IRT can be used to study the construct validity of DSM-IV diagnoses and to identify diagnostic criteria with poor performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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

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

Personality pathology is dimensional, so what shall we do with the DSM-IV personality disorder categories? The case of narcissistic personality disorder: Comment on Miller and Campbell (2010).

What is narcissism? Is it a dimensional personality trait? Is it the core element of a categorical form of psychopathology? Miller and Campbell (see record 2010-17135-004) present a thoughtful, scholarly, and well-written review of a substantial literature aimed at synthesizing research on trait narcissism and contemplating its relevance to the category of narcissistic personality disorder (NPD). They also present an argument that research on trait narcissism should be used to help propel research on NPD, as explicated in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV; American Psychiatric Association, 1994). This latter argument is somewhat surprising in the context of the rest of Miller and Campbell’s article and it is the focus of my commentary. (PsycINFO Database Record (c) 2010 APA, all rights reserved)