Differential diagnosis of attention deficit and conduct disorders using conditional probabilities.

Attention deficit and conduct disorders require an important yet often difficult differential diagnosis. Prior efforts to determine which symptoms are optimal for making this differential diagnosis have been limited by a reliance on statistics that do not supply the probability of the disorders given a symptom's presence (positive predictive power) or the probability that the disorder is not present given the absence of the symptom (negative predictive power). This investigation examined the utility of these latter statistics in the differential diagnosis of childhood attention deficit and conduct disorders. The data consisted of symptoms from a standardized maternal psychiatric interview collected for a sample of 76 clinic-referred boys. Results indicated that some symptoms are optimal as inclusion criteria, some as exclusion criteria, some as neither, and some as both. Furthermore, some symptoms that have been traditionally associated with the diagnosis of one disorder were actually found to be more useful in the diagnosis of the other disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic categories or dimensions? A question for the Diagnostic and statistical manual of mental disorders--fifth edition.

The question of whether mental disorders are discrete clinical conditions or arbitrary distinctions along dimensions of functioning is a long-standing issue, but its importance is escalating with the growing recognition of the frustrations and limitations engendered by the categorical model. The authors provide an overview of some of the dilemmas of the categorical model, followed by a discussion of research that addresses whether mental disorders are accurately or optimally classified categorically or dimensionally. The authors' intention is to document the importance of this issue and to suggest that future editions of the Diagnostic and Statistical Manual of Mental Disorders give more recognition to dimensional models of classification. They conclude with a dimensional mental disorder classification that they suggest provides a useful model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prototypic typology and the Borderline Personality Disorder.

Based on interview data from 76 18–45 yr old outpatients, the implications of a prototypic rather than a classical model of personality-disorder classification were demonstrated for DSM-III Axis II Borderline Personality Disorder (BPD). Heterogeneity of membership is described, and conditional probabilities are used to demonstrate the relative efficiency of single diagnostic criteria and combinations of criteria and the degree of overlap among BPD and other personality disorders. The conditional probability approach can be used to determine empirically the covariation of symptoms and to link the study of prototypicality to the individual patient rather than to the group. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Definitions and diagnoses: A brief response to Morey and McNamara.

Morey and McNamara (see record 1987-34626-001) provided a thoughtful discussion of Widiger, Frances, Warner, and Bluhm (1986). The distinctions between definitions and diagnoses, prototypal and classical categories, and artifactual and natural concepts do have important implications for the classification and validation of the personality disorders. In this brief response, we clarify our position with respect to these issues and offer further considerations and discussion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comprehensive 2-D inductance modeling approach for VLSI interconnects: frequency-dependent extraction and compact circuit model synthesis

Although three-dimensional (3-D) partial inductance modeling costs have decreased with stable, sparse approximations of the inductance matrix and its inverse, 3-D models are still intractable when applied to full chip timing or crosstalk analysis. The 3-D partial inductance matrix (or its inverse) is too large to be extracted or simulated when power-grid cross-sections are made wide to capture proximity effect and wires are discretized finely to capture skin effect. Fortunately, 3-D inductance models are unnecessary in VLSI interconnect analysis. Because return currents follow interconnect wires, long interconnect wires can be accurately modeled as two-dimensional (2-D) transmission lines and frequency-dependent loop impedances extracted using 2-D methods . Furthermore, this frequency dependence can be approximated with compact circuit models for both uncoupled and coupled lines. Three-dimensional inductance models are only necessary to handle worst case effects such as simultaneous switching in the end regions. This paper begins by explaining and defending the 2-D modeling approach. It then extends the extraction algorithm to efficiently include distant return paths. Finally, a novel synthesis technique is described that approximates the frequency-dependent series impedance of VLSI interconnects with compact circuit models suitable for timing and noise analysis.     

An A to Z guide to DSM-IV conundrums.

The work on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) poses many puzzling conundrums that touch on complicated and important theoretical and practical issues. None of these can be resolved in the DSM-IV, but the authors hope that the Task Force's decisions will be informed by thorough reviews of the currently available evidence and extensive input from all sectors of the mental health field. A. J. Frances et al provide an alphabetical guide to DSM-IV conundrums that they hope will stimulate comments, suggestions, and criticisms about the work of the Task Force. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Generalized social phobia versus avoidant personality disorder: A commentary on three studies.

The findings of J. D. Herbert et al (see record 1992-27377-001), C. S. Holt et al (see record 1992-27380-001), and S. M. Turner et al (see record 1992-27401-001) are largely consistent. Avoidant personality disorder and generalized social phobia appear to be overlapping constructs that have only minor differences with respect to severity of dysfunction. This commentary addresses the implications of the findings with respect to the validity of the categorical distinction in the Diagnostic and Statistical Manual of Mental Disorders-III—Revised (DSM-III—R) between avoidant personality and generalized social phobia, revisions of their respective diagnostic criteria, and their reclassification as either an anxiety or a personality disorder. Methodological and substantive suggestions for future research are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An acceptance of suicide.

Discusses suicidal behavior, which is traditionally considered to be reflective of a mental disorder or at least a psychopathological event. The acceptance of suicide has been defended primarily in terms of an ethical right to and psychotherapeutic respect for autonomy. These arguments, however, have failed to provide an adequate basis for refraining from indiscriminate prevention. The acceptance of suicide can also be defended in terms of the reasonableness of death as an alternative to a tragic life. Arguments for voluntary euthanasia are shown to be applicable to insurmountable and intolerable psychosocial conditions. It is asserted that acceptance of suicide entails an empathic understanding of the patient's tragic condition and a recognition of an inability to relieve the suffering. It is a difficult decision but nonetheless reasonable and deserving of consideration. It is concluded that suicide prevention can be as harmful as failing to see a suicidal gesture as a cry for help, especially if it becomes a dogmatic, unthinking intervention that does not consider the alternative and potentially acceptable view of suicide acceptance. (49 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narcissistic personality disorder and the DSM-V.

We address 3 issues relevant to narcissistic personality disorder (NPD) and the DSM–V. First, we argue that excluding NPD while retaining other traditional personality disorder constructs (e.g., avoidant) makes little sense given the research literature on NPD and trait narcissism and their association with clinically relevant consequences such as aggression, self-enhancement, distorted self-presentation, failed relationships, cognitive biases, and internalizing and externalizing dysregulation. Second, we argue that the DSM–V must include content (in diagnostic form or within a dimensional trait model) that allows for the assessment of both grandiose and vulnerable variants of narcissism. Finally, we suggest that any dimensional classification of personality disorder should recover all of the important component traits of narcissism and be provided with official recognition in the coding system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)