Chinese diagnostic interview schedule. II. A validity study on estimation of lifetime prevalence

The validity of DIS-CM (Chinese modified version of Diagnostic Interview Schedule) was examined by analyzing lifetime prevalence of each age group, age at onset, and recency of illness. The magnitude of the discrepancy between the empirical and the estimated data was adopted as the criterion of the degree of deviation. Manic and depressive episodes were found to be seriously underestimated. Schizophrenic, panic, phobic and antisocial personality disorders were probably underestimated. The observed lifetime prevalence figures with DIS-CM are rather conservative for these disorders. The prevalence data of a recent 1-year period are less biased and more reliable. The nature of the disease, recall effect, active or passive psychological resistance, mortality, and uncooperative attitude are considered factors that induce an underestimate of lifetime prevalence.

Chinese diagnostic interview schedule. I. Agreement with psychiatrist's diagnosis

NIMH-DIS was translated into Chinese and modified to the Chinese version of DIS (DIS-CM). One hundred clinical patients and 187 community subjects were studied for diagnostic agreement between the DIS-CM and the psychiatrist's clinical diagnosis. In the community sample, DIS-CM overdiagnosed the cases of manic episode, phobic disorder, obsessive-compulsive disorder and alcoholic problem, while it underdiagnosed the cases of tobacco dependence in the community sample and manic episode in the clinical cases. Standard diagnostic criteria, method of symptom detection, and social desirability, were identified as the major factors contributing to the diagnostic disparity. Variables related to life situations, language habit and medical histories were also analysed to test the external validity of the DIS-CM in case identification. The results affirm that the DIS-CM is reliable as a psychiatric epidemiological tool.

The clinical diagnostic value of dexamethasone suppression test in depressive illness

Dexamethasone suppression test (DST) was done for Chinese melancholics. The overall sensitivity of DST is 41.0%, and its specificity is 85%. The prevalence of abnormal DST is higher in inpatient melancholics (66.7%) than in outpatient melancholics (7.1%). Three schizophrenic patients who had abnormal DST were found to have severe degree of depression and impaired social function. The clinical diagnostic value of DST for severely impaired inpatient was tested. 35.7% of primary depressives (28 cases) had abnormal DST. 50% of secondary depressives (26 cases) had abnormal DST. 11 cases (50%) of 22 initially admitted, undiagnosed cases were found to have abnormal DST. 5 (45.5%) of these 11 cases were of primary depressives. 6 (54.5%) of these were of secondary depressives. DST was found to be of limited value in differential diagnosis for inpatient undiagnosed cases. Yet, DST could be a powerful research tool in psychopathology.

Dexamethasone suppression test in primary depression: significance of family history and psychosis

The overnight dexamethasone suppression test (DST) was administered to 31 inpatients with endogenous depression. DST results were abnormal in 42% of the group and in 67% of those patients with psychotic depression. Division of the sample into genetic subtypes based on family history criteria of Winokur et al. failed to replicate his group's DST findings. Subjects with sporadic depressive disorder, especially delusional patients, had a higher rate of dexamethasone nonsuppression than the others. Familial pure depressive patients did not show the expected greater frequency of DST abnormality compared to the depression spectrum disorder group.

Derealization syndrome and the outcome of schizophrenia: a report from the international pilot study of schizophrenia

Eighty-five schizophrenic patients were found to have worse two-year follow-up outcome (history of remission, clinical course, improvement in psychotic symptoms, general treatment result) than 39 non-schizophrenic psychotic patients. The outcome of 36 schizophrenic patients with derealization at initial evaluation, especially when nine hebephrenics were excluded, was better than that of 49 schizophrenic patients without derealization but similar to that of 39 non-schizophrenic patients. The hebephrenics with derealization demonstrated similar outcomes to schizophrenic patients without derealization. In non-schizophrenic patients, derealization had no prognostic significance.

A longitudinal record study of renal function in patients treated with lithium

We reviewed hospital charts of 62 patients receiving long-term lithium therapy in an attempt to see if renal function deteriorated in association with lithium treatment. We found no association between duration of lithium treatment of up to four years and change in BUN or creatinine or the development of proteinuria. There was a nonsignificant tendency for cases showing a rise in BUN from index to follow-up to have had a chart record of lithium intoxication, but these same cases tended to have a lower follow-up creatinine. There was a tendency for older patients to have higher BUN and creatinine at follow-up than at index, but there was no association between this and duration of lithium treatment.