Reducing American diagnosis of schizophrenia: will the DSM III suffice?

Bouffée délirante et evolution schizophrénique : rôle pronostique de la classification DSM III

La validité du diagnostic psychiatrique a, depuis toujours, soulevé des objections et des critiques. Malgré tous les progrès récents dans ce domaine, on est encore loin d’une nosologie psychiatrique acceptée par tous les pays. Dans le domaine des psychoses non affectives, les nosologies française et américaine sont différentes. Dans un premier temps les auteurs décrivent les épisodes classées «bouffée délirante aiguë», entité clinique traditionnellement française, au moyen du DSM III. Le reclassement, selon les critères du DSM III, de 55 patients hospitalisés entre 1975 et 1980 avec le diagnostic de bouffée délirante aiguë a abouti à un éclatement de cette entité française dans les 5 entités DSM III suivantes: troubles schizophréniques, troubles schizophréniformes, psychoses atypiques, psychoses réactionnelles brèves, troubles affectifs. Dans un deuxième temps, une évaluation des 2 nosologies, française et américaine, est tentée, sur la base d’informations sur l’evolution à 5 ans, obtenues chez les 55 patients. Pendant cette période l’épisode est resté unique chez 29% des patients, 18% ont présenté une ou plusieurs rechutes sous forme d’épisodes identiques, 36% ont évolué vers la schizophrenic et 16% vers la psychose maniaco-depressive. Parmi les épisodes classés «troubles schizophréniques» par le DSM III, 60% ont évolué vers la schizophrenic. Dans un troisième temps, la sémiologie des épisodes classés «bouffée délirante aiguë» est décrite à l’aide de la Liste Intégrée de Critères d’évaluation Taxinomique pour les psychoses non affectives (LICET-S) afin de rechercher des éléments témoignant ou prédictifs d’une evolution schizophrénique. Les épisodes classés «bouffée délirante aiguë» s’avèrent être de nature et de pronostic très divers; leur description au moyen du DSM III permet de définir des entités plus homogènes, comme le montrent leurs evolutions.

Absence of bias in clinician ratings of everyday functioning among African American, Hispanic and Caucasian patients with schizophrenia

A substantial research literature implicates potential racial/ethnic bias in the diagnosis of schizophrenia and in clinical ratings of psychosis. There is no similar information regarding bias effects on ratings of everyday functioning. Our aims were to determine if Caucasian raters vary in their ratings of the everyday functioning of schizophrenia patients of different ethnicities, to find out which factors determine accurate self-report of everyday functioning in different ethnic groups, and to know if depression has similar effects on the way people of different ethnicities self-report their current functionality. We analyzed data on 295 patients with schizophrenia who provided their self-report of their everyday functioning and also had a Caucasian clinician rating their functionality. Three racial/ethnic groups (African American (AA), Hispanic and Caucasian) were studied and analyzed on the basis of neurocognition, functional capacity, depression and real-world functional outcomes. No differences based on racial/ethnic status in clinician assessments of patients' functionality were found. Differences between racial groups were found in personal and maternal levels of education. Severity of depression was significantly correlated with accuracy of self-assessment of functioning in Caucasians, but not in AAs. Higher scores on neurocognition and functional capacity scales correlated with reduced overestimation of functioning in AAs, but not in Hispanics. This data might indicate that measurement of everyday functionality is less subject to rater bias than measurement of symptoms of schizophrenia.

Importance of interfaces in governing thermal transport in composite materials: modeling and experimental perspectives

Thermal management in polymeric composite materials has become increasingly critical in the air-vehicle industry because of the increasing thermal load in small-scale composite devices extensively used in electronics and aerospace systems. The thermal transport phenomenon in these small-scale heterogeneous systems is essentially controlled by the interface thermal resistance because of the large surface-to-volume ratio. In this review article, several modeling strategies are discussed for different length scales, complemented by our experimental efforts to tailor the thermal transport properties of polymeric composite materials. Progress in the molecular modeling of thermal transport in thermosets is reviewed along with a discussion on the interface thermal resistance between functionalized carbon nanotube and epoxy resin systems. For the thermal transport in fiber-reinforced composites, various micromechanics-based analytical and numerical modeling schemes are reviewed in predicting the transverse thermal conductivity. Numerical schemes used to realize and scale the interface thermal resistance and the finite mean free path of the energy carrier in the mesoscale are discussed in the frame of the lattice Boltzmann-Peierls-Callaway equation. Finally, guided by modeling, complementary experimental efforts are discussed for exfoliated graphite and vertically aligned nanotubes based composites toward improving their effective thermal conductivity by tailoring interface thermal resistance.

Patterns of illness in parent-child pairs both hospitalized for either schizophrenia or a major mood disorder

Results are reported of a blind rediagnosis of a consecutive series of parent-child pairs hospitalized with a diagnosis of schizophrenia or mood disorder. Patterns of illness in pairs meeting DSM-III-R criteria for either disorder were examined by contrasting the two generations on their respective distributions of diagnoses, and means of age at onset and severity of illness. While no case of mood disorder was found in the children of schizophrenic parents, 50% of the children of parents with psychotic mood disorders presented with schizophrenia. The offspring also had an earlier age at onset of illness than did their parents.

Cultural phenomenology and residency training revisited: a personal account

A field experience in the Northern Galilee area of Israel is described by a Senior American Resident in Psychiatry, with emphasis on the cultural aspects of the experience as well as the benefits related to professional maturation. The author discusses the field experience as part of a residency education, invites other such experiences, and compares his own experiences with others described in the literature.