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Krueger RF, Kotov R, Watson D, Forbes MK, Eaton NR, Ruggero CJ, Simms LJ, Widiger TA, Achenbach TM, Bach B, Bagby RM, Bornovalova MA, Carpenter WT, Chmielewski M, Cicero DC, Clark LA, Conway C, DeClercq B, DeYoung CG, Docherty AR, Drislane LE, First MB, Forbush KT, Hallquist M, Haltigan JD, Hopwood CJ, Ivanova MY, Jonas KG, Latzman RD, Markon KE, Miller JD, Morey LC, Mullins-Sweatt SN, Ormel J, Patalay P, Patrick CJ, Pincus AL, Regier DA, Reininghaus U, Rescorla LA, Samuel DB, Sellbom M, Shackman AJ, Skodol A, Slade T, South SC, Sunderland M, Tackett JL, Venables NC, Waldman ID, Waszczuk MA, Waugh MH, Wright AG, Zald DH, Zimmermann J. Les progrès dans la réalisation de la classification quantitative de la psychopathologie ☆. Ann Med Psychol (Paris) 2021; 179:95-106. [PMID: 34305151 PMCID: PMC8309948 DOI: 10.1016/j.amp.2020.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level" dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity" by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.
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Affiliation(s)
- Robert F. Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Miriam K. Forbes
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Nicholas R. Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Camilo J. Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Leonard J. Simms
- Department of Psychology, University at Buffalo, State University of New York, New York, NY, USA
| | - Thomas A. Widiger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | | | - Bo Bach
- Psychiatric Research Unit, Slagelse Psychiatric Hospital, Slagelse, Denmark
| | - R. Michael Bagby
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | | | - David C. Cicero
- Department of Psychology, University of Hawaii, Honolulu, HI, USA
| | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Christopher Conway
- Department of Psychology, College of William and Mary, Williamsburg, VA, USA
| | - Barbara DeClercq
- Department of Developmental, Personality, and Social Psychology, Ghent University, Ghent, Belgium
| | - Colin G. DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Anna R. Docherty
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Laura E. Drislane
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Michael B. First
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Michael Hallquist
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - John D. Haltigan
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Masha Y. Ivanova
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | - Robert D. Latzman
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Joshua D. Miller
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Leslie C. Morey
- Department of Psychology, Texas A&M University, College Station, TX, USA
| | | | - Johan Ormel
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Praveetha Patalay
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | | | - Aaron L. Pincus
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - Darrel A. Regier
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA
| | - Ulrich Reininghaus
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | | | - Douglas B. Samuel
- Department of Psychology, Purdue University, West Lafayette, IN, USA
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | | | - Andrew Skodol
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
| | - Tim Slade
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Susan C. South
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Matthew Sunderland
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | | | - Noah C. Venables
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Mark H. Waugh
- Oak Ridge National Laboratory, University of Tennessee, Oak Ridge, TN, USA
| | - Aidan G.C. Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - David H. Zald
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
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Krueger RF, Kotov R, Watson D, Forbes MK, Eaton NR, Ruggero CJ, Simms LJ, Widiger TA, Achenbach TM, Bach B, Bagby RM, Bornovalova MA, Carpenter WT, Chmielewski M, Cicero DC, Clark LA, Conway C, DeClercq B, DeYoung CG, Docherty AR, Drislane LE, First MB, Forbush KT, Hallquist M, Haltigan JD, Hopwood CJ, Ivanova MY, Jonas KG, Latzman RD, Markon KE, Miller JD, Morey LC, Mullins-Sweatt SN, Ormel J, Patalay P, Patrick CJ, Pincus AL, Regier DA, Reininghaus U, Rescorla LA, Samuel DB, Sellbom M, Shackman AJ, Skodol A, Slade T, South SC, Sunderland M, Tackett JL, Venables NC, Waldman ID, Waszczuk MA, Waugh MH, Wright AGC, Zald DH, Zimmermann J. Progress in achieving quantitative classification of psychopathology. World Psychiatry 2018; 17:282-293. [PMID: 30229571 PMCID: PMC6172695 DOI: 10.1002/wps.20566] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 12/13/2022] Open
Abstract
Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level" dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity" by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.
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Affiliation(s)
- Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Miriam K Forbes
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, State University of New York, New York, NY, USA
| | - Thomas A Widiger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | | | - Bo Bach
- Psychiatric Research Unit, Slagelse Psychiatric Hospital, Slagelse, Denmark
| | - R Michael Bagby
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | | | - David C Cicero
- Department of Psychology, University of Hawaii, Honolulu, HI, USA
| | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Christopher Conway
- Department of Psychology, College of William and Mary, Williamsburg, VA, USA
| | - Barbara DeClercq
- Department of Developmental, Personality, and Social Psychology, Ghent University, Ghent, Belgium
| | - Colin G DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Anna R Docherty
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Laura E Drislane
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Michael B First
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Michael Hallquist
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - John D Haltigan
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Masha Y Ivanova
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Katherine G Jonas
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Robert D Latzman
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Joshua D Miller
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Leslie C Morey
- Department of Psychology, Texas A&M University, College Station, TX, USA
| | | | - Johan Ormel
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Praveetha Patalay
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | | | - Aaron L Pincus
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - Darrel A Regier
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA
| | - Ulrich Reininghaus
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | | | - Douglas B Samuel
- Department of Psychology, Purdue University, West Lafayette, IN, USA
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | | | - Andrew Skodol
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
| | - Tim Slade
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Susan C South
- Department of Psychology, Purdue University, West Lafayette, IN, USA
| | - Matthew Sunderland
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | | | - Noah C Venables
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Irwin D Waldman
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Monika A Waszczuk
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Mark H Waugh
- Oak Ridge National Laboratory, University of Tennessee, Oak Ridge, TN, USA
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - David H Zald
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
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Abstract
AIMS DSM-IV drug use disorders, a major public health problem, are highly comorbid with other psychiatric disorders, but little is known about the role of this comorbidity when studied prospectively in the general population. Our aims were to determine the role of comorbid psychopathology in the 3-year persistence of drug use disorders. DESIGN AND SETTING Secondary data analysis using waves 1 (2001-02) and 2 (2005-05) of the National Epidemiologic Survey on Alcohol and Related Conditions. PARTICIPANTS Respondents with current DSM-IV drug use disorder at wave 1 who participated in wave 2 (n = 613). MEASUREMENTS Alcohol Use Disorders and Associated Disabilities Interview Schedule IV (AUDADIS-IV) obtained DSM-IV Axis I and II diagnoses. Persistent drug use disorder was defined as meeting full criteria for any drug use disorder between waves 1 and 2. FINDINGS Drug use disorders persisted in 30.9% of respondents. No Axis I disorders predicted persistence. Antisocial [odds ratio (OR) = 2.75; 95% confidence interval (CI): 1.27-5.99], borderline (OR = 1.91; 95% CI: 1.06-3.45) and schizotypal (OR = 2.77; 95% CI: 1.42-5.39) personality disorders were significant predictors of persistent drug use disorders, controlling for demographics, psychiatric comorbidity, family history, treatment and number of drug use disorders. Deceitfulness and lack of remorse were the strongest antisocial criteria predictors of drug use disorder persistence, identity disturbance and self-damaging impulsivity were the strongest borderline criteria predictors, and ideas of reference and social anxiety were the strongest schizotypal criteria predictors. CONCLUSIONS Antisocial, borderline and schizotypal personality disorders are specific predictors of drug use disorder persistence over a 3-year period.
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Affiliation(s)
- Miriam C Fenton
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY 10032, USA
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Hasin D, Fenton MC, Skodol A, Krueger R, Keyes K, Geier T, Greenstein E, Blanco C, Grant B. Personality disorders and the 3-year course of alcohol, drug, and nicotine use disorders. ACTA ACUST UNITED AC 2011; 68:1158-67. [PMID: 22065531 DOI: 10.1001/archgenpsychiatry.2011.136] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Little is known about the role of a broad range of personality disorders in the course of substance use disorder (SUD) and whether these differ by substance. The existing literature focuses mostly on antisocial personality disorder and does not come to clear conclusions. OBJECTIVE To determine the association between the 10 DSM-IV personality disorders and the persistence of common SUDs in a 3-year prospective study of a national sample. DESIGN Data were drawn from participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who had alcohol dependence (n = 1172), cannabis use disorder (n = 454), or nicotine dependence (n = 4017) at baseline and who were reinterviewed 3 years later. Control variables included demographic characteristics, family history of substance disorders, baseline Axis I disorders and treatment status, and prior SUD duration. Main Outcome Measure Persistent SUD, defined as meeting full criteria for the relevant SUD throughout the 3-year follow-up period. RESULTS Persistent SUD was found among 30.1% of participants with alcohol dependence, 30.8% with cannabis use disorder, and 56.6% with nicotine dependence at baseline. Axis I disorders did not have strong or consistent associations with persistent SUD. In contrast, antisocial personality disorder was significantly associated with persistent alcohol, cannabis, and nicotine use disorders (adjusted odds ratios, 2.46-3.51), as was borderline personality disorder (adjusted odds ratios, 2.04-2.78) and schizotypal personality disorder (adjusted odds ratios, 1.65-5.90). Narcissistic, schizoid, and obsessive-compulsive personality disorders were less consistently associated with SUD persistence. CONCLUSIONS The consistent findings on the association of antisocial, borderline, and schizotypal personality disorders with persistent SUD indicates the importance of these personality disorders in understanding the course of SUD. Future studies should examine dimensional representations of personality disorders and the role of specific components of these disorders, biological and environmental contributors to these relationships, and potential applications of these findings to treatment development.
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Affiliation(s)
- Deborah Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, NY 10032, USA.
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Abstract
The DSM-IV model of personality disorders is composed of trait sets arranged into 10 theoretically distinct, polythetically assessed categories, with little regard for how the traits comprising these disorders are interrelated and structured. Research since the publication of DSM-III has shown that this model is untenable. The question is not whether this model needs revision; rather, the question is how to move from the existing DSM-IV framework to a model better connected with data. Empirically-based models of personality trait variation provide a starting point for DSM-5, and ongoing research will be used to delineate further the empirical structure of personality traits in the pathological range. The ultimate goal is to frame future DSMs in a way that is maximally useful for clinicians as well as researchers. It is also critical to understand that the DSM-5 is intended to be a living document that will facilitate novel inquiry and clinical applications, as opposed to a document designed to promote and perpetuate a fixed set of constructs. Thus, we view a proposed trait system as a first step on a path to a well-validated, clinically-useful structure.
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Affiliation(s)
- Robert F Krueger
- Psychology Department, University of Minnesota,75 East River Road, Minneapolis, MN 55455-0344, USA.
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Squires-Wheeler E, Friedman D, Amminger GP, Skodol A, Looser-Ott S, Roberts S, Pape K, Erlenmeyer-Kimling L. Negative and positive dimensions of schizotypal personality disorder. J Pers Disord 1997; 11:285-300. [PMID: 9348492 DOI: 10.1521/pedi.1997.11.3.285] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The positive (perceptual-cognitive) and negative (social-interpersonal) dimensions of schizotypal personality traits were examined in biological relatives of individuals with Axis I disorder. The subjects were young adult offspring from three contrasting parental groups, including schizophrenic disorder, affective disorder, and normal controls. Cognitive correlates, including digit span (presumed to assess working memory) and P3 amplitudes, were also examined. Preliminary results showed that positive and negative dimensions were distinguished by different prevalence patterns in the offspring subjects, and by a different pattern of correlations with cognitive measures. Negative dimensions were more frequent in offspring from the schizophrenic parental group than in the offspring from affective disorder and normal control parental groups. Digits forward and backward, and P3 amplitude decrements, characterized a subset of offspring with negative features from the schizophrenic parental group. Positive dimensions did not differ between the psychiatric parental groups, and did not covary with digit span or P3 amplitude assessments. These results support the view that positive and negative dimensions may reflect separable pathophysiologic processes.
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Affiliation(s)
- E Squires-Wheeler
- Department of Medical Genetics, New York State Psychiatric Institute, NY 10032, USA
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Neugebauer R, Kline J, Shrout P, Skodol A, O'Connor P, Geller PA, Stein Z, Susser M. Major depressive disorder in the 6 months after miscarriage. JAMA 1997; 277:383-8. [PMID: 9010170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test a priori hypotheses that miscarrying women are at increased risk for a first or recurrent episode of major depressive disorder in the 6 months following loss and that this increased risk is greater for childless women, women with prior reproductive loss, and women aged 35 years or older; and to evaluate whether risk varies by time of gestation or by attitude toward the pregnancy. DESIGN Cohort study. SETTING The miscarriage cohort consisted of women attending a medical center for a spontaneous abortion (n=229); the comparison group was a population-based cohort of women drawn from the community (n=230). PARTICIPANTS Miscarriage was defined as the involuntary termination of a nonviable intrauterine pregnancy before 28 completed weeks of gestation. Half of all participants were between 25 and 34 years of age; 40% were white and 35% Hispanic; 55% had more than a high school education. Participants constituted 60% of miscarrying women and 72% of community women who completed the first phase of this cohort study. MAIN OUTCOME MEASURE Major depressive disorder was measured using the Diagnostic Interview Schedule. RESULTS Risk for an episode of major depressive disorder among miscarrying women in the 6 months following loss was compared with the 6-month risk among community women who had not been pregnant in the preceding year. Among miscarrying women, 10.9% experienced an episode of major depressive disorder, compared with 4.3% of community women. The overall relative risk (RR) for an episode of major depressive disorder for miscarrying women was 2.5 (95% confidence interval [CI], 1.2-5.1) and was substantially higher for childless women (RR, 5.0; 95% CI, 1.7-14.4) than for women with children (RR, 1.3; 95% CI, 0.5-3.5) (P<.06). Among miscarrying women, 72% of cases of major depressive disorder began within the first month after loss; only 20% of community cases started during the comparable period. Among miscarrying women with a history of major depressive disorder, 54% experienced a recurrence. However, RR did not vary significantly by history of prior reproductive loss or by maternal age, nor did risk vary by time of gestation or attitude toward the pregnancy. CONCLUSIONS Physicians should monitor miscarrying women in the first weeks after reproductive loss, particularly women who are childless or who have a history of major depressive disorder. Where appropriate, supportive counseling or psychopharmacologic treatment should be considered.
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Affiliation(s)
- R Neugebauer
- Epidemiology of Developmental Brain Disorders Department, New York State Psychiatric Institute, New York, NY 10032, USA
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8
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Abstract
OBJECTIVE The purpose of this study was to investigate the childhood antecedents of personality disorders that are diagnosed in adolescence. METHOD A randomly selected community sample of 641 youths was assessed initially in childhood and followed longitudinally over 10 years. Childhood behavior ratings were based on maternal report; diagnoses of adolescent personality disorders were based on data obtained from both maternal and youth informants. Four composite measures of childhood behavior problems were used: conduct problems, depressive symptoms, anxiety/fear, and immaturity. Adolescent personality disorders were considered present only if the disorders persisted over a 2-year period. For all analyses, personality disorders were grouped into the three clusters (A, B, and C) of DSM-III-R. RESULTS Logistic regression analyses indicated that all four of the putative childhood antecedents were associated with greater odds of an adolescent personality disorder 10 years later. Childhood conduct problems remained an independent predictor of personality disorders in all three clusters, even when other childhood problems were included in the same regression model. Additionally, depressive symptoms emerged as an independent predictor of cluster A personality disorders in boys, while immaturity was an independent predictor of cluster B personality disorders in girls. No moderating effects of age at time of childhood assessment were found. CONCLUSIONS These results support the view that personality disorders can be traced to childhood emotional and behavioral disturbances and suggest that these problems have both general and specific relationships to adolescent personality functioning.
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Affiliation(s)
- D P Bernstein
- Bronx Veterans Affairs Medical Center, Psychiatry Service, NY 10468, USA
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9
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Abstract
The American Psychiatric Association published the fourth edition of the Diagnostic and Statistical Manual (DSM-IV) in May 1994. Referred to by some in the popular media as the mental health profession's diagnostic bible, the decisions reflected in this fourth edition are likely to shape diagnostic practice and education and may impact on treatment approaches as well. This article describes the goals and process involved in preparing this document, examines the major changes from DSM-III-R to DSM-IV and comments on the relevance of DSM-IV to psychiatric/mental health nursing.
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Affiliation(s)
- H S Wilson
- University of California, San Francisco, Department of Mental Health, Community & Administrative Nursing, San Francisco
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10
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Neugebauer R, Kline J, O'Connor P, Skodol A. Reply. Am J Obstet Gynecol 1993. [DOI: 10.1016/s0002-9378(12)90869-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Neugebauer R, Kline J, O'Connor P, Shrout P, Johnson J, Skodol A, Wicks J, Susser M. Determinants of depressive symptoms in the early weeks after miscarriage. Am J Public Health 1992; 82:1332-9. [PMID: 1415855 PMCID: PMC1695859 DOI: 10.2105/ajph.82.10.1332] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES We tested whether and under what conditions miscarriage increases depressive symptoms in the early weeks following loss. METHODS We interviewed 232 women within 4 weeks of miscarriage and 283 pregnant women and 318 community women who had not recently been pregnant. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression (CES-D) Scale. RESULTS Among women who had miscarried, the proportion who were highly symptomatic on the CES-D was 3.4 times that of pregnant women and 4.3 times that of community women. Among childless women, the proportion of women who had miscarried who were highly symptomatic was 5.7 times that of pregnant women and 11.0 times that of community women. Women who had miscarried were equally depressed regardless of length of gestation; among pregnant women, depressive symptoms declined with length of gestation. Among women who had miscarried, symptom levels did not vary with attitude toward the pregnancy; among pregnant women, depressive symptoms were elevated in those with unwanted pregnancies. Prior reproductive loss and advanced maternal age (35+ years) were not associated with symptom levels in any cohort. CONCLUSIONS Depressive symptoms are markedly increased in the early weeks following miscarriage. This effect is substantially modified by number of living children, length of gestation at loss, and attitude toward pregnancy.
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Affiliation(s)
- R Neugebauer
- New York State Psychiatric Institute, Epidemiology of Developmental Brain Disorders Department, NY 10032
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12
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Neygebayer R, Kline J, O'Connor P, Shrout P, Johnson J, Skodol A, Wicks J, Susser M. Depressive symptoms in women in the six months after miscarriage. Int J Gynaecol Obstet 1992. [DOI: 10.1016/0020-7292(92)90829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Neugebauer R, Kline J, O'Connor P, Shrout P, Johnson J, Skodol A, Wicks J, Susser M. Depressive symptoms in women in the six months after miscarriage. Am J Obstet Gynecol 1992; 166:104-9. [PMID: 1733177 DOI: 10.1016/0002-9378(92)91839-3] [Citation(s) in RCA: 125] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study, the first systematic investigation of the psychiatric impact of miscarriage, tests whether miscarriage markedly increases depressive symptoms in the 6 months after loss. We interviewed 382 miscarrying women entering the study at 2 weeks, 6 weeks, or 6 months after loss and, for comparison, 283 pregnant women and 318 community women not recently pregnant. Among women interviewed 2 weeks after miscarriage the proportion highly symptomatic on the Center for Epidemiologic Studies-Depression scale was 3.4 times that of pregnant women (95% confidence limits 2.0 and 5.0) and 4.3 times that of community women (95% confidence limits 3.0 and 5.8). Among women first interviewed 6 weeks and 6 months after miscarriage the proportion highly symptomatic was three times that of the community women. Women reinterviewed at 6 weeks and 6 months did not have elevated symptom levels, a result attributed to the unintended therapeutic and test effects of study interviews. Interviews were fully structured, readily administered by telephone by nonmedical personnel. The possibility that such interviews afford miscarrying women substantial psychologic benefits merits future investigation.
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Affiliation(s)
- R Neugebauer
- Epidemiology of Developmental Brain Disorders Department, New York State Psychiatric Institute, New York
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Hollander E, Mullen L, DeCaria CM, Skodol A, Schneier FR, Liebowitz MR, Klein DF. Obsessive compulsive disorder, depression, and fluoxetine. J Clin Psychiatry 1991; 52:418-22. [PMID: 1938978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Fluoxetine, a selective serotonin reuptake blocker, is an antidepressant medication that has also been shown in open clinical trials and one controlled trial to be effective in the treatment of obsessive compulsive disorder (OCD). OCD is often complicated by depression, and depressive symptoms may interfere with response to both pharmacologic and behavioral treatments. METHOD We describe pilot data from 10 outpatients who met DSM-III-R criteria for OCD in whom the possibility of a depressive reaction or lack of antidepressant response occurred during an open trial of fluoxetine. RESULTS Rapid increase in fluoxetine dose to high doses was associated with depressive symptoms in 6 patients. In 8 patients, improvement in depression was associated with addition of a tricyclic antidepressant to fluoxetine treatment. In 5 patients, both OCD and depressive symptoms improved when the patient was switched to the partially selective serotonin reuptake blocker clomipramine. CONCLUSION This paper serves to alert clinicians to the possibility of a depressive reaction, or lack of antidepressant response, to fluoxetine in OCD patients. This possibility can only be resolved scientifically by adequately controlled experimental trials. If depression occurs, combined fluoxetine and tricyclic treatment, or a switch to a partially selective serotonin reuptake inhibitor, may be helpful. Special considerations and side effects of combined fluoxetine-tricyclic treatment are described.
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Affiliation(s)
- E Hollander
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032
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Abstract
In this study 32 randomly selected psychiatric emergency room patients, who were in concurrent psychotherapy, completed the SCL-90 and a clinically oriented questionnaire. Their therapists independently rated the patients' degree of psychopathology on the nine SCL-90 symptom scales. Therapists were highly efficient in recognizing depression (94% of the cases) and anxiety (89%) but not psychotic (35%) and obsessive-complusive (16%) pathology. Variables significantly associated with the therapists' nonrecognition of psychopathology were the diagnosis of borderline, the patient's expression of inadequacy in comparison to the therapist, the patient's fear of offending the therapist, and the patient wanting but not receiving empathy from the therapist. The authors discuss the implications of these findings for peer review and further research.
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Plutchik R, Jerrett I, Karasu TB, Skodol A. Appearance of new symptoms in hospitalized patients: an instance of institutional iatrogenesis? J Clin Psychiatry 1979; 40:276-9. [PMID: 447610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Data from the admission and termination forms of 100 consecutively discharged psychiatric inpatients were analyzed to determine the changes that occurred in the symptom profile of each patient during hospitalization. In general, patients entered the hospitalization. In general, patients entered the hospital with severe, chronic symptoms some of which were relieved and some of which remained unchanged. A number of symptoms, however, were reported present on the termination forms that had not been noted at admission. The results of this study offer evidence that a possible effect of the therapeutic process is the occasional appearance of new symptoms in some patients.
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Skodol A, Buckley P, Salamon I. The ubiquitous symptoms of schizophrenia. Compr Psychiatry 1976; 17:511-6. [PMID: 963993 DOI: 10.1016/0010-440x(76)90033-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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