Nimodipine in acute alcohol withdrawal state.

The effect of the calcium channel blocker, nimodipine, in acute alcohol withdrawal was investigated in a randomized, placebo controlled, double blind study. Thirty-two male patients with a history of alcohol dependence according to DSM-III criteria, but no other substance abuse, were included. A new rating instrument which fulfilled theoretical test criteria was applied to determine the severity of the alcohol withdrawal state. The patients received nimodipine or a placebo on four separate occasions (4 x 60 mg) and, in addition, clomethiazole, according to a standardized procedure. Our investigation has shown that, in the first 48-72 h of alcohol withdrawal, both groups consumed similar amounts of additional clomethiazole medication. Thus, no significant effect of nimodipine on the acute alcohol withdrawal state could be demonstrated. There was some tendency for nimodipine to ameliorate psychosensory dysfunction.     

Sexual dysfunction and dual psychiatric diagnoses

Controversy continues to exist about whether a sexual dysfunction is a discrete problem or it is symptomatic of more elaborate psychiatric disorder. To date no study of this question has been reported on patients evaluated using DSM-III criteria. To meet such a need, 592 patients with various sex-related complaints and their partners were evaluated at the Sexual Behaviors Consultation Unit of the Johns Hopkins Hospital over a 2-year period. Two hundred and eighty-eight patients (males = 223; females = 65) fulfilled DSM-III criteria for psychosexual dysfunction. Of these 30.5% (N = 68) of the males and 30.8% (N = 20) of the females were assigned concurrent Axis I/II diagnoses. Patients who had dual diagnoses reported more (P = .026) problems with alcohol. Despite equivalent psychosocial stressors on Axis IV they were rated less (P less than .01) adjusted on Axis V. Dual diagnostic profiles were described for each of the psychosexual dysfunctions. Results support the hypothesis that while the majority of patients with sexual dysfunction have a discrete disorder, there is another group whose sexual dysfunction is but one of several conditions which deserve treatment.     

Marked reduction in the number of platelet-tritiated imipramine binding sites in geriatric depression

The number (Bmax) and affinity (Kd) of platelet-tritiated imipramine binding sites was determined in young and middle-aged controls 50 years of age and younger (n = 25), elderly normal controls over 60 years of age (n = 18), patients who fulfilled DSM-III criteria for major depression who were under 50 years of age (n = 29), patients who fulfilled DSM-III criteria for major depression who were 60 years of age and older (n = 19), and patients who fulfilled both DSM-III criteria for primary degenerative dementia and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease (n = 13). Both groups of depressed patients (under 50 and over 60 years of age) exhibited significant reductions (decreases 42%) in the number of platelet-tritiated imipramine binding sites with no change in affinity, when compared with their age-matched controls. There was little overlap in Bmax values between the elderly depressed patients and their controls. The patients with probable Alzheimer's disease showed no alteration in platelet-tritiated imipramine binding. There was no statistically significant relationship between postdexamethasone plasma cortisol concentrations and tritiated imipramine binding. These results indicate that platelet-tritiated imipramine binding may have potential utility as a diagnostic adjunct in geriatric depression, and moreover that the reduction in the number of platelet-tritiated imipramine binding sites is not due to hypercortisolemia.     

DSM-III and DSM-III-R: What are American psychiatrists using and why?

The purpose of this study was to determine whether American psychiatrists have switched from DSM-III to DSM-III-R as their primary diagnostic reference, and to examine what factors predicted the continued use of DSM-III. In 1989, we conducted a mail survey of practicing psychiatrists (N = 454), residency program directors (N = 128), residents (N = 1,331), and researchers (N = 196) regarding their training in, use of, and opinions about DSM-III and DSM-III-R. Approximately 30% of practitioners continued to use DSM-III as their primary diagnostic reference, although this was less frequently true of researchers and residents. In none of the four groups did a majority believe that DSM-III-R was needed, despite the fact that the majority of each group indicated that it was an improvement over DSM-III. The most commonly perceived reasons for publishing DSM-III-R were that it corrected problems with DSM-III and new research indicated changes were warranted. Compared with DSM-III-R users, DSM-III users more frequently believed that the 7-year interval between the two editions was too short, that DSM-III-R was not needed, and that the revised manual was little better than the original. Thus, 2 years after the publication of DSM-III-R 90% of psychiatrists were using DSM-III-R, at least in part, although a substantial minority continued to use DSM-III as their primary diagnostic manual. Even among DSM-III-R users, many believed that the revised manual was not needed. The perceived need for DSM-III-R was associated with the reasons ascribed to its publication; therefore, acceptance of DSM-IV may be partially a function of how its development is promoted and justified. That nearly one third of a random sample of practicing psychiatrists continued to use DSM-III supports concerns that the publication of DSM manuals every 6 or 7 years will divide the psychiatric community into subgroups using different diagnostic criteria.     

Gender differences in severity, symptomatology and distribution of melancholia in major depression

BACKGROUND: Studies of gender differences in the clinical presentation of depression have provided divergent results. This study aimed at analyzing gender differences in severity, symptomatology and distribution of melancholia in major depression. SAMPLING AND METHODS: The study comprised 930 in- and out-patients (652 women, 278 men) from 6 randomized controlled trials. All patients fulfilled DSM-III or DSM-III-R criteria for major depression. The 17-item Hamilton Depression Scale (HDS) was applied to all patients. A multi-axial evaluation was completed using the Newcastle 1 Depression Rating Scale from 1965 for melancholia (N1) in a subsample of patients (n = 439). A factor analysis on the HDS was performed. Non-parametric statistical tests were used and only gender differences greater than 20% were considered clinically relevant. RESULTS: The median on the HDS total score was 22 and the median number of symptoms was 13 for both men and women. Presentation of specific symptoms was similar for men and women. The factor analysis revealed no gender differences, and neither did analyses on symptoms of Axes II and IV. According to the N1, 80% of the men and 66% of the women suffered from melancholic depression (p = 0.004). CONCLUSIONS: In a large and broad sample of in- and out-patients with major depression, the severity and symptomatology of depression were similar for men and women. Melancholic depression was significantly more frequent among male than female patients. Inclusion and exclusion criteria in the randomized controlled trials provided a selected group of patients, which limited the generalisability of the results to an exclusive subgroup of patients treated for depression in routine clinical practice.     

Somatization disorder and Briquet's syndrome. An assessment of their diagnostic concordance

Somatization disorder (SD) as defined by DSM-III is a modification of criteria previously established to define Briquet's disorder (BD). We examined whether the less stringent SD criteria identify the same patient population as the more stringent BD criteria. All psychiatric female outpatients who reported having multiple unexplained physical problems prior to the age of 30 years were included in the study. Eighty-five (10.7%) of 794 patients fulfilled these screening criteria. Of the 85 patients, 41 had both SD and BD. Thirty-six patients did not have either disorder. The results indicate that the DSM-III criteria for SD are equally effective in identifying patients with BD but considerably less time-consuming and cumbersome to apply.     

Lifetime and 6-month prevalence of abuse and dependence of alcohol in the Munich follow-up study

Summary This paper reports lifetime and 6-month prevalence rates of alcohol abuse and dependence in West Germany. Assessment instruments are a modified German version of the Diagnostic Interview Schedule (DIS), a fully standardized interview for the assessment of selected DSM-III diagnoses and the Munich Alcoholism Test (MALT). According to the DIS/DSM-III criteria, 13.0% of the adult general population (aged 25–64 years) were found to fulfill the lifetime criteria for alcohol abuse, alcohol dependence, or both; however, only 1.3% of all men and 0.9% of the women interviewed received a current DSM-III diagnosis of alcohol abuse or dependence. There was good consensus between current DSM-III diagnoses with current clinical ICD-diagnoses, but poor concordance with lifetime diagnoses. Symptoms of alcoholism, onset and severity, comorbidity with other DIS/DSM-III disorders as well as some selected risk factors are reported. The results are primarily compared with the results of the US-Epidemiological Catchment Area Program (ECA).     

Are social fears and DSM-IV social anxiety disorder associated with smoking and nicotine dependence in adolescents and young adults?

To investigate associations between social anxiety and smoking behaviour in order to explore whether social anxiety predicts the first onset of cigarette smoking, regular smoking and the development of nicotine dependence. Baseline and four-year follow-up data from the Early Developmental Stages of Psychopathology Study (EDSP), a prospective-longitudinal community study of 3,021 adolescents and young adults, are used. Smoking behaviour and psychopathology were assessed with the M-CIDI and its DSM-IV algorithms. At baseline, 35.7% of the sample were regular smokers, and 18.7% fulfilled criteria for DSM-IV nicotine dependence. Twenty-seven point two percent reported at least one social fear, and 7.2% met criteria for DSM-IV social phobia, most of whom reported first onset of social fear problems clearly prior to smoking initiation. Cross-sectional retrospective baseline analyses based on retrospective reports revealed that social fears and DSM-IV social phobia were both significantly associated with higher rates of nicotine dependence. Prospective-longitudinal analyses that were conducted in an attempt to confirm cross-sectional retrospective results showed that baseline non-users with social fears (OR = 3.85) and baseline non-dependent users with social fears (OR = 1.5) had an increased risk of onset of nicotine dependence during the follow-up period of four years. These findings remained significant even when controlling for co-morbid depressive disorders. Social anxiety was found to be significantly associated with nicotine dependence in both cross-sectional retrospective and prospective-longitudinal analyses. It is suggested that social fears could lead to heavy tobacco use as smoking is a socially acceptable behaviour that relieves anxiety in social situations. Possible differential effects of social anxiety on the early stages of smoking behaviour compared to effects on nicotine dependence are discussed. These findings should stimulate a continued search into potentially causal links between social fear symptoms and the development of tobacco consumption and nicotine dependence in adolescence.     

Borderline personality disorder and unipolar affective disorder. Long-term effects of comorbidity

This study tracks the baseline clinical presentation and long-term course (average 15 years) of three patient groups defined largely by DSM-III from the Chestnut Lodge follow-up study: unipolar affective disorder (UNI, N = 22), borderline personality disorder (BPD, N = 55), and a comorbid cohort (UNI/BPD, N = 21). Comorbid BPD effects on UNI include earlier onset and absence of psychotic symptoms at baseline and more substance abuse and use of psychiatric treatment at follow-up. Comorbid UNI effects on BPD include better premorbid instrumental functioning, later onset at baseline, and a higher risk for suicide over the long term. Other noteworthy findings are a low rate of suicide (2%) among the noncomorbid BPD patients and a high rate of diagnostic instability (68%) among the noncomorbid UNI patients. Findings demonstrate a lack of syndromal stability within and among all three study groups and highlight the shortcomings of DSM-III for the investigation of comorbidity.     

Psychiatric disorders among elderly Koreans in the United States

This study examines the lifetime prevalence of various psychiatric disorders among 100 Korean elderly in Los Angeles. The instrument used in this study is the Diagnostic Interview Schedule, Version III (DIS III, 1–10). The main finding is of relatively low prevalence of most DSM-III disorders with the exception of alcohol abuse and dependence. The rate of alcoholism is astonishingly high among elderly Korean males in Los Angeles. The findings are compared with the U.S. Epidemiological Catchment Area studies, and with other much larger community studies conducted in Korea. A comparison shows that there are no significant differences in the prevalence of mental disorders between elderly Koreans in Los Angeles and elderly Americans in St. Louis (N=576) except for the prevalence of alcohol abuse and dependence. The lifetime prevalence of DSM-III disorders among Koreans in Korea (N=5100) is generally higher than among elderly Koreans in Los Angeles.Presented at the 144th Annual Meeting of the American Psychiatric Association, New Orleans, May 11–16, 1991.This study was supported in part by the National Research Center on Asian American Mental Health (NIMH RO1 MH44331).     

Schizophrenic relapse after drug withdrawal is predictable

Thirty-two patients in remission were followed by regular ratings during a prospective neuroleptic withdrawal study. They were outpatients who fulfilled the DSM-III criteria of schizophrenia and who were motivated for drug withdrawal. The relapse rate was 81%. The results from the rating scales confirm the hypothesis that a symptom increase occurs before psychotic relapse. In the order statistical differences occurred, the factors predicting relapse were those concerned with positive psychopathology, motor dysfunction, impaired affects and sleep disturbances. The corresponding symptoms and signs were mainly concerned with thought disorders, paranoid ideation, overactivity, depression and insomnia middle, all of nonpsychotic degree of severity. If prodromes appear, the patient should resume his neuroleptic treatment, or other preventive measures should be taken. By such therapeutic interactions, psychotic relapse may be prevented, or can be dealt with in an outpatient setting.     

Axis I phenomenology of borderline personality disorder

The Axis I phenomenology of 50 outpatients meeting both Diagnostic Interview for Borderlines (DIB) and DSM-III criteria for Borderline Personality Disorder (BPD), 29 outpatients meeting DSM-III criteria for Antisocial Personality Disorder (APD), and 26 outpatients meeting DSM-III criteria for Dsythymic Disorder as well as DSM-III criteria for some other type of Axis II disorder (dysthymic OPD) was assessed blind to clinical diagnosis using the Structured Clinical Interview for DSM-III (SCID). Borderlines were significantly more likely than antisocial controls to have met DSM-III criteria for an affective disorder, particularly Dysthymic Disorder, and an anxiety disorder. They were also significantly more likely than dysthymic OPD controls but significantly less likely than antisocial controls to have met DSM-III criteria for alcohol abuse/dependence and drug abuse/dependence. The authors conclude that: (1) the link between BPD and unipolar affective disorders is less specific than previously suggested, and (2) there is a link between BPD and impulse disorders that may be of equal, if not greater, importance.     

Depression and dexamethasone suppression testing in children and adolescents

The authors compare the incidence of dexamethasone nonsuppression in a large group of child and adolescent inpatients (N = 94) diagnosed by two criteria (DSM-III and Weinberg criteria). The incidence of dexamethasone suppression test nonsuppression in patients diagnosed with DSM-III major depressive disorder (n = 33) was 55%, compared to 11% in those with no affective disorder (n = 35). This was compared to the incidence of dexamethasone suppression test nonsuppression utilizing Weinberg criteria. In addition, symptoms that to varying degrees discriminated suppressors from nonsuppressors were examined. These included change in school performance and, to a lesser degree, somatic complaints and weight and appetite changes. Differences in the diagnostic criteria are discussed.     

An empirical study of different diagnostic criteria for delirium among elderly medical inpatients

This study compared the sensitivity and specificity of DSM-IV criteria for delirium with the sensitivity and specificity of DSM-III and ICD-10 criteria among elderly medical inpatients with or without dementia. Secondary objectives were to examine the effect of changing the definition of criterion A on sensitivity and specificity and to compare the sensitivity and specificity of different numbers of symptoms of delirium. A total of 322 elderly patients who had been admitted from the emergency department to the medical services were classified into one of four groups using DSM-III-R criteria: delirium and dementia (n = 128), delirium only (n = 40), dementia only (n = 94), and neither (n = 60). The sensitivity and specificity of DSM-IV, DSM-III, and ICD-10 criteria were determined against DSM-III-R criteria using three definitions of criterion A (clouding of consciousness only, clouding of consciousness and inattention, clouding of consciousness or inattention). When criterion A was defined as clouding of consciousness or inattention, the sensitivity and specificity of DSM-IV, DSM-III, and ICD-10 criteria were 100% and 71%, 96% and 91%, and 61% and 91%, respectively. The results were similar among patients with or without dementia. The lower specificity of DSM-IV was accounted for by its inclusion of patients who did not show disorganized thinking. DSM-IV criteria for delirium are the most inclusive criteria to date for elderly medical patients with or without dementia.     

An outcome study of psychotherapy for patients with borderline personality disorder.

OBJECTIVE: This study evaluated the effectiveness of well-defined outpatient psychotherapy for patients with borderline personality disorder. METHOD: Thirty patients with borderline personality disorder diagnosed according to the DSM-III criteria were given twice weekly outpatient psychotherapy for 12 months by trainee therapists who were closely supervised. The treatment approach was based on a psychology of self (this term being used in its broad sense), and strong efforts were made to ensure that all therapists adhered to the treatment model. Outcome measures included frequency of use of drugs (both prescribed and illegal), number of visits to medical professionals, number of episodes of violence and self-harm, time away from work, number of hospital admissions, time spent as an inpatient, score on a self-report index of symptoms, and number of DSM-III criteria (weighted for frequency, severity, and duration) fulfilled. RESULTS: The subjects showed statistically significant improvement from the initial assessment to the end of the year of follow-up on every measure. Moreover, 30% of the subjects no longer fulfilled the DSM-III criteria for borderline personality disorder. This improvement had persisted 1 year after the cessation of therapy. CONCLUSIONS: The results suggest that a specific form of psychotherapy is of benefit for patients with borderline personality disorder.     

The impact of different diagnostic criteria on prevalence rates for delirium

A cross-sectional study was performed to evaluate the concordance of the present criteria of delirium among elderly (>70 years) geriatric hospital patients (n = 230) and nursing home residents (n = 195). Different subjects were diagnosed as having delirium when operationalized criteria according to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III, DSM-III-R, DSM-IV) and the World Health Organization's International Classification of Diseases (ICD-10) were used. Whereas 132 subjects (31.1%) met the criteria for delirium by at least 1 classification, only 25 (5.9%) met all 4. The most inclusive was the DSM-IV (24.9% of the subjects) followed by DSM-III-R (19.5%), DSM-III (18.8%) and ICD-10 (10.1%), respectively. The DSM-IV and ICD-10 had the largest number of patients not overlapping with any other diagnostic group. The newest DSM-IV classification found more cases of delirium especially among acutely ill, hospitalized patients.     

Signs and symptoms of tobacco withdrawal

To test the validity, magnitude, and clinical significance of the signs and symptoms of tobacco withdrawal defined by DSM-III, both observed and reported signs and symptoms were measured in 50 smokers during two days of ad lib smoking and then during the first four days of abstinence. Observer and subject ratings of the DSM-III symptoms of craving for tobacco, irritability, anxiety, difficulty concentrating, and restlessness increased after cessation. In addition, bradycardia, impatience, somatic complaints, insomnia, increased hunger, and increased eating occurred after cessation. The frequency and intensity of these symptoms varied across subjects; however, the average distress from tobacco withdrawal was similar to that observed in psychiatric outpatients. Subjects who had more withdrawal discomfort were more tolerant to the cardiovascular effects of nicotine. Subjects who had more withdrawal discomfort did not have a lower rate of smoking cessation.     

Elevated risk of tobacco dependence among offspring of mothers who smoked during pregnancy: a 30-year prospective study

OBJECTIVE: The authors' goal was to investigate whether maternal smoking during pregnancy is associated with an increased risk of nicotine dependence among adult offspring. METHOD: Prospective data from two samples of offspring in the National Collaborative Perinatal Project, a long-term prospective investigation from pregnancy through adulthood, were combined (N=1,248). Maternal smoking during pregnancy was assessed during each prenatal visit. Offspring smoking behavior and lifetime risk of nicotine dependence were obtained by structured interview with the Diagnostic Interview Schedule; the mean age of the offspring at the time of interview was 29 years. RESULTS: Offspring whose mothers reported smoking a pack or more of cigarettes during their pregnancy were significantly more likely to meet DSM criteria for lifetime tobacco dependence than offspring of mothers who reported that they never smoked during pregnancy. The odds of progressing from smoking to nicotine dependence were almost twice as great for offspring whose mothers smoked heavily during pregnancy. These significant differences remained after adjustments for participants' gender and age and maternal socioeconomic status and age at pregnancy. Results were comparable for men and women. The findings were specific for tobacco dependence; odds of marijuana dependence were not significantly elevated among the offspring of tobacco smokers. CONCLUSIONS: Offspring of mothers who smoked a pack or more of cigarettes during pregnancy are at elevated risk of developing nicotine dependence but not marijuana dependence as adults. Maternal smoking during pregnancy is a risk factor for subsequent nicotine dependence among offspring.     

Topographic quantitative EEG amplitude in recovered alcoholics.

Topographic measures of electroencephalographic (EEG) amplitude were used to compare recovered alcoholics (n = 14) with sex- and age-matched control subjects. Delta, alpha, and beta activity did not distinguish the groups, but regional differences in theta distribution did. Recovered alcoholics showed more uniform distributions of theta amplitudes in bilateral anterior and posterior regions compared with controls. Because a minimum of 5 years had elapsed since the recovered alcoholic subjects fulfilled DSM-III-R criteria for alcohol abuse or dependence, it is unlikely these EEG theta differences reflect the effects of withdrawal.