The quality of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition dependent personality disorder prototype

OBJECTIVE: The aim of this study was to investigate the quality of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition dependent personality disorder (DPD) prototype with special reference to possible bidimensionality. METHOD: The sample included 1078 patients, 81% (n = 875) had 1 or more personality disorders. The proportion of patients with DPD was 11.3% (n = 122). Frequency distribution, chi2, correlations, reliability statistics, exploratory and confirmatory factor analyses were performed. RESULTS: Of the DPD criteria, criterion 3 showed a higher correlation with avoidant personality disorder than with DPD itself, whereas criterion 5 was weakly correlated with DPD, findings being confirmed by an exploratory factor analysis and a low internal consistency of all DPD criteria. An a priori hypothesized 2-factor model was confirmed by the confirmatory factor analysis. CONCLUSIONS: These results indicate a moderate to low quality of the DPD construct. The main objection is that DPD is based too heavily on a bidimensional model of perceived incompetence and dysfunctional attachment. Items should be revised, in particular, items 3 and 5.     

Intact prototype learning in schizophrenia.

In this study, we examined executive functions and visual prototype learning in patients with schizophrenia (n=22) and matched healthy control subjects (n=20). The patients demonstrated marked perseveration in the Wisconsin Card Sorting Test (WCST), whereas they successfully learned prototypes of dot-pattern category exemplars. These findings are against the hypothesis of a pure generalized cognitive dysfunction in schizophrenia, providing preliminary evidence for intact neocortical mechanisms related to perceptual classification functions.     

Neurologist as expert witness.

Prevailing liberal rules of evidence permit qualified medical and scientific experts to offer opinions designed to help courts decide issues to which their expertise relates. The opinions can be based on direct examinations, review of data assembled by others and data or inferences of a type relied on by other experts in the field. Application of these rules is illustrated through analysis of expert testimony in litigation involving a neurologic syndrome allegedly caused by an immunization and in a case involving controversy over the extent and outcome of major brain injury. Concerns about misuse of expert medical and scientific testimony in litigation are addressed. The article closes with a consideration of approaches designed to improve the reliability of expert testimony.     

Psychiatric expert witnesses in the new millennium.

We may anticipate changes in who is the expert in terms of gender, ethnicity, and professional discipline. We anticipate elaboration of training approaches. We foresee emergence of the "forensic tutor" role. We expect expansion of expert roles outside the courtroom. We expect demands for more constraint of expert roles, increased rigor, and empiric support. We expect vast expansion of technologic approaches to assessment and presentation. We expect evolution of ethical issues with preservation of core forensic values but changes in confidentiality, due process, and the nature of assessments. We expect extreme expansion of hard sciences in relation to understanding psychopathology.     

Diagnostic spectrum and filter function of ambulatory sleep centers

In a prospective study all first admittances into the outpatient sleep clinics of the Bezirksklinikum Regensburg and the BKH W-ilershof within 6 months were studied. Data of 212 patients (66% men, median age 51 years, ages from 7 to 88 years) were collected and evaluated. In over 40% of the cases the symptoms had persisted for more than 5 years. The most common main diagnoses were: obstructive sleep apnea (34%), psychophysiological insomnia (21%), restless-legs-syndrome including periodic leg movement in sleep (15%) and sleeping disorders in the context of affective disorders (8.5%). After ambulatory diagnostics 56% were referred to the sleep laboratory within the same hospital, 5% were referred to other sleep laboratories, 22% were treated on an outpatient basis, 7.5% received somatic or psychiatric treatment and only 7% of the patients did not need further treatment. Therefore the function of an outpatient sleep clinic as a filter for further treatment can be proven.     

The expert witness in forensic psychiatry.

Forensic psychiatry operates at the interface of the Justice and Health systems and has been defined as: "That branch of psychiatry which requires special knowledge and training in the law as it relates to the mental state of the offender, or alleged offender" [1]. As a consequence of working in this area, psychiatrists are often called into court to give evidence as "expert witnesses". This article examines some of the professional and legal issues involved in providing expert testimony. Secondly, it aims to outline some practical guidelines for giving evidence in the court-room. The predominant focus is on criminal, rather than civil, proceedings in which the forensic psychiatrist gives expert testimony; however much of the information is also relevant to other psychiatrists and psychologists undertaking this role in the legal arena.     

探索性眼球轨迹运动对精神分裂症的诊断作用

目的：探讨探索性眼球轨迹运动检查在精神分裂症诊断中的作用。方法：应用眼球轨迹运动标记记录仪对81例精神分裂症患者,81名正常对照人群进行测试,比较眼球轨迹运动的组间差异。结果：81例精神分裂症患者的判别分析值结果获正分67例,负分14例,D分值敏感性82．7％;81名正常对照人群获正分7例,负分74例,D分值的特异性91．4％;眼球轨迹运动的各项指标在精神分裂症组与正常对照人群比较其差异有非常显著性（P〈0．01）,且不受患者发病年龄、性别、受教育年限、不同病程及精神分裂症不同临床症状的影响（P〉0．05）。结论：精神分裂症患者眼球轨迹运动的敏感性较高,对精神分裂症辅助诊断有重要的价值,探究性眼球轨迹运动可能是精神分裂症的生物学指标。     

Issues of validity in the Diagnostic Interview Schedule.

The Diagnostic Interview Schedule, the chief instrument in contemporary studies in psychiatric epidemiology, enhances the reliability of psychiatric diagnosis and enables lay interviewers to closely reproduce psychiatric interviews. However, despite frequent references in the literature to the validity of the Diagnostic Interview Schedule, most studies fundamentally represent variations of reliability paradigms to the neglect of criterion-related validity. Mistaken assertions of validity persist in the psychometric language used to describe the Diagnostic Interview Schedule. This article examines the basis for claims and counterclaims of validity in accordance with standard psychometric definition, and identifies sources of erroneous reasoning in attempts to infer validity from reliability. The article presents a general framework organizing the process of diagnostic validation and discusses strategies for research seeking to validate psychiatric diagnoses achieved through the Diagnostic Interview Schedule.     

Stereotactic pallidotomy in the treatment of Parkinson disease: an expert opinion.

The objective of this workshop was to provide recommendations on several issues involving pallidotomy for patients with medically intractable Parkinson disease to physicians, patients, and other health care providers. An international consortium of experts in neurology, neurosurgery, and neurophysiology who had extensive experience with pallidotomy were invited to the workshop. Participants were sent background materials from the scientific literature for review-based participant recommendations. A proposed agenda was circulated to all participants before the workshop, and the final agenda was based on their recommendations. Topics were introduced at the workshop by members of the organizing committee, followed by extensive group discussion. A draft of a consensus statement, based on the previous day's discussion, was circulated and further modifications were made. The final statement was agreed on by all members.The conclusions of the participants were: (1) Pallidotomy should be performed only at centers that have a team of physicians with substantial expertise and experience in the field. (2) Patients with disabling idiopathic Parkinson disease, without dementia, and who have exhausted medical therapy should be considered for pallidotomy. (3) All patients should be examined by means of standardized rating scales both preoperatively and postoperatively to ensure quality of care at each center. (4) Symptoms that respond best to pallidotomy include medication-induced dyskinesias, rigidity, and tremor, while balance, gait disorders, and hypophonia are generally less responsive to surgery. Benefits of pallidotomy appear to be long lasting. (5) Each institution's complication rate should be discussed before surgery.     

Murder, insanity, and medical expert witnesses.

Recent advances in the ability to study brain anatomy and function and attempts to link these findings with human behavior have captured the attention of the legal system. This had led to the increasing use of the "neurological defense" to support a plea of not guilty by reason of insanity. This article explores the history of the insanity defense and explores the role of the medical expert witnesses in integrating clinical and laboratory findings, eg, computed tomographic scans, magnetic resonance scans, and single-photon emission computed tomographic scans. Three cases involving murder and brain dysfunction are discussed: the first case involves a subarachnoid hemorrhage resulting in visual perceptual and memory impairment; the second case, a diagnosis of Alzheimer's disease; and the third case, the controverted diagnosis of complex partial seizures in a serial killer.