"Folk" criteria for the diagnosis of mental illness in rural Laos: on being insane in sane places.

"Folk" criteria for identifying the mentally ill, as distinguished from folk theories about the causes of mental illness, have been comparatively neglected in cultural psychiatry. The authors describe the criteria by which villagers in Laos labeled 35 subjects as baa (insane). Unprovoked assaultive or destructive behavior, social isolation, self-endangerment due to neglect of personal needs, nonviolent but socially disruptive or inappropriate behavior, and inability to do productive work were found to be important folk criteria. The authors emphasize that folk criteria for mental illness are determined primarily by the persistence of socially dysfunctional behavior rather than by disturbances in thought and affect.     

Evaluation of clinical diagnostic criteria for neurofibromatosis 2

BACKGROUND: Four sets of clinical diagnostic criteria for neurofibromatosis 2 (NF2) have been developed by groups of expert clinicians, but sensitivity has never been formally assessed. The sets of criteria differ for people without bilateral vestibular schwannomas, which are pathognomonic for NF2. OBJECTIVE: To empirically evaluate the four existing sets of clinical diagnostic criteria for NF2. METHODS: The study was based on 163 of 403 people in the United Kingdom NF2 registry (41%) who presented without bilateral vestibular schwannomas. The authors applied the sets of criteria to each person at initial assessment and at the most recent clinical evaluation (mean +/- SE length of follow-up, 13 +/- 1 years). RESULTS: In people with "definite NF2" and a negative family history of NF2, the 1987 US NIH and 1991 NIH criteria each identify 78% of people at the most recent clinical evaluation but 0% at initial assessment. The National Neurofibromatosis Foundation (NNFF) criteria and the Manchester criteria each identify higher proportions at both time points (NNFF criteria, 91% and 10%; Manchester criteria, 93% and 14%), but the proportions at initial assessment are still low. CONCLUSIONS: None of the existing sets of criteria are adequate at initial assessment for diagnosing people who present without bilateral vestibular schwannomas as having NF2, particularly people with a negative family history of NF2. The authors recommend that a single, revised set of diagnostic criteria be devised to replace all of the existing sets of criteria.     

THE LANGUAGE OF REINFORCEMENT: A SOURCE OF CONFUSION?

SUMMARY. 100 people with mental handicaps attending adult training centres in the North West of England were asked to define the terms “good” and “bad”. Rating criteria were developed to accommodate the broad range and variety of responses, many of which appeared to be a function of training environments.     

Late luteal phase dysphoric disorder and DSM-III-R

Text and diagnostic criteria for a new category, late luteal phase dysphoric disorder, appear in appendix A of DSM-III-R: "Proposed Diagnostic Categories Needing Further Study." The inclusion of this category in the manual was perhaps the most controversial aspect of the revision of DSM-III. In this paper the authors describe the work of the advisory committee that first proposed the category, the rationale for the category's inclusion in the manual, and the many issues that were the focus of heated debates.     

Depressive attributional style and the dexamethasone suppression test: relationship to the endogenous/melancholic distinction and to each other.

The dexamethasone suppression test (DST) and the depressive attributional style questionnaire (ASQ) were administered to 105 depressed patients prior to participation in a double-blind outpatient study and to 29 normal controls. The depressed patients were classified into three groups (1) met criteria for both research diagnostic criteria for definite endogenous depression and DSM III melancholia; (2) met criteria for neither, and (3) met criteria for one but not both. The group that met criteria for both RDC endogenous depression and DSM-III melancholia had a statistically greater frequency of abnormal DST versus the group that met neither criteria and the normal controls. With regard to ASQ, patients who met both criteria had statistically higher bad event internality scores but statistically lower bad event stability and globality scores as opposed to the group that met neither criteria. In general, normal controls had significantly lower bad event ASQ scores than the three depressive groups. There was no correlation between ASQ and DST, as both DST suppressors and nonsuppressors had similar ASQ scores and there was no correlation between ASQ bad event attributions and initial severity of depression.     

Diagnostic criteria for respiratory chain disorders in adults and children

BACKGROUND: Respiratory chain (RC) disorders are clinically, biochemically, and molecularly heterogeneous. The lack of standardized diagnostic criteria poses difficulties in evaluating diagnostic methodologies. OBJECTIVE: To assess proposed adult RC diagnostic criteria that classify patients into "definite," "probable," or "possible" categories. METHODS: The authors applied the adult RC diagnostic criteria retrospectively to 146 consecutive children referred for investigation of a suspected RC disorder. Data were collected from hospital, genetics, and laboratory records, and the diagnoses predicted by the adult criteria were compared with the previously assigned assessments. RESULTS: The authors identified three major difficulties in applying the adult criteria:lack of pediatric-specific criteria; difficulty in segregating continuous data into circumscribed major and minor criteria; and lack of additivity of clinical features or enzyme tests. They therefore modified the adult criteria to allow for pediatric clinical and histologic features and for more sensitive coding of RC enzyme and functional studies. Reanalysis of the patients' data resulted in congruence between the diagnostic certainty previously assigned by the authors' center and that defined by the new general RC diagnostic criteria in 99% of patients. CONCLUSIONS: These general diagnostic criteria appear to improve the sensitivity of the adult criteria. They need further assessment in prospective clinical and epidemiologic studies.     

Estimating the prevalence of agitation in community-dwelling persons with Alzheimer's disease

To estimate the prevalence of, and develop norms for, significant agitation in community-dwelling persons with Alzheimer's disease (AD), the authors applied three different criteria to persons with AD (n=235) and normal elderly control subjects (NEC; n=64). The criteria were used to identify the minimum total score on the Cohen-Mansfield Agitation Inventory (CMAI) that represents significant or "excessive" agitation and to estimate its prevalence. The "ultraliberal" criterion resulted in 99.1% of persons with AD and 56.6% of NEC being classified as "excessively" disturbed. The "liberal" and "conservative" criteria classified 66.7% and 68.2% of persons with AD, and no NEC, as "excessively" disturbed. The authors conclude that the best estimate of prevalence of excessive agitation in this population is 67.5%, and that individuals with CMAI scores of 0 to 14 probably should not be considered to have excessive agitation.     

The "open door" system in psychiatry

The authors describe the situation which developed as a result of construction work, when the grounds of the psychiatric clinic were open. Before that time there were during a five-year period on average 2.2 escapes per year; despite an unaltered regime of the patients and unaltered supervision there was not a single escape. This is in favour of an "open door system" in psychiatry, with the possibility to apply it in future rationalization activities.     

Predicting long-term outcome in schizophrenia.

Prediction of 14- to 17-year outcome from symptoms present at admission and psychological and personality data was attempted among the 92 survivors of a group of 110 first-admitted schizophrenic patients. Three different outcome criteria were used and the correlations between these varied from low to high. Using a discriminant analytical approach where all 107 predictor variables were used to predict a combination of outcome criteria, 23% of outcome variance could be explained, which should be compared with 49% in a previous 5- to 9-year outcome study on the same material. At least one outcome variable--economic self-support--could not at all be predicted. "Atypical" symptoms were associated with favourable outcome and longitudinal variables indicative of "high-risk personality", or duration and severity of illness, were related to bad prognosis. Overt psychotic symptoms had no significant correlation with outcome.     

Anxiety disorders in mid-adolescence: a community sample

The authors report the 6-month period prevalence of anxiety disorders in a community sample of 150 adolescents 14 to 16 years old. Diagnoses were based on structured psychiatric interviews, DSM-III criteria, and a psychiatrist's review of the data. Additional measures of affect, self-concept, and coping were also obtained for all subjects. Seventeen percent of the adolescents met criteria for one or more anxiety diagnoses and 8.7% were identified as "cases" of anxiety disorder. A significant relationship was found between anxiety and depression. The authors discuss the distribution and expression of anxiety disorders among adolescents in the community.     

Individuating psychotherapies

One goal of an empirically oriented psychotherapist is to implement the same psychotherapy across similar clients for a similar specified problem. Adherence to a specified treatment is imperative when following a treatment manual. In other cases, such as when developing a new treatment, psychotherapists desire that the intervention be different from those currently available. To develop new treatments and to substantively increase the arsenal of psychological "tools" available to alleviate human suffering, criteria by which treatments are judged to be novel must be developed. The authors discuss criteria to make such delineations. They argue that psychotherapies are defined by two key properties: (a) a mechanism or mechanisms that causally produce the treatment's effects (if any) and (b) a manner or manners of instantiating these mechanisms. They also argue that if two psychotherapies share these two properties, then they are the same treatment: if not, they should be considered different treatments.     

The induction of acute psychosis in a group setting.

The case histories of two patients are described, each of whom suffered a severe psychotic decompensation, one apparently schizophreniform and the other affective, after attending a seven day marathon group conducted by a charismatic, aggressive leader. The work of Yalom and Lieberman is reviewed, with regard to leader and participant characteristics in encounter group casualties. Drawing upon the work of Bion and Kernberg, a specific means for the induction of psychosis is suggested, involving primitive splitting and the projection of "all bad" self-object constellations within a group setting.     

DSM-IV and new diagnostic categories: holding the line on proliferation.

The authors discuss aspects of the decision-making process for including "new" diagnostic categories in DSM-IV. They detail the different kinds of new categories proposed for inclusion in DSM-IV and discuss the risks and benefits of incorporating them. The authors comment on whether new diagnostic categories should be included in official nosologies as a stimulus for research or as a culmination of research. They also highlight problems with "sunsetting" diagnoses. The criteria for change in DSM-IV--a way to deal with the expanding array of proposals for additional diagnostic entities--are discussed. The authors also offer a series of specific examples of the different kinds of new categories being considered for inclusion in DSM-IV.     

Psychiatric disturbances in children of parents with bipolar disorder

The early symptoms of bipolar disorder in children and adolescents are often qualitatively different from the classic symptoms of mania and depression that present in adults, complicating the diagnosis of the disorder in younger populations. The focus of this article is the evaluation and treatment of children with bipolar parents who begin to develop behavioral and other psychiatric problems. The authors first review the current criteria available for diagnosing bipolar disorder in children. They consider issues related to how the DSM-IV criteria have been applied in this population, in particular the increase in the number of children diagnosed with bipolar disorder as a result of the decision to allow a "manic" episode to be diagnosed in the absence of expansive or elated mood. The practice parameters for the diagnosis and treatment of bipolar disorder in children and adolescents developed by the American Academy of Child and Adolescent Psychiatry are also discussed. The literature concerning children of parents with bipolar disorder is reviewed and indicates that these children are at increased risk for a wide range of psychiatric disorders, including bipolar disorders, other affective disorders, disruptive behavior disorders, and other psychiatric illnesses. The authors then review what is known about treatment for the early symptoms of bipolar disorder in this population and discuss the utility of mood stabilizers. The authors then discuss the role genomic screening may play in the future in identifying children at the highest risk for developing bipolar disorder. The article concludes with a summary of several endophenotypic expressions of bipolar disorder that have been described in children of parents with bipolar disorder.     

The prevalence of schizophrenia: a reassessment using modern diagnostic criteria

Using strict research diagnosis criteria, the authors found a hospital admission prevalence of schizophrenia of about 6%. Other recent studies yielded similar figures, with correspondingly low figures for the morbid risk of schizophrenia in the general population and in the relatives of schizophrenic probands. In view of the data supporting the validity of this "narrow" concept of schizophrenia, the authors suggest that the true prevalence of schizophrenia is much lower than generally accepted.     

Automatic bad channel detection in intracranial electroencephalographic recordings using ensemble machine learning

Objective

Intracranial electroencephalographic (iEEG) recordings contain “bad channels”, which show non-neuronal signals. Here, we developed a new method that automatically detects iEEG bad channels using machine learning of seven signal features.

Psychiatric commitment of the elderly

Involuntary hospitalization of the elderly has been the focus of controversy. In many jurisdictions, commitment criteria are stringently and narrowly defined, require a showing of "dangerousness," and are difficult to apply toward securing proper treatment for the elderly. In other areas, broader criteria apply, but some authors argue that such criteria are inappropriately used with the elderly and leave them vulnerable to the abuse of unnecessary institutionalization. The authors examined 274 consecutive admissions aged 55 years and over, comparing voluntary and involuntary patients. Patients admitted involuntarily were significantly more likely to have organic mental disorders, be violent before admission, and be disoriented, withdrawn, and apathetic. Voluntary patients were significantly more likely to have major mood disorders. Patients who lived with others were more likely to be committed than those living alone. The authors discuss these findings with attention to the appropriateness of broader commitment standards and the more stringent dangerousness criteria as they apply to the geriatric population.     

Physical recklessness in adolescence. Trait or byproduct of depressive/suicidal states?

The authors assessed adolescents (264 psychiatric inpatients and 742 high school students) with a new instrument (the Sommerfeldt-Clark Adolescent Recklessness Scale) to test whether adolescents show individual differences on a dimension ranging from physical caution to physical recklessness. The three dimensions that emerged reflect an interest in weapons and military dangers, which we have tentatively labeled "foolhardiness"; the combination of dangerous driving and substance abuse; and involvement with smoking, drug use, and "bad company." The personality traits of "venturesomeness" and "impulsiveness" were significantly correlated with all three recklessness factors. The first two factors showed no significant relationship with patient status, diagnosis of mood disorder, or history of suicidal behavior; the third factor was associated with inpatient status and a history of suicide attempts.     

"Schizoaffective disorder": an invalid diagnosis? A comparison of schizoaffective disorder, schizophrenia, and affective disorder

The authors compared patients meeting widely accepted criteria for the diagnosis of schizoaffective disorder, manic type, with patients meeting rigorous criteria for manic disorder and schizophrenia, using three methods of validation: family history, short-term treatment response, and long-term outcome. No significant differences were found between patients with manic disorder and schizoaffective disorder. However, consistent and often highly significant differences separated patients with schizophrenia from those with manic disorder and schizoaffective disorder. The findings suggest that schizoaffective disorder, as currently defined, is not a valid and independent entity. The authors suggest that psychotic disorders not diagnosable as manic-depressive illness or schizophrenia and without apparent organic basis would best be called "undiagnosed" or "atypical" psychosis. Further, while proposals for new diagnoses or for subtyping of schizophrenia or manic-depressive illness should be encouraged, these should undergo rigorous screening for validity before being accepted into clinical use.