The reliability of the family history method for psychiatric diagnoses

We evaluated the test-retest interrater reliability of the Family History Research Diagnostic Criteria (FH-RDC) in 58 depressed patients who described 341 first-degree relatives. Reliability was examined as a function of the threshold to determine caseness. In general, diagnostic reliability was good-excellent for specific FH-RDC disorders, but not for the residual category of other psychiatric disorder. A higher diagnostic threshold was associated with greater reliability, especially for the diagnosis of depression. Patient variance accounted for a greater percentage of the disagreements between the interviewers than did rater variance.     

Classifications in psychiatry: a conceptual history.

BACKGROUND: Historical accounts of psychiatric classifications have hitherto been written in terms of a 'received view'. This contains two assumptions, that: (i) the activity of classifying is inherent to the human mind; and (ii) psychiatric 'phenomena' are stable natural objects. OBJECTIVES: The aim of this article is to provide an outline of the evolution of psychiatric classifications from the perspective of conceptual history. This is defined as a theoretical and empirical inquiry into the principles, sortal techniques and contexts in which alienists carried out their task. It assumes that all psychiatric classifications are cultural products, and endeavours to answer the question of whether classificatory models imported from the natural sciences can be applied to man-made constructs (such as mental illness) definitionally based on 'personalised semantics'. METHODS: Exemplars of classificatory activity are first mapped and contextualised. Then, it is suggested that in each historical period crafting classifications has been like playing a game of chess with each move being governed by rules. This is illustrated by offering an analysis of the 1860-1861 French debate on classification. RESULTS AND CONCLUSIONS: (1) Medicine is not a contemplative but a modificatory activity and hence classifications are only valuable if they can release new information about the object classified. (2) It should not be inferred from the fact that psychiatric classifications are not working well (i.e. that they only behave as actuarial devices) that they must be given up. Conceptual work needs to continue to identify 'invariants' (i.e. stable elements that anchor classifications to 'nature'. (3) Because mental disorders are more than unstable behavioural epiphenomena wrapped around stable molecular changes, 'neurobiological' invariants may not do. Stability depends upon time frames. Furthermore, it is unlikely that gene-based classifications will ever be considered as classifications of mental disorders. For once, they would have low predictive power because of their lack of information about the defining codes of mental illness. 'Social' and 'psychological' invariants have problems of their own.     

Validity of family history in essential tremor

In this study, we found the sensitivity and specificity of family history data given by essential tremor (ET) patients to be 43.3% and 94.4%. Compared to relatives with less severe tremor (tremor score <24), those with more severe tremor (tremor score 24) were more likely to be identified by the ET probands (8/8 vs. 5/22, p=0.001, chi2 14.3). Our study suggests that family history information reported by ET patients was inaccurate, and poorly validated. Clinical and genetic studies in ET should take the limitation of family history data into consideration.     

Validity of family history data on essential tremor.

BACKGROUND: In family studies of essential tremor (ET), valid data on the presence of ET in relatives of probands with ET is important. The family history method uses information obtained by interviewing probands with ET to identify ET in their relatives. The validation of this method by direct examination of the relatives has not been performed. OBJECTIVE: To determine the validity of family history data on ET in families in which the proband has ET. METHODS: ET cases (probands) and their respective relatives were enrolled in a genetic study of ET in Washington Heights-Inwood, New York. Each underwent a tremor interview and videotaped examination. Two neurologists rated the severity of tremor and assigned diagnoses (ET versus normal). Probands were asked to identify their relatives who had ET. The validity of the probands' responses was tested against the neurologists' diagnoses. RESULTS: There were 206 subjects: 46 ET cases and 160 relatives. Twelve (7.5%) of 160 relatives were diagnosed with ET (four definite ET and eight probable ET). Probands with ET reported that two of these 12 had tremor (sensitivity of probands' report = 16.7%). Six of the 12 affected relatives (50.0%) reported their own tremor. The probands reported that one of 136 of their unaffected relatives had tremor (specificity of probands' report = 99.3%). CONCLUSIONS: For family studies of ET, information on reportedly unaffected relatives is of limited use given the low sensitivity of family history data. The neurologic examination remains the only valid means of ascertaining cases of ET among relatives.     

Listening to the past: history, psychiatry, and anxiety.

This article explores the history of psychiatry and the rise of biological psychiatry and suggests ways in which the study of history can shed light on current psychiatric practice and debate. Focusing on anxiolytics (meprobomate in the 1950s and benzodiazepines in the 1960s, 1970s, and 1980s) as a case study in the development of psychopharmacology, it shows how social and political factors converged to popularize and later stigmatize outpatient treatments for anxiety. The importance of social context in the creation of new therapeutic paradigms in modern psychiatry suggests the need to take into account a broad range of historical variables to understand how modern psychopharmacology has emerged and how particular treatments for disorders have been developed, diffused, and assessed.     

Psychiatry and history: aspects of history of psychiatry.

Psychiatry has asked and has been helped from many sides. As far as history is concerned, it was interested, almost exclusively, as long as it was history of psychiatry. In this paper an attempt has been made to show that history and, especially, philosophy of history could offer substantial help, particularly as teachers of methodology and hermeneutics.     

A study of the reliability of the family history method in genetic studies of Alzheimer disease

The reliability between 2 raters conducting independent family history interviews for Alzheimer disease-like and other dementias was investigated. The interviews were conducted at least 1 year apart with the second rater blind to the data collected by the first rater. Raters agreed on the presence and type of dementia in 153 relatives age 45 or older of 30 AD probands, the age at onset in secondary cases, and the age of nonaffected relatives.     

Validity and reliability of the Japanese version of the family needs survey

Early intervention and disability services in Japan historically have focused on supporting the individual with a disability, with only secondary attention to family needs and priorities. Since the Basic Law for Persons with Disabilities was codified in 2011, the Japanese government has been responsible for supporting families with members who have disabilities. To assess the needs of these families, we evaluated the reliability and validity of the Family Needs Survey (FNS), initially developed in 1988 (Bailey & Simeonsson), to determine its usefulness for programs providing services for Japanese families who have a child with a disability. The FNS is a practical tool to assess family needs and is already used across many different cultures and populations. To evaluate the reliability and validity of the FNS, we conducted an anonymous survey with a self-administered questionnaire at 6 treatment and education institutions, 3 medical institutions mainly for children with disabilities, and 39 special needs schools in the Osaka area. We analyzed 1171 parents’ survey responses: 452 fathers and 719 mothers of children with disabilities aged 0–15 years old who answered all items on the Japanese version of the FNS. Another survey was administered to 130 specialists who work with children with disabilities to assess the content validity of the Japanese version of the FNS. We verified the factor structure, content validity, and reliability of the Japanese version of the FNS as an assessment tool with 34 items among four factors that were based on the same items in the original FNS. The assessment could be used for families with school-age children as well as younger children, in contrast to the original version, which is not appropriate for school-age children. We also confirmed that it could be used without regard to type or degree of disability.     

Validity of the family history method for diagnosing schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders in first-degree relatives of schizophrenia probands

This study examined the validity of the family history method for diagnosing schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders in first-degree relatives of schizophrenia probands. This is the first large-scale study that examined the validity of the family history method for diagnosing DSM-III-R personality disorders. The best estimate DSM-III-R diagnoses of 264 first-degree relatives of 117 adult-onset schizophrenia probands based on direct structured diagnostic interviews, family history interview, and medical records were compared to Family History Research Diagnostic Criteria (FH-RDC) diagnoses based on the NIMH Relative Psychiatric History Interview and to family history Structured Clinical Interview for DSM-III-R: Personality Disorders (SCID-II) diagnoses based on the SCID-II adapted to a third person format. Diagnoses of relatives were made blind to proband diagnostic status. The median sensitivity for schizophrenia and the related psychoses was 29% (range 0-50%), the median specificity 99% (range 98-100%), and the median positive predictive value (PPV) 67% (range 20-80%). The median sensitivity for the personality diagnoses was 25% (range 14-71%), the median specificity 100% (range 99-100%), and the median PPV 100% (range 67-100%). The family history method has low sensitivity but has excellent specificity and PPV for schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders. The kappa coefficient for the family history method was moderately good for the psychoses (0.598) and for paranoid and schizotypal personality disorder (0.576). Using the family history method, the validity of making schizophrenia-related personality disorder diagnoses was comparable to that of making psychotic disorder diagnoses.     

Validity of the ICD-9 schizophrenia classification: A blind family history study

ABSTRACT– Within the framework of the multifactorial-polygenic model of inheritance, multiple threshold strategy was applied to a large set of pedigree data to examine the clinico-genetical position of some subtypes within the ICD-9 classification of schizophrenic psychoses. It appeared highly probable that the ICD-9 subtypes examined, oased mainly on the classical Kraepelin-Bleulerian classification (simplex, hebephrenic, catatonic, paranoid, schizo-affective) are not homogeneous from the clinico-genetical point of view and genetical factors cannot be held primarily responsible for the clinical differences between the subtypes.     

Chronic fatigue syndrome in private practice psychiatry: family history of physical and mental health

Forty-five psychiatric patients with chronic fatigue syndrome (CFS) were compared, using the case-control method, to two control groups selected from the same practice and matched on age, gender, and psychiatric diagnosis. The first control group (C-I, N=90) was selected on the basis of relatively good physical health. The second control group (C-II, N=45) was selected without regard to physical health. The reported family history of physical health revealed: the CFS mothers died at a younger age than the C-II mothers; both parents died before age 65 among the CFS parents more frequently than did the C-I parents; and the CFS parents had an increased prevalence of cancer, autoimmune disorders, and CFS-like conditions as compared to the families of one or both control groups. The reported family history of mental disorders revealed no significant differences in any of these conditions between the CFS patients and either control group.     

Ascertaining psychiatric diagnoses with the family history method in a substance abuse population.

Research investigating patterns of familial aggregation of psychiatric disorders has used the family history method in which a single family member reports on the psychiatric history of their relatives. This method is more efficient and less costly than the family study method, in which direct interviews are performed on as many family members as possible. The family history method has been shown to have good specificity, in family studies of depression, but sensitivity has been less acceptable. The present study is the first study to report on the sensitivity and specificity of five psychiatric diagnoses made in a substance abusing population using the family history method. Among substance abusers and their family members, substance abuse is the most accurately diagnosed disorder. However, among family members only, the accuracy of diagnosing substance abuse declines significantly. Spouses and offspring are better informants than parents or siblings, and female relatives are better informants than male relatives. When more than one informant is available and positive diagnoses are determined by any positive family report, sensitivity for most disorders increases significantly. The results are discussed in terms of increasing the accuracy of the family history method.     

Validity, reliability, and feasibility of clinical staging scales in dementia: a systematic review

New staging systems of dementia require adaptation of disease management programs and adequate staging instruments. Therefore, we systematically reviewed the literature on validity and reliability of clinically applicable, multidomain, and dementia staging instruments. A total of 23 articles describing 12 staging instruments were identified (N = 6109 participants, age 65-87). Reliability was studied in most (91%) of the articles and was judged moderate to good. Approximately 78% of the articles evaluated concurrent validity, which was good to very good, while discriminant validity was assessed in only 25%. The scales can be applied in ±15 minutes. Clinical Dementia Rating (CDR), Global Deterioration scale (GDS), and Functional Assessment Staging (FAST) have been monitored on reliability and validity, and the CDR currently is the best-evidenced scale, also studied in international perspective, and is available in 14 languages. Taking into account the increasing differentiation of Alzheimer's disease in preclinical and predementia stages, there is an urgent need for global rating scales to be refined as well.     

Spirituality, psychiatry and participation: a cultural analysis

This article begins by asking whether religion and spirituality are useful terms for cross-cultural comparisons. After discussing the increasing distinction between religion and spirituality in Western cultures, it points out how the terms religion and spirituality are used in divergent ways in the literature and the need for conceptual clarification in this area. Broadly, spirituality relates to interconnectedness, ultimate meaning or life force itself. The current use of the term spirituality in Western cultures derives both from Christian spirituality and 'New Age' thinking, which often appropriates ideas from Eastern religious traditions. The sociocultural roots of this division are complex, involving both growth of individualism, the pursuit of meaning and discontent with materialism and scientific rationalism. This situation is contrasted with other monotheistic religions where there is no distinction between religion and spirituality. This turn to spirituality has influenced health care professionals' conceptualizations of health and healing. The implications for psychiatry are discussed. I conclude that spirituality is a way of 'being in the world' and shares affinities with Tambiah's notion of a participatory mode of thinking.