The relationship between generalized social phobia and avoidant personality disorder in a national mental health survey

Objective: There has been ongoing clinical controversy dating back to the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders concerning the boundaries and extent of overlap between Axis I generalized social phobia (GSP) and Axis II avoidant personality disorder (APD). This study sought to examine the relationship between the fourth edition of Diagnostic and Statistical Manual of Mental Disorders GSP and APD in a large nationally representative sample of the United States population. Method: We used the National Epidemiologic Survey on Alcohol and Related Conditions (n=43,093; age 18+; response rate=81%) to study fourth edition of Diagnostic and Statistical Manual of Mental Disorders Axes I and II psychiatric disorders, assessed by a reliable semi‐structured in‐person interview. Results: The lifetime prevalence was 2.8% for GSP and 2.4% for APD. The overlap between GSP and APD varied according to the number of GSP social situations feared. Although 36.4% of individuals with GSP were diagnosed with APD, the majority (57.3%) of individuals with GSP who feared all 13 social situations assessed were diagnosed with APD. Nearly 40% of individuals with APD also had GSP. Compared to individuals with GSP alone, individuals with comorbid GSP and APD showed significantly lower mental health‐related quality of life on the Medical Outcomes Study Short Form, more interaction and observation fears, and an increased likelihood of having other psychiatric disorders such as major depression. Conclusions: APD and GSP show a high degree of overlap (16–57%), depending on the number of social situations feared. Overall, results suggest that APD and GSP appear to be highly related, but potentially separable constructs. Further research is needed to identify the determinants and consequences of having either or both diagnoses. Depression and Anxiety, 2009. Published 2008 Wiley‐Liss, Inc.     

Validity of nonaffective functional psychosis of the DSM IV in a Congolese population. A transversal clinical trial

Background

The fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM IV) distinguishes schizophrenia, schizophreniform disorder and brief psychotic disorder only according to the duration of the illness. Thus, the validity of these nosological concepts sounds uncertain.

Aim

The aim of this study was to evaluate the validity of the DSM IV concepts schizophrenia, schizophreniform disorder and brief psychotic disorder.

Population and methods

Seventy schizophrenics, 68 patients with brief psychotic disorder and 50 with schizophreniform disorder, all Congolese people, selected from the ‘Telema’ Mental Health Centre and the ‘Neuropsychopathological centre of the University of Kinshasa, from 5^th August 2003 to 14^th March 2005 were compared with respect to the following clinical parameters: family schizophrenia and brief psychoses history, precipitating psychosocial factors, mode of onset of the disease, clinical syndromes linked to psychoses and general functioning. Statistical analyses included analysis of variances ‘one way’ (Anova), post hoc Tukey's test, discriminant analysis, and analysis of covariances.

Results

Brief psychotic disorder differed from schizophrenia and schizophreniform Disorder in respect with positive syndrome (F = 8.76, df = 2; 179, p = 0.0002), cognitive syndrome (F = 3.79, df = 2; 179, P = 0.024), syndrome of excitement (F = 3.23, df = 2; 179, P = 0.042), general functioning (F = 13.73, df = 2; 179, P < 0.0001), family history of schizophrenia (χ² = 8.65; P = 0.013), precipitating psychosocial factors (χ² = 19.82; P < 0.0001), and mode of onset of the disease (χ² = 91.3; P < 0.0001). Schizophreniform disorder differered from schizophrenia only by a more frequent acute onset and a better general functioning. Two nosological realities were thus distinguishable: brief psychotic disorder and schizophrenia-schizophreniform disorder complex. Surprisingly, negative syndrome could not distinguish brief psychotic disorder from schizophrenia and schizophreniform (F = 2.80, df = 2; 179, P = 0.063). Data of the discriminant analysis based on scores on general functioning, positive, negative, depressive, cognitive and excitement syndromes was conclusive (F = 6.41, df = 2; 185, P < 0.0001) and allowed correct classification rates of 75% for brief psychotic disorder, 48% for schizophreniform disorder, 54% for schizophrenia. Schizophreniform disorder was thus the less distinguishable group; this is in the line with longitudinal studies, which demonstrated the lowest diagnostic stability of this affection, compared with the two other diseases. Total error rate was 41%.

Conclusions

Brief psychotic disorder could constitute a distinct affection from schizophrenia and schizophreniform disorder, whereas schizophreniform disorder and schizophrenia could be the same affection; the first being an acute and “good functioning” form of the second. However, these viewpoints need to be confirmed by data on long-term course. The data of this study validate ultimately a binary model of the major nonaffective functional psychoses, like that of the tenth edition of the International classification of mental and behavioural disorders (ICD-10).     

An evaluation of the proposed DSM-5 alcohol use disorder criteria using Australian national data

Aims To evaluate the proposed revisions to the DSM‐IV alcohol use disorder criteria using epidemiological data. Design, setting and participants Data came from the 1997 Australian National Survey of Mental Health and Well‐Being. The sample consisted of 10 641 participants aged 18 years and over. Measurements Alcohol use disorders were assessed using a revised version of the CIDI version 2.0. Alcohol use disorders were assessed in all respondents who indicated that they had used alcohol more than 12 times in the previous 12 months (n = 7746). Findings The proposed introduction of a single alcohol use disorder was supported by confirmatory factor analysis (CFA). DSM‐5 criteria were all indicators of a single underlying disorder. Under DSM‐5, the prevalence of alcohol use disorders would increase by 61.7% when compared with those diagnosed under DSM‐IV. When investigating the most appropriate diagnostic threshold, the 3+ threshold maximized agreement between DSM‐IV and DSM‐5 diagnoses, and produced similar prevalence estimates to those yielded by DSM‐IV. Item response theory (IRT) analyses supported the removal of the legal criterion while provided equivocal results for the craving criterion. Conclusions Under the proposed DSM‐IV revisions for alcohol use disorders, estimates of the prevalence in the general population would increase substantially. Whereas evidence supports some of the revisions such as a single underlying disorder, others such as the 2+ threshold for diagnosis of alcohol use disorder and the inclusion of a ‘craving’ criterion may be problematic.     

Impaired functioning in euthymic patients with bipolar disorder--HSV-1 as a predictor

There is a possible association between infectious agents and psychiatric disorders. Previous studies in the US provided evidence for cognitive impairment correlated with Herpes simplex virus type 1 (HSV-1) infection. For a replication study in Europe we chosed individuals diagnosed with bipolar disorder to analyse the correlation with HSV-1 infection. Antibody prevalence was analyzed by using solid phase immunoassay techniques. Cognitive functioning was tested with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Form A, the Trail Making Test A&B, and two subtests from the WAIS III: the Letter Number Sequencing Task and the subtest on information. History and psychopathology was assessed using structured interviews and validated rating scales (SCID, HRSD-21, YMRS, PANSS). Additionally, we investigated social functioning and quality of life using self-assessment-scales (SAS, LQLP). Prevalence rates of antibodies against diverse infectious agents did not differ significantly between patients and controls. We found a significant correlation between cognitive impairment in patients with bipolar disorder and the prevalence of antibodies directed against HSV-1. Cognitive functions were significantly impaired including language, attention, and immediate memory.The results of this study confirm previous findings suggesting that HSV-1 affects cognitive functions in patients with bipolar disorder. This may also result in more impaired functioning, less quality of life and difficulties in social adjustment.