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Biomedical subjects

A E Skodol

Publications and source records attributed to A E Skodol.

At least 19 recordsLinked to original sources
PubMed1995

Comorbidity of axis I and axis II disorders.

OBJECTIVE: In light of continuing controversies concerning the DSM-III-R system for diagnosing personality disorders, their construct validity, and the assignment of disorders to a particular axis, the authors studied patterns of axis I-axis II comorbidity. METHOD: Semistructured interviews were used to assess axis I and axis II disorders in 200 inpatients and outpatients. Odds ratios were calculated to determine significant comorbidity between classes of current axis I disorders and axis II personality disorders diagnosed according to two methods and defined at two diagnostic thresholds. Distributions of personality disorder traits were also compared in patients with and without axis I disorders. RESULTS: Significantly elevated odds ratios were found for co-occurrence of current mood disorders with avoidant and dependent personality disorders; anxiety disorders with borderline, avoidant, and dependent personality disorders; psychotic disorders with schizotypal, borderline, and dependent personality disorders; psychoactive substance use disorders with borderline and histrionic personality disorders; and eating disorders with schizotypal, borderline, and avoidant personality disorders. These results held when conservative and liberal definitions of personality disorders were used. Non-specific axis I and axis II associations were confirmed for distributions of personality disorder traits. CONCLUSIONS: Significant associations occurred between most axis I classes of disorders and axis II disorders and traits in more than one cluster. All axis I classes of disorders except mood disorders co-occurred with borderline personality disorder; however, patients with mood disorders had elevated levels of borderline traits. When any personality disorder was present, there were significant odds that a mood, anxiety, psychotic, or eating disorder would also be present; psychoactive substance use disorders, in contrast, significantly co-occurred with borderline and histrionic personality disorders.

Adolescent↗
PubMed1994

Minor depression in a cohort of young adults in Israel.

BACKGROUND: A diagnosis of minor depression was considered for DSM-IV. Mild depression is thought to be common in primary care settings and the community, but studies of the validity of minor depression as a separate diagnostic category are few. METHODS: Minor depression as defined by Research Diagnostic Criteria was assessed by psychiatrists using a modified Schedule for Affective Disorders and Schizophrenia-Lifetime version in a cohort of 5200 young adults in Israel. Subjects with year-prevalent minor depression were compared with subjects with major depression or generalized anxiety disorder and with controls on aspects of psychopathologic condition, psychosocial functioning, help-seeking behaviors, and demographic correlates. RESULTS: Symptomatically, minor depression appeared to be a mild version of major depression. Minor depression was associated with good teenage and general social functioning, but also with absence from work, separation or divorce, recent impairment in overall functioning, and help-seeking. CONCLUSIONS: The results lend support for including minor depression or expanding severity modifiers in future classifications to better capture the phenomenon of subthreshold depression.

Adult↗
PubMed1992

Socioeconomic status and psychiatric disorders: the causation-selection issue.

Are inverse relations between psychiatric disorders and socioeconomic status due more to social causation (adversity and stress) or social selection (downward mobility of genetically predisposed)? This classical epidemiological issue is tested by focusing on ethnic status in relation to socioeconomic status. Ethnic status cannot be an effect of disorder because it is present at birth whereas socioeconomic status depends on educational and occupational attainment. A birth cohort sample of 4914 young, Israel-born adults of European and North African background was selected from the country's population register, screened, and diagnosed by psychiatrists. Results indicate that social selection may be more important for schizophrenia and that social causation may be more important for depression in women and for antisocial personality and substance use disorders in men.

Education↗
PubMed1992

Diagnosis of DSM-III-R personality disorders by two structured interviews: patterns of comorbidity.

OBJECTIVE: The purpose of this study was to examine patterns of co-occurrence of axis II disorders in a group of consecutive patients evaluated with two contrasting structured interviews. METHOD: One hundred of 106 consecutive applicants for long-term, inpatient treatment of severe personality psychopathology were assessed, face-to-face, by psychiatrists using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Personality Disorder Examination (PDE). The percent of co-occurrence of pairs of disorders diagnosed by each structured interview separately was calculated, and significance levels were determined by using chi-square tests of independence. Finally, odds ratios were computed for the odds of each pair of disorders occurring together compared with the odds for the occurrence of each disorder alone. RESULTS: The two interview methods revealed different comorbidity patterns. Significant covariation was found for 29 pairs of disorders diagnosed with the PDE, compared with 12 pairs diagnosed with the SCID-II. Six pairs of disorders covaried significantly and were associated with odds ratios greater than 4: histrionic with borderline, histrionic with narcissistic, narcissistic with antisocial, narcissistic with passive-aggressive, avoidant with schizotypal, and avoidant with dependent. CONCLUSIONS: Substantial overlap occurred among personality disorders. In this group of patients, consistent patterns of comorbidity involving narcissistic, avoidant, and histrionic personality disorders suggest that categorical distinctions between them and certain other DSM-III-R personality disorders may be illusory. The question of which of two overlapping disorders is more valid, however, is left unanswered. For clinical purposes, a two-level diagnostic convention is proposed.

Comorbidity↗
PubMed1992

Revising axis V for DSM-IV: a review of measures of social functioning.

OBJECTIVE: Axis V, which uses the Global Assessment of Functioning Scale in the multiaxial system of DSM-III-R, is under review for DSM-IV. This article examines what is known about axis V and selectively reviews the literature on measures of social functioning to identify potential alternatives to the Global Assessment of Functioning Scale. METHOD: About 25 studies on the use, reliability, and validity of axis V in DSM-III and DSM-III-R are reviewed. In addition, nearly 30 measures of social functioning are reviewed and analyzed as potential substitutes for the Global Assessment of Functioning Scale. The analysis focuses on the strengths and weaknesses of each measure for assessing functioning on axis V. RESULTS: Axis V measures are modestly reliable and valid but not widely used. The authors identify and discuss two particular limitations of the Global Assessment of Functioning Scale: 1) the combination of measures of symptoms and measures of social functioning on a single axis and 2) the exclusion of physical impairments from the rating of functioning. CONCLUSIONS: None of the measures of social functioning reviewed is clearly superior to the Global Assessment of Functioning Scale for use on axis V. A modified version of the Global Assessment of Functioning Scale, separating the measures of social and occupational functioning from the measures of symptoms and psychological functioning, is proposed for field testing, along with a new set of instructions permitting the rating of limitations due to both physical and mental impairments.

Persons with Disabilities↗
PubMed1991

The assessment of schizotypal features over two points in time.

The expression of schizotypal personality traits was assessed in mid-adolescence and again in young adulthood for three groups of offspring defined by the psychiatric diagnosis of their parents. Parental diagnoses included schizophrenic disorder (47 offspring), affective disorder (39 offspring), and 'no psychiatric disorder', or normal controls (82 offspring). Initially, schizotypal traits were assessed from video-taped semi-structured psychiatric interviews, subsequently rated by trained psychiatrists blind to the parental psychiatric status of the subjects, and/or direct clinical interviews (Schedule for Affective Disorders-Lifetime Version (SADS-L)). The second assessment was conducted by trained social workers and psychologists by means of a semi-structured interview specifically for DSM-III-R personality disorders (Personality Disorder Examination) and sections of the SDS-L where indicated. These interviewers were blind to the parental status and to previous psychiatric assessments of the offspring. The rates of stability of features or the rates of progression to axis I psychotic disorders (Schizophrenia, Schizoaffective Disorder, and Unspecified Functional Psychosis) were evaluated. Concordance of assessments over time is reported as a function of threshold for expression of traits at initial evaluation, i.e., two or more, three or more, or four or more features present. Concordance increases as the threshold for expression increases, as expected. The effect of comorbid clinical status, e.g., the coexistence of schizotypal traits and anxiety and/or depressive features on the concordance pattern, is also examined by parental diagnostic group status. The offspring of affective disorder parents exhibited higher rates of anxiety and/or depressive features at both points in time, exhibited higher concordance for anxiety and/or depressive features, and exhibited higher rates of 'transformation' of initial schizotypal features to anxiety and/or depressive features at the second assessment.

Adolescent↗
PubMed1991

Assessment and diagnosis of borderline personality disorder.

Borderline personality disorder is common in treatment settings and may be so in the general population. In this guide to assessment strategies for diagnosing borderline personality disorder, the authors discuss the reliability and validity of structured interviews and self-report instruments and suggest the use of a self-report questionnaire as a cost-effective screening test. Assessment problems, such as the need for longitudinal observation, are reviewed. Essential features of the recommended diagnostic approach include clarity about the diagnostic concept, consideration of the full range of diagnostic criteria, incorporation of recently developed diagnostic methodologies, care in distinguishing personality disorders from comorbid axis I syndromes, and complete assessment of the full range of axis II disorders.

Borderline Personality Disorder↗
PubMed1991

Diagnosis of physical illness in psychiatric patients using axis III and a standardized medical history.

Psychiatrists' axis III diagnoses of physical illnesses in 357 psychiatric patients were compared with diagnoses by a physician's assistant using a standardized medical history form. The physician's assistant detected nearly three times as many physical illnesses as the psychiatrists. The psychiatrists were significantly more likely to miss diagnoses among older patients and women. Patients who met criteria for depressive disorders appeared to be at greatest risk for undetected illnesses, followed by patients with bipolar disorders and schizophrenia. Patients with a secondary diagnosis of substance abuse had significantly more undetected illness than those who did not abuse substances. The authors suggest that current axis III guidelines are inadequate and that a systematic review of physical health problems should be part of the psychiatric diagnostic assessment.

Adolescent↗
PubMed1991

Personality disorders in the public sector.

Using a clinical data base for New York state hospitals, the authors examined the prevalence of DSM-III axis II personality disorders in state hospital patients and explored the patterns of comorbidity between axis I and axis II disorders. They found that 11 percent of the patients received a diagnosis of personality disorder and that these patients were more likely than other patients to have a primary diagnosis of schizoaffective disorder, major affective disorder, dysthymia, and substance use disorder other than alcoholism. Comparison of state hospital data with data from nonstate facilities showed different patterns of coexisting primary diagnoses and personality disorders and a much higher frequency of borderline personality disorder in nonstate patients. Based on the low percentage of state hospital patients diagnosed as having personality disorders, the authors conclude that axis II disorders are underreported in state facilities.

Adolescent↗
PubMed1990

Validity of the Personality Diagnostic Questionnaire--revised: comparison with two structured interviews.

The authors gave the self-report Personality Diagnostic Questionnaire--Revised (PDQ-R) to 87 applicants for inpatient treatment of severe personality psychopathology and, blind to these results, diagnosed personality disorders in the applicants by using the Personality Disorder Examination and the Structured Clinical Interview for DSM-III-R Personality Disorders. The PDQ-R was not a substitute for a structured interview assessment of axis II disorders because many of its diagnoses were false positives. Its high sensitivity and moderate specificity for most of the axis II disorders suggest, however, that it is an efficient instrument for screening patients with DSM-III-R personality disorders.

Adult↗
PubMed1989

DSM-III-R schizotypal personality traits in offspring of schizophrenic disorder, affective disorder, and normal control parents.

The aggregation of disorder in families identified by a schizophrenic disorder proband (index case) has provided indirect clues to the question of diagnostic boundaries of schizophrenic spectrum categories. The Danish Adoption Studies provided quasi-experimental evidence for the range of expression of a putative schizophrenic spectrum disorder which was subsequently denoted schizotypal personality disorder (STPD) in DSM-III-R. It has been hypothesized that such schizophrenic spectrum categories bear a genetic relationship to schizophrenic disorder and thus are continuous with schizophrenia in terms of etiology and pathogenesis. For meaningful use of such spectrum categories in genetic analyses, i.e., linkage analysis, it is important that rates of spectrum traits and disorder in normal control and in psychiatric control populations are known. The rate of DSM-III-R schizotypal traits and disorder was assessed in three offspring groups (ages 18-29) defined by parental diagnoses, including schizophrenic disorder (N = 90), affective disorder (N = 79), and no parental disorder (N = 161). The assessment was conducted by trained social workers and psychologists by means of a direct interview (Personality Disorder Examination). The interviewers were blind to the parental status and to previous psychiatric assessments of these offspring. The rates of three, four and five schizotypal features were elevated in the offspring with parental psychiatric disorder in contrast to the offspring with no parental psychiatric disorder. However, the rates between the offspring of the schizophrenic disorder parental group and the offspring of the affective disorder parental group did not differ significantly, thus failing to support the assumption of diagnostic specificity.

Adolescent↗
PubMed1989

Use of DSM-III Axis IV in clinical practice: rating the severity of psychosocial stressors.

This study investigates the usefulness of DSM-III Axis IV ratings of Severity of Psychosocial Stressors. Multiaxial evaluations were made on a diagnostically heterogeneous group of 362 psychiatric patients. Severity ratings on Axis IV were compared to a more extensive system for measuring life event stress, embedded in the Psychiatric Epidemiology Research Interview (PERI). The results indicate that Axis IV ratings are consistent with meaningful diagnostic and demographic group differences, and correlate significantly with PERI ratings of normative change or disruption associated with rated events. The Axis IV guideline that the stressor reflect the summed effect of all psychosocial stressors listed, however, appeared to be too complex to be incorporated into routine clinical practice, even by relatively well-trained evaluators with expert supervision.

Adaptation, Psychological↗
PubMed1989

Characterizing life events as risk factors for depression: the role of fateful loss events.

Empirical associations between life events and health are often weak, in part because event exposure measures may group together very different kinds of experiences within a single event category. Attempts to refine the measures (by using respondents' subjective appraisals of event stressfulness or by taking into consideration situational and personal factors that influence the contextual threat of the events) may strengthen the association, but they cloud the clarity of any causal inference by confounding the measure with extraneous variation. Instead, the use of descriptive information about what actually happened before, during, and after each event is recommended to define exposure to potent, fateful life events. In a comparison of 96 patients with major depression and 404 community residents with no apparent depression, the odds that a person would have experienced one or more events meeting criteria for fatefulness and disruptiveness was 2.5 times greater in the depressed group.

Adult↗
PubMed1989

Use of DSM-III axis IV in clinical practice: rating etiologically significant stressors.

This study compared the etiologically significant stressors listed on DSM-III axis IV (severity of psychosocial stressors) with life events elicited by the Psychiatric Epidemiology Research Interview (PERI). Multiaxial evaluations of a diagnostically heterogeneous group of 362 patients were made, and all patients were subsequently administered the PERI by interviewers blind to the clinical assessments. The results indicated that axis IV functions well as a shorthand method for identifying the more severe psychosocial stressors. However, the DSM-III requirement that the stressor be important in the development or exacerbation of the current disorder resulted in discrepancies between the axis IV and PERI assessments.

Adjustment Disorders↗
PubMed1988

Toward construct validity for DSM-III Axis V.

This study investigates the construct validity of DSM-III Axis V ratings, made in diverse clinical settings, by means of independent assessments of adaptive functioning. Three hundred and sixty-two patients received supervised multiaxial assessments and were then blindly reinterviewed with the Psychiatric Epidemiology Research Interview, which contains scales measuring various aspects of social and occupational functioning. A subsample of 154 patients received a second independent interview that assessed characteristics of the individuals' social networks. The results indicate that Axis V ratings (1) demonstrate predictable diagnostic and demographic group differences, and (2) are determined by both social and occupational variables, but occupational factors predominate. The significance of the results for defining the adaptive functioning construct, for methods of assessment, and for the revisions of Axis V in DSM-III-R, is discussed.

Adaptation, Psychological↗
PubMed1988

The specificity of DSM-III schizotypal personality traits.

The rate of DSM-III schizotypal personality traits was evaluated in three groups of adolescent offspring (ages 15-21), defined by the psychiatric diagnosis of their parents. Parental diagnoses included schizophrenic disorder (40 adolescents), affective disorder (35 adolescents), and 'no psychiatric disorder' (normal controls) parents (82 adolescents). The presence of the eight component features of schizotypal personality disorder was assessed from video-taped semistructured psychiatric interviews, subsequently rated by trained psychiatrists, blind to the parental psychiatric status of the subjects. The effect of age, sex, and social class on the pattern of prevalence results was examined. The expected specificity of DSM-III schizotypal personality traits to schizophrenia was not supported by the prevalence pattern of the traits. Rates of 2 or more, 3 or more, and 4 or more schizotypal personality features were highest in the parental psychiatric groups. The rates of schizotypal personality traits in adolescent offspring of affective disorder parents were as high as those previously reported for relatives of schizophrenic disorder probands.

Adolescent↗