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Biomedical subjects

J E Mezzich

Publications and source records attributed to J E Mezzich.

At least 37 records · Page 2Linked to original sources
PubMed1992

On the descriptive validity of DSM III schizophrenia.

The study sample is drawn from patients seeking evaluation in a psychiatric intake facility. It concentrates on those who are assigned a diagnosis of psychosis as stipulated in DSM III. The aim is to elucidate the distinguishing characteristics of patients diagnosed as Schizophrenia Disorder. The descriptive validity of this disorder is pursued by systematically comparing clinical and demographic characteristics of patients with this disorder to those diagnosed as Paranoid Disorder, Atypical Psychosis, Brief Reactive Psychosis, Schizoaffective Disorder and Schizophreniform Disorder. These comparisons uncover special characteristics pertaining to the demography and impact of schizophrenia. The results obtained are explained using generalizations drawn from the epidemiology, natural history and clinical manifestations of schizophrenia and other psychoses.

Adult↗
PubMed1991

Architecture of clinical information and prediction of service utilization and cost.

The state of the art in predicting service utilization and cost in general medical care and psychiatry is reviewed. Diagnosis-related groups (DRGs) and measures of illness severity are specifically examined. Building on this experience and searching for other promising informational elements, key components of clinical information schemas are considered. The interface between patient and treatment domains is examined by using multiaxial classifications connected with the upcoming Tenth Revision of the International Classification of Diseases and the European International Classification of Mental Health Care. Within this framework, univariate and multivariate approaches to the prediction of service utilization and cost are outlined.

Cost Control↗
PubMed1990

DSM III as a systemic culture pattern: studying intracultural variation among psychiatrists.

DSM III is viewed as embodying a pool of information pertaining to a systemic culture pattern of psychiatry and attempts are made to describe how psychiatrists understand and apply it using ideas from cognitive anthropology. Each of seven psychiatrists evaluated a group of patients in an intake setting. Seven broad categories of Axis I diagnoses were formed and the frequencies with which psychiatrists used these categories were computed. In addition, twelve arithmetical measures pertaining to the five axes of DSM III and a current functioning axis and the decision regarding disposition were also computed. Using these dependent variables, the study analyzes the similarities and differences among psychiatrists in the way they formulate intake evaluations. Psychiatrists' selections of Axis I diagnoses were highly intercorrelated but they differed greatly among themselves in the way they coded many of the axes of DSM III. Group correlations among diagnostic measures indicated a patterning among diagnostic measures and the nature of this patterning is discussed. Each psychiatrists' set of correlations among the twelve diagnostic measures was itself correlated with that of others and this showed a very high level of interpsychiatrist agreement. Deductions drawn from the cultural consensus model suggest that psychiatrists share an underlying 'grammar' that references the pool of information pertaining to DSM III.

Cultural Characteristics↗
PubMed1990

Suicidal indicators in schizophrenia.

The clinical and sociodemographic profile of suicidal and nonsuicidal schizophrenia patients was investigated in 801 patients with this diagnosis seen at a comprehensive psychiatric facility between 1983 and 1987. Suicidal patients tended to exhibit depression, aggressiveness, substance abuse and a severe and progressive impairment in adaptive functioning.

Adolescent↗
PubMed1989

PROPOV-K: a FORTRAN program for computing a kappa coefficient using a proportional overlap procedure.

The computer program PROPOV-K allows the computation of an unweighted kappa coefficient for expressing interrater agreement in the general case in which multiple raters (not necessarily fixed in number) formulate a variable number of multiple diagnoses for each subject. PROPOV-K assesses agreement among lists of multiple diagnoses composed of nonordered categories. PROPOV-K calculates a kappa coefficient on the basis of estimating proportion of agreement between two diagnostic formulations as the ratio of the number of agreements between specific categories over the number of different specific categories mentioned in the two diagnostic lists. When multiple raters formulate a variable number of multiple diagnoses for each subject, the use of a kappa coefficient has been limited to researchers since there are no generally available computer programs. The purpose of this paper is to present a FORTRAN computer program allowing the computation of a kappa coefficient for the case mentioned above and to illustrate its use with examples respectively involving multiple psychiatric and multiple physical diagnoses.

Algorithms↗
PubMed1989

DSM-III disorders in a large sample of psychiatric patients: frequency and specificity of diagnoses.

This study examined certain nosological features of DSM-III axis I diagnostic categories and subcategories as applied to 11,292 general psychiatric patients presenting for care, using a semistructured assessment procedure. The most frequently used major categories were affective, substance use, childhood-onset, and adjustment disorders. Secondary diagnoses were given to 26% of the patients. Male patients predominated in the categories of impulse-control, psychosexual, and substance use disorders, and female patients predominated in the categories of anxiety, affective, and somatoform disorders. Of the 329 five-digit subcategories available in DSM-III, 296 (90%) were actually used. Sixteen percent of the patients were given unspecific primary diagnoses.

Adolescent↗
PubMed1988

Contemporary psychiatric interviewing: new directions for training.

THERE has been an unheralded evolution in psychiatric interviewing, an evolution that is, nonetheless, of a critical nature. Over the past three decades the basic psychiatric interview has evolved into a collection of different psychiatric interviews. Each style of interview is determined by the immediate patient care tasks facing the clinician, whether in an emergency room or a private practice office. The acquisition of new skills, such as structuring techniques and diagnostic examinations using the DSM-III, has become a vital and challenging aspect of the education of contemporary psychiatrists. In this paper the influences that have created these new developments in psychiatric interviewing will be outlined and their implications for training discussed. We will describe a specific training approach that has evolved as a method of helping psychiatric residents develop the skills and confidence needed to handle any one of the numerous types of psychiatric interviews required of a contemporary clinician, ranging from a traditional psychodynamic assessment to a standard diagnostic interview.

Countertransference↗
PubMed1987

Adjustment disorder as a marginal or transitional illness category in DSM-III.

This study examines the resources of DSM-III for dealing with conditions that fall outside the domain of illnesses with specific, recognized, and clearly delineated symptom profiles. In discussing some of the theoretical and problematic aspects of the categories "Adjustment Disorder" (AD) and "not ill" (NI), AD is viewed as an example of a marginal or transitional illness category. Clinical psychopathologic features of subjects in the AD and NI categories are compared with those in the logical complementary category composed of all other specific diagnosis categories of DSM-III. The results support the descriptive validity of AD and NI in DSM-III.

Adjustment Disorders↗
PubMed1987

Multiaxial characterization of depressive patients.

A review of the literature on the comprehensive description of depressive patients revealed prominent concern with syndromic subtypes, course of illness, and personality factors, followed by severity, concomitant physical disorders, psychosocial stressors, and adaptive functioning. The descriptive value of multiaxial approaches for depression was illustrated through the application of an extended DSM-III formulation to all 3455 depressive (bipolar depression, major depression, dysthymic disorder, and atypical depression) and 7837 nondepressive patients of all ages and sexes presenting for evaluation and care at the Psychiatric Institute of the University of Pittsburgh during a period of 53 months. Twenty-six percent of the depressive patients received an additional diagnosis in axis I, the most frequent of which were substance use disorder, anxiety disorder, and condition not attributable to a mental disorder. In axis II, depressive patients presented a differentially higher frequency of dependent personality disorder and the "anxious/fearful" cluster of personality disorders. In axis III, 47% of the depressive vs. 40% of the nondepressive patients had a positive diagnosis of physical illness, with a significantly higher frequency among depressive patients attained by acquired hypothyroidism, migraine, essential hypertension, unspecified abdominal hernia, and unspecified arthropathies. Specific stressors differentially more frequent among depressive patients were those of conjugal, parenting, and occupational types and those reflecting the impact of physical illness. Overall stressor severity was at severe, extreme, or catastrophic levels for 42% of the depressive and 31% of the nondepressive patients. The highest level of adaptive functioning in the past year was good, very good, or superior for 44% of the depressive and 29% of the nondepressive patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Initial evaluation format (version 1982). Translation and adaptation to the Spanish language].

The Initial Evaluation Form is a non-schedule standardized evaluation procedure. Initially put into practice at the Western Psychiatric Institute and Clinic University of Pittsburgh, PA, and further in Peru, its usefulness for clinical care and research was clearly evidenced. A new version of the Form together with its Manual were translated into the Spanish language. A committee of consulting bilinguals to reviewing the translation participated, which issued successive drafts until a group consensus was reached upon. Both the English and Spanish terminologies are not only well-known among the translators but also a special care was put in seeking the precise terms which are meaningful and fully understandable as well to the Spanish-speaking psychiatrists.

Evaluation Studies as Topic↗