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J M Oldham

Publications and source records attributed to J M Oldham.

60 records · Page 4Linked to original sources

Neuropsychiatric diagnosis on a short-term treatment service.

The evaluation of suspected neuropsychiatric disorder in a series of 17 patients is described. The heuristic value of DSM-III's multiaxial approach is noted. The use of routine and neuropsychological tests, EEGs, CAT scans, T-3 and T-4 tests, and lumbar puncture, in conjunction with prolonged behavioral observation in a stable, therapeutic milieu, provided the means for clarification of neuropsychiatric illness in this series of complex cases. The value of CAT scans, neuropsychological tests and of prolonged behavioral observation in selected cases is discussed.

Adolescent↗

Validity of the Personality Diagnostic Questionnaire-Revised: a replication in an outpatient sample.

We report a replication study of the validity of the Personality Diagnostic Questionnaire-Revised (PDQ-R) in an outpatient sample. Fifty-nine applicants for psychoanalysis at a training institute completed the PDQ-R and were diagnosed by clinicians, blind to the PDQ-R results, using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Personality Disorder Examination (PDE). The PDQ-R showed high sensitivity and moderate specificity for most axis II disorders. Although not a substitute for a structured interview because it yields many false-positives, the PDQ-R is an efficient instrument for screening outpatients with DSM-III-R personality disorders.

Adult↗

Patterns of anxiety and personality disorder comorbidity.

The purpose of this study was to examine patterns of comorbidity of DSM-III-R anxiety disorders and personality disorders (PD). Two-hundred subjects were independently interviewed with the Structured Clinical Interview for DSM-III-R (SCID) and the Personality Disorder Examination (PDE) face-to-face by two experienced clinicians. One-hundred and forty-six also completed the Personality Diagnositc Questionnaire-Revised (PDQ-R). Rates of personality disorder among patients with and without anxiety disorders were determined by each of the three instruments. Comorbidity between panic disorder social phobia, obsessive-compulsive disorder and simple phobia and a conservative estimate of individual Axis II disorders was examined. Results indicate that panic disorder, either current or lifetime, is associated with borderline, avoidant, and dependent personality disorders: social phobia is associated with avoidant personality disorder, and obsessive-compulsive disorder is associated with obsessive-compulsive and avoidant personality disorders. Anxiety disorders with personality disorders are characterized by chronicity and lower levels of functioning compared with anxiety disorders without personality disorders.

Adolescent↗

Identifying personality disorders: towards the development of a clinical screening instrument.

The study objective was to identify a set of personality disorder (PD) criteria from the DSM PD diagnostic sets that can be used to detect subjects with an increased likelihood of having a PD diagnosis. In a series of outpatients evaluated systematically in two waves for every criteria item for 12 DSM-III-R PDs, stepwise logistic regression identified 45 criteria as discriminative for their specific PDs, which are selected for further analysis to assess their ability to discriminate for any PD. Receiver operating characteristic (ROC) analysis is used to evaluate their discriminative power in an independent conjoined sample (N = 1,342) from six centers that assessed every PD criteria item by structured instrument (Structured Clinical Interview for DSM-III-R PDs [SCID-II, Personality Disorder Examination [PDE], and Structured Interview for DSM-III-R PDs [SIDP-R]). The cutoff that maximizes information gain is used to determine the diagnostic threshold (DT). Initially, 15 of 45 criteria are identified. At the 0.43 PD prevalence, a DT of 2 or more of the 15 PD criteria across samples is optimal. The maximum information gain (MIG) is .42 bits, and the AUR is 0.94+/-.007. Other performance indices at this cutoff are .90 sensitivity, .84 specificity, .81 positive predictive power (PPP), .91 negative predictive power (NPP), and .86 hit rate (HR). Taken collectively, the 15 PD criteria selected by the data reduction techniques suggest a narrowed set to be assessed in screening for the presence or absence of any PD with comparable or better psychometric properties than other tests routinely used for diagnosing medical and psychiatric disorders. If specific PD categorization is needed, a second-step comprehensive assessment should follow.

Algorithms↗

Childhood verbal abuse and risk for personality disorders during adolescence and early adulthood.

Data from a community-based longitudinal study were used to investigate whether childhood verbal abuse increases risk for personality disorders (PDs) during adolescence and early adulthood. Psychiatric and psychosocial interviews were administered to a representative community sample of 793 mothers and their offspring from two New York State counties in 1975, 1983, 1985 to 1986, and 1991 to 1993, when the mean ages of the offspring were 5, 14, 16, and 22 years, respectively. Data regarding childhood abuse and neglect were obtained from the psychosocial interviews and from official New York State records. Offspring who experienced maternal verbal abuse during childhood were more than three times as likely as those who did not experience verbal abuse to have borderline, narcissistic, obsessive-compulsive, and paranoid PDs during adolescence or early adulthood. These associations remained significant after offspring temperament, childhood physical abuse, sexual abuse, neglect, physical punishment during childhood, parental education, parental psychopathology, and co-occurring psychiatric disorders were controlled statistically. In addition, youths who experienced childhood verbal abuse had elevated borderline, narcissistic, paranoid, schizoid, and schizotypal PD symptom levels during adolescence and early adulthood after the covariates were accounted for. These findings suggest that childhood verbal abuse may contribute to the development of some types of PDs, independent of offspring temperament, childhood physical abuse, sexual abuse, neglect, physical punishment during childhood, parental education, parental psychopathology, and co-occurring psychiatric disorders.

Adolescent↗

Uninformed decisionmaking. The case of surrogate research consent.

A New York court recently struck down state Office of Mental Health regulations governing research involving subjects with impaired decisionmaking capacity. The court held that neither incapacitated adults nor minors could participate in any research protocol that contained a nontherapeutic element, irrespective of possible benefits to the subject or the importance of the knowledge to be gained. Although the decision rested on a technical point of law and dealt only with psychiatric research, the court's holding has significantly broader implications.

Adolescent↗