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Biomedical subjects

M B First

Publications and source records attributed to M B First.

At least 19 recordsLinked to original sources
PubMed1996

Nosology of chronic mood disorders.

In attempting to assess the complex relationship of chronic depression with other conditions to which it may be a predisposition, an accompaniment, or a consequence of, a few concluding caveats may be useful. It must be recognized that chronic depression has a wide variety of different presentations and causes. Current definitions of major depressive disorder and dysthymic disorder may create a misleading distinction of what may be two aspects of the overall course of a depressive disorder. Furthermore, much of what is considered to be comorbidity of other disorders with chronic depression actually may be a complex syndrome with a common pathogenesis.

Adult↗
PubMed1995

Results of the DSM-IV mood disorders field trial.

OBJECTIVE: The DSM-IV mood disorders field trial, a multisite collaborative study, was designed to explore the reliability of a course-based diagnostic classification system for major depression, evaluate the symptom criteria for dysthymia, and explore the need for additional diagnostic categories for milder forms of mood disorder (e.g., minor and recurrent brief depression). METHOD: Five hundred twenty-four depressed subjects were recruited from inpatient, outpatient, and community settings at five sites and evaluated with structured interviews according to DSM-III and DSM-III-R criteria, with careful attention to longitudinal course. Within- and across-site interrater reliability studies and 6-month test-retest reliability studies were also conducted on subsets of the sample. RESULTS: For evaluations of major depression and dysthymia, intrasite reliability was good to excellent and intersite reliability was fair to good; 6-month test-retest reliability was fair for dysthymia and poor to fair for major depression. Interrater reliability for six course of illness specifiers was fair to good, and almost all subjects could be assigned to a specific type of course. CONCLUSIONS: The results supported the use of a course-based classification system for major depression. They also suggested that the content validity of the DSM-III-R symptom criteria for dysthymia could be improved by emphasizing cognitive and social/motivational symptoms, although such changes are unlikely to sharpen the distinction between dysthymia and major depression. Finally, 91% of the subjects met the criteria for current or lifetime major depression or dysthymia, suggesting that additional categories for milder forms of depression are not needed.

Adult↗
PubMed1994

DMS-IV meets philosophy.

The authors discuss some of the conceptual issues that must be considered in using and understanding psychiatric classification. DMS-IV is a practical and common sense nosology of psychiatric disorders that is intended to improve communication in clinical practice and in research studies. DSM-IV has no philosophic pretensions but does raise many philosophical questions. This paper describes the development of DSM-IV and the way in which it addresses a number of philosophic issues: nominalism vs. realism, epistemology in science, the mind/body dichotomy, the definition of mental disorders, and dimensional vs. categorical classification.

Humans↗
PubMed1993

The reliability of three definitions of bizarre delusions.

OBJECTIVE: This study was conducted to determine whether the interjudge reliability of the DSM-III-R concept of bizarre delusions could be improved by alternative definitions of the concept. METHOD: Twelve raters evaluated 180 delusions of separate psychiatric patients according to the DSM-III-R and two alternative definitions of bizarre delusions. RESULTS: The kappas for the DSM-III-R definition and for one of the alternative definitions were 0.64 and 0.65, respectively; for the other alternative definition it was 0.45. All three definitions were highly intercorrelated, largely identifying the same cases. CONCLUSIONS: Neither of the alternative definitions of bizarre delusions was more reliable than the DSM-III-R definition. The reliability of the DSM-III-R definition, although only fair, is comparable to that of other important clinical concepts that play a major role in the DSM-III-R diagnostic criteria for psychotic disorders.

Adult↗
PubMed1992

The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description.

The history, rationale, and development of the Structured Clinical Interview for DSM-III-R (SCID) is described. The SCID is a semistructured interview for making the major Axis I DSM-III-R diagnoses. It is administered by a clinician and includes an introductory overview followed by nine modules, seven of which represent the major axis I diagnostic classes. Because of its modular construction, it can be adapted for use in studies in which particular diagnoses are not of interest. Using a decision tree approach, the SCID guides the clinician in testing diagnostic hypotheses as the interview is conducted. The output of the SCID is a record of the presence or absence of each of the disorders being considered, for current episode (past month) and for lifetime occurrence.

Decision Trees↗
PubMed1992

The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test-retest reliability.

A test-retest reliability study of the Structured Clinical Interview for DSM-III-R was conducted on 592 subjects in four patient and two nonpatient sites in this country as well as one patient site in Germany. For most of the major categories, kappa s for current and lifetime diagnoses in the patient samples were above .60, with an overall weighted kappa of .61 for current and .68 for lifetime diagnoses. For the nonpatients, however, agreement was considerably lower, with a mean kappa of .37 for current and .51 for lifetime diagnoses. These values for the patient and nonpatient samples are roughly comparable to those obtained with other structured diagnostic instruments. Sources of diagnostic disagreement, such as inadequate training of interviewers, information variance, and low base rates for many disorders, are discussed.

Diagnosis, Computer-Assisted↗
PubMed1992

DSM-IV and new diagnostic categories: holding the line on proliferation.

The authors discuss aspects of the decision-making process for including "new" diagnostic categories in DSM-IV. They detail the different kinds of new categories proposed for inclusion in DSM-IV and discuss the risks and benefits of incorporating them. The authors comment on whether new diagnostic categories should be included in official nosologies as a stimulus for research or as a culmination of research. They also highlight problems with "sunsetting" diagnoses. The criteria for change in DSM-IV--a way to deal with the expanding array of proposals for additional diagnostic entities--are discussed. The authors also offer a series of specific examples of the different kinds of new categories being considered for inclusion in DSM-IV.

Anxiety Disorders↗
PubMed1992

Now is the time to retire the term "organic mental disorders".

The organic/nonorganic distinction in contemporary classifications of mental disorders such as DSM-III and DSM-III-R has important prognostic and treatment implications, because it directs the clinician to pay special attention to the possibility of an underlying "physical" disorder as the cause of the mental disturbance. However, the term "organic" raises serious and intractable problems, since the connotative meaning of the term always returns to its historical roots, which imply an outmoded functional/structural, psychological/biological, and mind/body dualism. The authors present a proposal being considered for DSM-IV that would eliminate the term "organic" and reorganize the classification of organic mental disorders. Disorders previously referred to as "organic mental disorders" would be renamed as either "secondary disorders" (if they are due to "physical" disorders) or "substance-induced disorders." The entire classification of mental disorders would be reorganized to distribute the secondary and substance-induced disorders into the major groups with which they share phenomenology. The traditional organic mental disorders--delirium, dementia, and amnestic disorder--would be grouped together under the rubric of "cognitive impairment disorders." While acknowledging problems with the suggested new terminology and reorganization of the classification, the authors argue that the potential benefits of the proposal for clarity and for facilitating differential diagnosis justify putting to rest the familiar but now anachronistic term "organic mental disorders."

Humans↗
PubMed1991

Toward an empirical classification for the DSM-IV.

The provision of explicit and specific diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1980, 1987) was instrumental in the production of a substantial amount of informative research. The major emphasis in the preparation of the DSM-IV has been to maximize the impact of this accumulating research on the revision and to document the rationale and empirical support for any changes that are made. In this article we discuss the empirical basis for the DSM-IV. The historical context provided by the previous editions is briefly presented and followed by a description of the process by which the DSM-IV is being constructed. The input of empirical data through literature reviews, data reanalyses, and field trials is described, and an illustration with the antisocial personality disorder diagnosis is given.

Antisocial Personality Disorder↗