Biomedical subjects

Mark Zimmerman

Publications and source records attributed to Mark Zimmerman.

At least 19 recordsLinked to original sources

PubMed2007

Childhood emotional, physical, and sexual abuse, and diagnoses of depressive and anxiety disorders in adult psychiatric outpatients.

Although a number of theorists have hypothesized a link between negative experiences during childhood (e.g., abuse) and the presence of psychopathology in adults, little is known about the relative specificity of childhood emotional, physical, or sexual abuse to different forms of psychopathology. In this study, we hypothesized that adult psychiatric outpatients' reports of childhood emotional abuse would exhibit a specific relationship with diagnoses of depression. Analyses partially supported our hypothesis. Specifically, diagnoses of major depression were significantly more strongly related to reports of childhood emotional abuse than to physical or sexual abuse. However, the same effect was observed for social phobia. In addition, patients with major depression reported equivalent levels of childhood emotional abuse as patients with social phobia, but lower levels of emotional abuse than those with posttraumatic stress disorder.

Adult↗

PubMed2007

Diagnosing major depressive disorder XI: a taxometric investigation of the structure underlying DSM-IV symptoms.

Psychopathologists have long debated the latent structure of mental disorders, and a number of researchers have suggested that depression may be best characterized as a continuous, rather than categorical, phenomenon. Nonetheless, attention has been drawn to limitations permeating existing research and the need for studies using more appropriate statistical methods developed expressly to tease apart taxonic (categorical) and dimensional (continuous) structural models. The present study examined the structure underlying the DSM-IV symptoms of major depressive disorder in a large outpatient sample rigorously assessed using semistructured clinical interviews. The results of a series of taxometric procedures and consistency tests supported a taxonic structural model, consistent with the only previous taxometric study of DSM-IV symptoms in an adult outpatient sample. In addition to the need for further replication and clarification, these results have implications for the assessment and diagnosis of major depressive disorder. Suggestions for several additional avenues of research are discussed.

Ambulatory Care↗

PubMed2006

Does comorbid Social Anxiety Disorder impact the clinical presentation of principal Major Depressive Disorder?

BACKGROUND: Although previous research has examined comorbidity in principal Social Anxiety Disorder (SAD), few studies have examined the disorders for which those with comorbid SAD seek treatment. Further, studies have shown that depressive disorders often are associated with SAD, but few have examined the clinical characteristics of patients with this particular comorbidity. METHOD: The current study examined the prevalence of various principal Axis I disorders in 577 individuals diagnosed with comorbid SAD. RESULTS: Consistent with previous research, Major Depressive Disorder (MDD) was the most frequent principal diagnosis in patients with comorbid SAD. Those with principal MDD and comorbid SAD (MDD-SAD) were compared to those with MDD without SAD (MDD) on demographic and clinical characteristics. Patients with MDD-SAD versus those with MDD were more severe in terms of social functioning, duration of depressive episode, suicidal ideation, time out of work, presence of current alcohol abuse/dependence, and age of onset of MDD. Social functioning, duration of episode, suicidal ideation, and age of onset of MDD remained significant even after controlling for additional comorbid disorders. CONCLUSIONS: Findings suggest the need for future research to determine how treatments could be adapted for this commonly occurring comorbidity.

Adolescent↗

PubMed2006

Prevalence and diagnostic correlates of DSM-IV pathological gambling in psychiatric outpatients.

Studies of the prevalence of pathological gambling (PG) in psychiatric and substance abusing patients suggest that the disorder is not rare. Most studies have been of substance abusers in treatment, and the rate of PG has been found to be several times higher than the rate found in community based epidemiological surveys. However, only one study has examined the prevalence of PG in a heterogeneous sample of patients, and this was a study of psychiatric inpatients. We are not aware of any prior study of the prevalence of PG in a psychiatric outpatient sample. In the present report from the Rhode Island Methods to Improve Diagnosis and Services (MIDAS) project we examined the current and lifetime prevalence of PG in 1,709 psychiatric outpatients interviewed with a semi-structured diagnostic interview that included a module to diagnose DSM-IV PG. Forty (2.3%) patients had a lifetime history of DSM-IV PG, all of whom had at least one other DSM-IV axis I disorder. Patients with PG had significantly more axis I disorders than patients without PG, and had significantly higher rates of bipolar disorder, social phobia, panic disorder with agoraphobia, alcohol use disorder, and other impulse control disorders. Possible reasons for the low prevalence of PG in our sample are discussed.

Adult↗

PubMed2006

The impact of gender, age and depressed state on patients' perspectives of remission.

BACKGROUND: Current standards for treatment outcome from major depression assess remission solely from the vantage point of symptom resolution. Recent evidence, however, suggests that depressed patients consider factors beyond symptom resolution as important for defining remission. The goal of this study was to examine the influence of three predictors on patients' views of factors important for achieving remission: gender, age and current depressed state (i.e., remitted or depressed). METHODS: Five hundred and sixty-two depressed psychiatric outpatients completed a survey assessing the importance of 16 remission factors. Depressed state was assessed by the Standardized Clinical Outcome Rating scale for Depression (SCOR-D), a clinician rated scale that is based on the number of DSM-IV criteria for a major depressive episode and level of psychosocial impairment present during the past week. RESULTS: Relative to male patients, females showed a greater likelihood for rating remission factors related to emotional stabilization (e.g., achieving emotional control, being able to cope with normal stress) as very important. Relative to younger cohorts, the oldest depressed patients endorsed a greater number of remission factors as very important and emphasized positive mental health states (e.g., feeling satisfied, having a general sense of well-being) more. There were no significant differences between remitted and depressed patients in rating the remission factors' importance. CONCLUSION: Perspectives on remission may be differentially perceived by women versus men and by older versus younger depressed patients. LIMITATIONS: The study was conducted in a single outpatient clinical practice.

Adolescent↗

PubMed2006

Disentangling depressive personality disorder from avoidant, borderline, and obsessive-compulsive personality disorders.

Several studies have found that 3 personality disorders (PDs) tend to share moderate rates of comorbidity with depressive PD: avoidant, borderline, and obsessive-compulsive. This study sought to evaluate the diagnostic criteria of each disorder in an effort to understand where areas of overlap may occur and to modify criteria sets where reasonable to reduce any degree of overlap. One thousand two hundred psychiatric outpatients were interviewed with the Structured Interview for DSM-IV Personality Disorders. The highest degree of comorbidity was observed between avoidant PD and depressive PD. Logistic regression analyses indicated that 2 criteria-avoidant criterion 5 and depressive criterion 2-could be removed from the diagnostic criteria sets and reduce the rates of overlap by as much as 15%. A factor analysis of the criteria of all 4 PDs indicated that there is a common clustering of many of the symptoms of avoidant, borderline, depressive, and obsessive-compulsive PDs and that borderline symptoms tend to cluster together most consistently. Avoidant and obsessive-compulsive personality symptoms clustered in ways that may reflect a problem of how to engage with others, suggestive of an approach-avoidance conflict. Depressive PD symptoms clustered in a way suggestive of problems with anger that is directed toward oneself and others. The factor analysis results suggest that an organization of symptoms around themes of conflict may provide useful ways of understanding the personality patterns of these 4 disorders.

Adult↗

PubMed2006

Salmonella enterica serovar Paratyphi A and S. enterica serovar Typhi cause indistinguishable clinical syndromes in Kathmandu, Nepal.

BACKGROUND: Enteric fever is a major global problem. Emergence of antibacterial resistance threatens to render current treatments ineffective. There is little research or public health effort directed toward Salmonella enterica serovar Paratyphi A, because it is assumed to cause less severe enteric fever than does S. enterica serovar Typhi. There are few data on which to base this assumption, little is known of the serovar's antibacterial susceptibilities, and there is no readily available tolerable vaccination. METHODS: A prospective study was conducted of 609 consecutive cases of enteric fever (confirmed by blood culture) to compare the clinical phenotypes and antibacterial susceptibilities in S. Typhi and S. Paratyphi A infections. Variables independently associated with either infection were identified to develop a diagnostic rule to distinguish the infections. All isolates were tested for susceptibility to antibacterials. RESULTS: Six hundred nine patients (409 with S. Typhi infection and 200 with S. Paratyphi A infection) presented during the study period. The infections were clinically indistinguishable and had equal severity. Nalidixic acid resistance, which predicts a poor response to fluoroquinolone treatment, was extremely common (75.25% of S. Paratyphi A isolates and 50.5% of S. Typhi isolates; P < .001). S. Paratyphi A was more likely to be resistant to ofloxacin (3.6% vs. 0.5%; P = .007) or to have intermediate susceptibility to ofloxacin (28.7% vs. 1.8%; P < .001) or ciprofloxacin (39.4% vs. 8.2%; P < .001). MICs for S. Paratyphi A were higher than for S. Typhi (MIC of ciprofloxacin, 0.75 vs. 0.38 microg/mL [P < .001]; MIC of ofloxacin, 2.0 vs. 0.75 microg/mL [P < .001]). CONCLUSIONS: The importance of S. Paratyphi A has been underestimated. Infection is common, the agent causes disease as severe as that caused by S. Typhi and is highly likely to be drug resistant. Drug resistance and lack of effective vaccination suggest that S. Paratyphi A infection may become a major world health problem.

Adolescent↗

PubMed2006

Discordance between self-reported symptom severity and psychosocial functioning ratings in depressed outpatients: implications for how remission from depression should be defined.

The diagnosis of depression is based on the presence of symptoms along with functional impairment. One might therefore expect the definition of remission of depressive disorder to be based on the resolution of both symptoms and functional impairments. This, however, is not how the field has been defining remission. Rather, in treatment studies of depression, remission has been defined in symptom terms only. Clinical experience suggests that there is sometimes discordance between patients' symptom severity and functioning. No studies, however, have examined the frequency of this discordance. We examined the concordance of ratings of depression symptom severity and psychosocial functioning in a sample of 503 outpatients receiving treatment for major depressive disorder. The majority of patients were concordant in these ratings (i.e. no symptoms and no functional impairment, or ongoing symptoms and impairment), though one quarter of the patients were discordant. Specifically, approximately one quarter of the patients with depressive symptoms denied concurrent psychosocial impairment. In contrast, it was rare for patients without symptoms to report functional impairment. Almost all patients without both symptoms and functional impairment considered themselves to be in remission, and almost all patients with both symptoms and functional impairment did not consider themselves to be in remission. Half of the patients who reported normal functioning despite ongoing depressive symptoms considered themselves to be in remission from their depression. This suggests that current symptom-based definitions of remission might be too narrow.

Adult↗

PubMed2006

Modulation of antigen-specific T cell response by a non-mitogenic anti-CD3 antibody.

Suppression of T cell response is the key to enhance graft survival and control autoimmune diseases. A mitogenic anti-CD3 monoclonal antibody (mAb), OKT3, has been used for decades to control acute rejection in organ transplantation. Although effective, the clinical use was limited by its side effects, such as cytokine release mediated by T cell activation. A low mitogenic humanized OKT3 with reduced FcR-binding (hgammaOKT3 Ala-Ala) was generated and tested in several clinical studies. Although hgammaOKT3 Ala-Ala demonstrated maintained efficacy and better safety it still activated T cells. To investigate if a non-mitogenic anti-CD3 mAb can be equally effective in immune suppression, a chimeric non-FcR-binding anti-mouse CD3 mAb (anti-CD3 IgG2a Ala-Ala) was generated. Unlike the hgammaOKT3 Ala-Ala, the mouse IgG2a Ala-Ala anti-CD3 mAb did not induce T cell activation as measured by proliferation, cytokine production and apoptosis. Nevertheless, the IgG2a Ala-Ala anti-CD3 mAb was equally effective in the inhibition of antigen-specific CD4+ T cell activation in vitro to that of the mitogenic anti-CD3 mAb (Anti-CD3 IgG2a). In vivo, the IgG2a Ala-Ala anti-CD3 mAb only induced transient reduction of peripheral and spleen T cells and did not trigger detectable cytokine release. Nonetheless, this non-mitogenic anti-CD3 mAb significantly prolonged islet graft survival as effectively as the mitogenic anti-CD3 mAb in an allogenic islet transplantation model. These results demonstrated that a non-mitogenic anti-CD3 mAb could be used as an effective immune modulator. It may also indicate that a true non-mitogenic version of OKT3 could further improve its safety profile for clinical use.

Animals↗

PubMed2006

Personality pathology and its relation to couple functioning.

The study aimed at understanding the relationship between personality pathology and couple functioning, both in terms of general functioning and communication specifically, in a sample of 146 psychiatric outpatients. The results indicated that couple communication was best predicted by a combination of the symptoms within each of the three personality disorder clusters and the total number of personality disorder symptoms while general family functioning was best predicted by the total number of Axis I disorders. No demographic variables were found to be related to the level of couple functioning. Future research needs to focus on understanding what makes it difficult for people with personality disorder traits to function in relationships.

Adult↗

PubMed2006

A psychometric evaluation of the DSM-IV pathological gambling diagnostic criteria.

Specific diagnostic criteria for pathological gambling (PG) have been available for 25 years, since the publication of DSM-III. Little research has examined the psychometric performance of the diagnostic criteria. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to examine the sensitivity, specificity and predictive values of the DSM-IV PG criteria for psychiatric outpatients who screened positive for a gambling problem. A total of 1709 psychiatric outpatients were evaluated with a semistructured diagnostic interview for PG. Of all patients 88 screened positive for PG, 40 of whom met DSM-IV diagnostic criteria for a lifetime history of PG. All ten DSM-IV criteria were significantly more frequent in the PG group. The sensitivity of the criteria ranged from 25.0% to 90.0% (mean = 67.8%), whereas specificity ranged from 62.5% to 100% (mean = 81.9%). Positive predictive values ranged from 64.1% to 100% (mean = 78.9%), and negative predictive values ranged from 61.5% to 90.7% (mean = 77.1%). Guidelines are recommended for determining whether a diagnostic criterion should be retained as part of the set of diagnostic criteria, and our results suggested that two of the DSM-IV PG criteria are candidates for elimination (criterion 8--commitment of illegal acts; criterion 10--reliance on others for financial assistance to relieve a desperate financial problem).

Adult↗

PubMed2006

Screening for anxiety disorders in depressed patients.

The Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a brief, psychometrically strong, questionnaire designed to screen for common Axis I disorders. In the present report, we examine the ability of the PDSQ to identify anxiety disorders in psychiatric outpatients with a principal diagnosis of major depressive disorder. Eight hundred patients presenting for treatment were evaluated with the Structured Clinical Interview for DSM-IV (SCID) after completing the PDSQ. Two hundred ninety-five patients had a principal diagnosis of major depressive disorder. The mean sensitivity and negative predictive value of the anxiety disorder subscales was 88.5% and 96.5% when all patients were considered, and 88.2% and 95.6% when only depressed patients were examined. The PDSQ's anxiety disorder subscales have high sensitivity and negative predictive value thereby indicating that the scale could function well as a screening instrument in depressed patients.

Adult↗

PubMed2006

Diagnosing major depressive disorder introduction: an examination of the DSM-IV diagnostic criteria.

During the past 3 decades, more research has been conducted on depression than any other psychiatric disorder. While there are numerous studies on depression in the areas of epidemiology, biopsychosocial correlates, genetics, course, and treatment, remarkably little research has focused on the criteria used to diagnose major depressive disorder. Nearly 10 years ago, we began the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, an integration of a comprehensive assessment protocol into a community-based psychiatry outpatient practice. As part of this clinical-research program, patients have been administered semistructured diagnostic interviews to assess the DSM-IV Axis I and Axis II disorders by well-trained interviewers. One of the goals of the MIDAS project has been to examine issues of nosology. While changes in the successive editions of the American Psychiatric Association's DSM have been increasingly grounded on empirical research, many of the sets of diagnostic criteria have not been subject to empirical scrutiny. During the next 12 months, we will be publishing a series of papers examining varying aspects of the diagnostic criteria for major depression. This series represents the type of methodical psychometric and conceptual analysis that should be conducted when developing or revising diagnostic criteria. We will examine whether the assumptions underlying the DSM's diagnostic rules have empirical support, and examine the impact of these rules on clinical practice. Our goal is not to develop a new definition of depression that would classify some individuals differently than how they are currently classified. That is, we are not seeking to develop a more valid definition of depression. However, our findings sometimes suggest changes that would simplify the criteria, improve their psychometric properties, and enhance their applicability in medical settings. Thus, the focus in the series is on clinical utility rather than validity.

Major Depressive Disorder↗

PubMed2006

Diagnosing major depressive disorder I: A psychometric evaluation of the DSM-IV symptom criteria.

The diagnostic criteria for depression were developed on the basis of clinical experience rather than empirical study. Although they have been available and widely used for many years, few studies have examined the psychometric properties of the DSM criteria for major depression. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined whether criteria such as insomnia, fatigue, and impaired concentration that are also diagnostic criteria for other disorders are less specific than the other DSM-IV depression symptom criteria. We also conducted a regression analysis to determine whether all criteria are independently associated with the diagnosis of major depressive disorder. A total of 1538 psychiatric outpatients were administered a semistructured diagnostic interview. We inquired about all of the symptoms of depression for all patients. All of the DSM-IV symptom criteria for major depressive disorder were significantly associated with the diagnosis. Contrary to our prediction, symptoms such as insomnia, fatigue, and impaired concentration, which are also criteria of other disorders, generally performed as well as the criteria that are unique to depression such as suicidality, worthlessness, and guilt. The results of the regression analysis, which controlled for symptom covariation, indicated that five symptoms (increased weight, decreased weight, psychomotor retardation, indecisiveness, and suicidal thoughts) were not independently associated with the diagnosis of depression. The implications of these results for revising the diagnostic criteria for major depression are discussed.

Adult↗

PubMed2006

Diagnosing major depressive disorder: II: is there justification for compound symptom criteria?

The DSM-IV symptom inclusion criteria for the diagnosis of major depressive disorder (MDD) are constructed in three ways: single symptom criteria, compound criteria encompassing opposite variants of the same disturbance, and compound criteria encompassing related problems. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we tested the following three hypotheses: (1) the components of compound-opposite criteria rarely occur simultaneously, (2) the components of the compound-related criteria frequently occur simultaneously, and (3) the components of the compound-related criteria more frequently co-occur than other pairs of the MDD criteria. We also examined how many patients would be rediagnosed if the compound criteria were split into separate items. One thousand eight hundred psychiatric outpatients were evaluated with a semistructured diagnostic interview. We inquired about all of the DSM-IV diagnostic criteria for MDD for all patients. As hypothesized, the symptoms of the compound-opposite criteria usually did not co-occur, whereas the symptoms of the compound-related criteria frequently were present simultaneously. However, the results also indicated that other pairs of symptoms were as likely to co-occur, and were as strongly associated with each other, as the symptoms of the compound-related criteria. Thus, the findings provide mixed support for the assumptions hypothesized to underlie the composition of the DSM-IV criteria for MDD. When the compound criteria were subdivided and the diagnostic threshold for MDD was kept constant, only a small percentage of patients was reclassified from a noncase to a case. The implications of these results for constructing diagnostic criteria, and for developing measures to assess the severity of depression, are discussed.

Adult↗

PubMed2006

Diagnosing major depressive disorder III: can some symptoms be eliminated from the diagnostic criteria?

All criteria used to diagnose a psychiatric disorder should contribute to distinguishing cases from noncases. The principal of parsimony argues for defining a disorder with as few criteria as possible. Thus, criteria that do not contribute to the case-noncase distinction should be eliminated from the list of defining features because they unnecessarily increase the complexity of the definition of the disorder. In polythetically defined disorders such as major depressive disorder (MDD), diagnosis is based on the presence of a minimum number of features from a list. For a criterion to be retained on such a list, it should contribute to distinguishing between individuals with and without MDD. Simply demonstrating that a criterion is significantly more common in individuals with MDD than individuals without MDD is not a sufficient demonstration of its necessity. Rather, to demonstrate an impact on diagnosis, it should be shown that eliminating the criterion from the list results in individuals being reclassified from a case to a noncase. A criterion does not contribute to determining caseness if its elimination does not result in diagnostic reclassification. The goal of this report from the Rhode Island Hospital Methods to Improve Diagnostic Assessment and Services project was to determine if any of the criteria of MDD are candidates for elimination because of their lack of impact on diagnosis. The results indicated that the symptoms of increased weight, decreased weight, and indecisiveness rarely influenced diagnostic classification and thus are candidates for elimination.

Affective Symptoms↗

PubMed2006

Diagnosing major depressive disorder IV: relationship between number of symptoms and the diagnosis of disorder.

The symptom inclusion criteria for DSM-IV major depressive disorder (MDD) consist of a list of nine characteristic features of depression, at least five of which must be present. Two of the criteria for MDD, low mood and loss of interest or pleasure, are accorded greater importance than the remaining seven criteria in that one of these two features is required for the diagnosis. The implicit assumption underlying this organization of the criteria is that some individuals might meet five of the nine criteria without experiencing low mood or loss of interest or pleasure and thus be inappropriately diagnosed with major depression. We are not aware of any studies that have examined this assumption. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined how many psychiatric outpatients meet five of the nine DSM-IV criteria for MDD without simultaneously experiencing either low mood or loss of interest or pleasure. If this pattern is rare or does not exist, then the method of counting criteria to diagnose major depression could be simplified to a straightforward five out of nine. Twenty-seven (1.5%) patients reported five or more criteria in the absence of low mood or loss of interest or pleasure. More than half (N = 16) of these 27 patients were diagnosed with MDD or bipolar disorder, depressed type, in partial remission (N = 14), bipolar disorder mixed type (N = 1), or bipolar disorder not otherwise specified (N = 1). Six of the remaining 11 patients were diagnosed with depressive disorder not otherwise specified. Thus, few patients who met five or more of the MDD criteria were not diagnosed with a depressive disorder. This suggests that the diagnostic criteria for MDD can be simplified to a straightforward symptom count without reference to the necessity of low mood or loss of interest or pleasure.

Adolescent↗

PubMed2006

Diagnosing major depressive disorder V: applying the DSM-IV exclusion criteria in clinical practice.

To be diagnosed with DSM-IV major depressive disorder (MDD), a patient must meet five out of nine symptom criteria, one of which is depressed mood or pervasive loss of interest or pleasure. Once a patient has reached this symptom threshold, there are several exclusionary criteria that need to be passed to receive the diagnosis. The symptoms must cause significant distress or impairment in functioning, the symptoms cannot be caused by substance use or a general medical condition, and the symptoms cannot be better accounted for by bereavement. Finally, the presence of psychotic symptoms not coincident with the depressive symptoms excludes the diagnosis. We are not aware of any studies of psychiatric patients that have examined the impact of all of these exclusionary rules on the diagnosis of MDD in clinical practice. It is important for clinicians to know how often each of these factors might exclude the diagnosis of MDD so that they can be more or less vigilant to their presence. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project was to examine the impact of the DSM-IV exclusion rules on the diagnosis of MDD. In total, 38 (3.0%) of the 947 patients meeting the DSM-IV symptom inclusion criteria were excluded from a diagnosis of MDD or bipolar depression. These results suggest that the DSM-IV exclusion criteria for MDD had only a modest impact on diagnosis in psychiatric outpatients. It is likely that the results of a study of the impact of the DSM-IV depression exclusion criteria will depend on where the study is conducted. The potential influence of different settings on diagnostic exclusion is discussed.

Ambulatory Care↗