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Biomedical subjects

Michael B First

Publications and source records attributed to Michael B First.

At least 19 recordsLinked to original sources
PubMed2006

Saving PTSD from itself in DSM-V.

Papers in this special issue of the Journal of Anxiety Disorders concern critical issues and core assumptions that underlie the diagnostic construct of posttraumatic stress disorder. Rather than addressing specific points raised in these papers, we consider the issues and their implications for redefining PTSD and associated disorders in the DSM-V. Specific proposals are advanced to tighten definitional criteria for traumatic events and posttraumatic symptoms. We believe the more stringent criteria express the intent of the PTSD category and will promote more effective research on whether that intent was legitimate or based on misconceptions.

Diagnosis, Differential↗
PubMed2006

Relational processes in the DSM-V revision process: comment on the special section.

With the aim of stimulating research in advance of the revision process of the Diagnostic and Statistical Manual of Mental Disorders, "A Research Agenda for DSM-V" (D. A. Kupfer, M. B. First, and D. A. Regier, 2002) was published, highlighting areas for further study. A white paper included in the research agenda (M. B. First et al., 2002) identified the limited provision for the diagnosis of relational disorders as one of the most important gaps in the current DSM-IV (American Psychiatric Association, 1994). Specific recommendations in the research agenda included developing assessment modules, determining the clinical utility of relational disorders, determining the role of relational disorders in the etiology and maintenance of individual mental disorders, and considering aspects of relational disorders that might be modulated by individual mental disorders. In parallel with the 11 research planning conferences organized by the American Psychiatric Association from 2004 to 2007 under the title "The Future of Psychiatric Diagnosis: Refining the Research Agenda," a research planning conference sponsored by the Fetzer Institute was convened to promote research necessary for more empirically informed deliberations about the role of relational disorders in DSM-V. The current special section summarizes the conference proceedings and should serve as a valuable resource for the DSM-V revision process.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2006

General medical and psychiatric perspectives on somatoform disorders: separated by an uncommon language.

PURPOSE OF REVIEW: While Diagnostic and Statistical Manual of Mental Disorders-IV provided updated definitions and diagnostic criteria for the diagnoses subsumed under the category of somatoform disorders, various nosological questions are still unresolved. We assessed current research activity on important key concepts related to nosology, validity, and reliability of the Diagnostic and Statistical Manual of Mental Disorders-IV somatoform diagnoses. RECENT FINDINGS: The initial Medline search for articles from 2000 through 2005 yielded a total of 912 articles. After checking for redundancy and excluding publications using other than Diagnostic and Statistical Manual of Mental Disorders-IV diagnostic criteria, a total of 101 articles was further reviewed. Heterogeneity of papers precluded statistical approaches; thus, a descriptive and narrative review was pursued. SUMMARY: It appears that applying the specific categories and criteria as proposed by Diagnostic and Statistical Manual of Mental Disorders-IV only captures a small proportion of the phenomena of interest at the interface of medicine and psychiatry. A paradigm shift towards 'general medical/psychiatry interface disorders' in exchange for the current dichotomy of 'mind' vs. 'body' disorders, may reduce stigma associated with current diagnostic labeling, improve user acceptability, and stimulate research in this important but still fragmented clinical area that still lacks agreed-upon diagnostic definitions.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2006

Diagnosing psychotic disorders in the emergency department in the context of substance use.

OBJECTIVE: For patients who are actively using a substance and experience psychotic symptoms, determining whether the psychotic symptoms are due to a primary psychotic disorder or are substance induced is challenging, especially in emergency departments, where historical information is limited. This study examined the accuracy and subsequent treatment implications of emergency department diagnoses among substance-using patients who were having their first psychotic episode. METHODS: Emergency department diagnoses for 302 patients were compared with best-estimate longitudinal diagnoses (BELDs) based on research assessments at three time points (baseline, six months, and 12 months). RESULTS: Of the 223 patients whose symptoms were diagnosed in the emergency department as a primary psychotic disorder, one-quarter were determined by the BELD to have substance-induced psychosis or no psychosis. Overall, the diagnostic agreement was only fair (kappa=.32). Patients with an emergency department diagnosis of primary psychosis were significantly more likely than those with an emergency department diagnosis of substance-induced psychosis to be hospitalized, started on antipsychotic medication, and referred to mental health services instead of treatment for substance use (p<.001). Patients given an emergency department diagnosis of primary psychosis who were found by the BELD to have substance-induced psychosis or no psychosis were significantly more likely to be treated for a psychotic disorder rather than for substance-induced psychosis (p<.001) CONCLUSIONS: Clinicians in psychiatric emergency departments appear to have a tendency to attribute psychotic symptoms to a primary psychotic disorder rather than to concurrent substance use. Given that the diagnosis has significant implications for future management, it is important to improve diagnostic approaches in the emergency department.

Adolescent↗
PubMed2005

Desire for amputation of a limb: paraphilia, psychosis, or a new type of identity disorder.

BACKGROUND: The objective of this paper is to describe and conceptualize an unusual and probably rare condition: the intense longstanding desire to have an amputation. METHOD: Structured interviews were conducted by telephone of 52 subjects (mean age: 48.6, range 23-77 years; 47 male, 4 female, 1 intersexed) self-identified as having had a desire to have an amputation. RESULTS: Seventeen per cent (n = 9) had an arm or leg amputated with two-thirds using methods that put the subject at risk of death and one-third enlisting a surgeon to amputate their healthy limb. The most common reported reason for wanting an amputation was the subject's feeling that it would correct a mismatch between the person's anatomy and sense of his or her 'true' self (identity). None were delusional. For all but one subject age at onset was during childhood or early adolescence. For those who had psychotherapy or medication there was no change in the intensity of the desire for amputation. The six subjects who had an amputation at their desired site reported that following the amputation they felt better than they ever had and no longer had a desire for an amputation. CONCLUSIONS: These preliminary results suggest the existence of an extremely unusual clinically distinct condition characterized by a lifelong desire to have an amputation of a particular limb. The condition is associated with serious negative consequences: amputation attempts, impairment and marked distress. Reflecting similarities between Gender Identity Disorder and this condition, the author suggests that it may be conceptualized as an unusual dysfunction in the development one's fundamental sense of anatomical (body) identity.

Adult↗
PubMed2005

Clinical utility: a prerequisite for the adoption of a dimensional approach in DSM.

A potential obstacle to implementing dimensional representations in the Diagnostic and Statistical Manual of Mental Disorders (DSM) is lack of data about clinical utility and user acceptability. Adopting a dimensional approach would likely complicate medical record keeping, create administrative and clinical barriers between mental disorders and medical conditions, require a massive retreating effort, disrupt research efforts (e.g., meta-analyses), and complicate clinicians' efforts to integrate prior clinical research using DSM categories into clinical practice. Efforts to empirically demonstrate the clinical utility of dimensional alternatives should be a prerequisite for their future implementation in order to establish that their advantages outweigh the disadvantages. Approaches to promote user acceptability and the development of an empirical database include dimensionalizing existing DSM categories and including research dimensions in the DSM appendix.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2005

Adverse outcomes associated with personality disorder not otherwise specified in a community sample.

OBJECTIVE: The authors investigated 1) whether adolescents and adults in the community diagnosed with personality disorder not otherwise specified are at elevated risk for adverse outcomes, and 2) whether this elevation in risk is comparable with that associated with the DSM-IV cluster A, B, and C personality disorders. METHOD: A community-based sample of 693 mothers and their offspring were interviewed during the offspring's childhood, adolescence, and early adulthood. Offspring psychopathology, aggressive behavior, educational and interpersonal difficulties, and suicidal behavior were assessed. RESULTS: Individuals who met DSM-IV criteria for personality disorder not otherwise specified were significantly more likely than those without personality disorders to have concurrent axis I disorders and behavioral, educational, or interpersonal problems during adolescence and early adulthood. In addition, adolescents with personality disorder not otherwise specified were at significantly elevated risk for subsequent educational failure, numerous interpersonal difficulties, psychiatric disorders, and serious acts of physical aggression by early adulthood. Adolescents with personality disorder not otherwise specified were as likely to have these adverse outcomes as those with cluster A, B, or C personality disorders or those with axis I disorders. CONCLUSIONS: Adolescents and young adults in the general population diagnosed with personality disorder not otherwise specified may be as likely as those with DSM-IV cluster A, B, or C personality disorders to have axis I psychopathology and to have behavioral, educational, or interpersonal problems that are not attributable to co-occurring psychiatric disorders. Individuals with personality disorder not otherwise specified and individuals with DSM-IV cluster A, B, or C personality disorders are likely to be at substantially elevated risk for a wide range of adverse outcomes.

Achievement↗
PubMed2005

Self-reported personality disorder in the children in the community sample: convergent and prospective validity in late adolescence and adulthood.

Approximately 800 youths from the Children in the Community Study (Cohen & Cohen, 1996) have been assessed prospectively for over 20 years to study personality disorders (PDs) in adolescents and young adults. In this article we evaluate the Children in the Community Self-Report (CIC-SR) Scales, which were designed to assess DSM-IV PDs using self-reported prospective data from this longitudinal sample. To evaluate convergent validity, we assessed concordance between the CIC-SR Scales and the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1995) in 644 participants at mean age 33. To assess predictive validity, we used CIC-SR Scales at mean age 22 to predict subsequent CIC-SR and SCID-II Personality Questionnaire scores at mean age 33. In these analyses the CIC-SR Scales matched or exceeded benchmarks established in previous comparisons between self-report instruments and structured clinical interviews. Unlike other self-report scales, the CIC-SR did not appear to overestimate diagnoses when compared with SCID-II clinical diagnoses.

Adolescent↗
PubMed2004

Association between television viewing and sleep problems during adolescence and early adulthood.

BACKGROUND: Although research has suggested that extensive television viewing may be associated with sleep problems, the direction of this association has not yet been determined. OBJECTIVE: To investigate directional hypotheses regarding the association between television viewing and sleep problems during adolescence and early adulthood. DESIGN: The Children in the Community Study, a prospective longitudinal investigation. PARTICIPANTS AND SETTING: A community-based sample of 759 mothers from upstate New York and their offspring were interviewed during the early adolescence (mean age, 14 years), middle adolescence (mean age, 16 years), and early adulthood of the offspring (mean age, 22 years). MAIN OUTCOME MEASURES: Television viewing and sleep problems during adolescence and early adulthood measured using the Disorganizing Poverty Interview and the age-appropriate versions of the Diagnostic Interview Schedule for Children. RESULTS: Adolescents who watched 3 or more hours of television per day during adolescence were at a significantly elevated risk for frequent sleep problems by early adulthood. This elevation in risk remained significant after offspring age, sex, previous sleep problems, offspring psychiatric disorders, offspring neglect, parental educational level, parental annual income, and parental psychiatric symptoms were controlled statistically. Adolescents who reduced their television viewing from 1 hour or longer to less than 1 hour per day experienced a significant reduction in risk for subsequent sleep problems. Sleep problems during adolescence were not independently associated with subsequent television viewing when prior television viewing was controlled. CONCLUSION: Extensive television viewing during adolescence may contribute to the development of sleep problems by early adulthood.

Adolescent↗
PubMed2004

Clinical utility as a criterion for revising psychiatric diagnoses.

OBJECTIVE: Changes in DSM-IV were guided by empirical data that mostly focused on improving diagnostic validity and reliability. Although many changes were made explicitly to improve clinical utility, no formal effort was made to empirically determine actual improvements in clinical utility. The authors propose that future revisions of DSM empirically demonstrate improvement in clinical utility to clarify whether the advantages of changing the diagnostic criteria outweigh potential negative consequences. METHOD: The authors provide a formal definition of clinical utility and then suggest that the merits of a proposed change to DSM be evaluated by considering 1) its impact on the use of the diagnostic system, 2) whether it enhances clinical decision making, and 3) whether it improves clinical outcome. RESULTS: Evaluating a change based on its impact on use considers both user acceptability and accuracy in application of the diagnostic criteria. User acceptability can be measured by surveying users' reactions, assessing user acceptability in a field trial setting, and measuring the effects on ease of use. Assessment of the correct application of diagnostic criteria entails comparing the clinician's diagnostic assessment to expert diagnostic assessment. Assessments of the impact on clinical decision making use methods developed for evaluating adherence to practice guidelines. Improvement in outcome entails measuring reduction in symptom severity or improvement in functioning or in documenting the prevention of a future negative outcome. CONCLUSIONS: Empirical methods should be applied to the assessment of changes that purport to improve clinical utility in future revisions of DSM.

Attitude of Health Personnel↗
PubMed2004

Psychiatric comorbidity: is more less?

With each successive revision of the DSM and ICD, psychiatric comorbidity has become more prevalent. The 'atheoretical' approaches of the DSM and ICD explicitly encourage multiple diagnoses with few exclusionary hierarchies, in the hope that all clinically relevant information will be captured. However, the current strategy of diagnosing 'maximal' comorbidity may not reflect 'optimal' comorbidity. Many clinicians and health information systems, particularly those in developing countries, have a limited capacity for capturing this diagnostic information, and fail to characterize additional diagnoses that are present. This article will address the evolution of our current diagnostic system as a way of understanding the emergence of comorbid psychiatric diagnoses. Alternative diagnostic approaches (a dimensional system, diagnostic hierarchies, and mixed diagnostic categories) that could be used to address the emergence of comorbid psychiatric diagnoses are considered. Future challenges for the next evolution of DSM and ICD are presented.

Journal Article↗
PubMed2002

The DSM-IV Text Revision: rationale and potential impact on clinical practice.

One consequence of the longer interval between major revisions of the DSM(from seven years between DSM-III-R and DSM-IV to more than 15 years between DSM-IV and DSM-V) is that the accompanying descriptive text will become increasingly out of step with the psychiatric database. To remedy this problem, the DSM-IV Text Revision (DSM-IV-TR) was published in July 2000. The main objectives of the revision were to review the DSM-IV text and make changes to reflect information newly available since the close of the initial DSM-IV literature review process in mid-1992; to correct errors and ambiguities that have been identified in DSM-IV; and to update the diagnostic codes to reflect changes in the ICD-9-CM coding system the U.S. government uses officially for health care reporting. This paper reviews the rationale for the text revision and describes changes that may have an impact on the day-to-day use of DSM-IV.

Guidelines as Topic↗