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Biomedical subjects

R L Spitzer

Publications and source records attributed to R L Spitzer.

174 records · Page 10Linked to original sources
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The relationship of social phobia subtypes and avoidant personality disorder.

The diagnoses of social phobia (SP) and avoidant personality disorder (APD) have evolved from different historical sources, but their criteria appear to converge in DSM-III-R. Fifty anxiety disorder clinic patients with DSM-III-R SP were evaluated for presence of DSM-III-R APD. APD was present in 89% of those with the generalized subtype of SP (GSP) and 21% of those with the discrete subtype of SP (DSP). The findings are discussed in conjunction with other recent reports showing substantial overlap between GSP and APD.

Adult↗
PubMedDate not supplied

SCID-PANSS: two-tier diagnostic system for psychotic disorders.

The SCID-PANSS was developed as a two-tier diagnostic system for psychotic disorders to supplement categorical diagnosis with functional-dimensional assessment. The procedure combines the DSM-III-R Structured Clinical Interview and Rating Criteria (SCID) with those from the Positive and Negative Syndrome Scale (PANSS). The comprehensive 50- to 60-minute interview yields diagnostic classification, plus a profile of 30 symptoms and 10 dimensional scales, including positive and negative syndromes, depression, thought disturbance, and severity of illness. A study of 34 psychotic inpatients assessed by five psychiatrists showed strong interrater correlations (0.85 to 0.97 for summary scales, P less than .0001), supporting the reliability of the SCID-PANSS for clinical and research applications.

Adult↗
PubMedDate not supplied

Evaluation in an inpatient setting of DTREE, a computer-assisted diagnostic assessment procedure.

This study examined the procedural validity of DTREE, a microcomputer-based expert system that guides the user through the diagnostic logic of DSM-III-R. A DTREE-guided DSM-III-R diagnosis of 20 inpatients (made by the treating clinician) was compared with a "standard" diagnosis made simultaneously during a weekly 2-hour case conference consisting of a presentation by the treating clinician and other staff, a chart summary, and the administration of the Structured Clinical Interview for DSM-III-R (SCID), and culminating in a group consensus diagnosis. The kappa agreements were .80 for schizophrenia (N = 10), .83 for major depression (N = 3), and -.08 to 1.00 for other disorders. These results suggest that DTREE can produce valid assessments, at least in an acute setting of primarily patients with schizophrenia.

Adolescent↗
PubMedDate not supplied

A symptom checklist to screen for somatoform disorders in primary care.

Current DSM-IV somatoform diagnoses may inadequately capture many somatizing patients in primary care. By using data from two studies (1,000 and 258 patients, respectively), the authors determined 1) the optimal threshold on a checklist of 15 physical symptoms to screen for a recently proposed somatoform diagnosis, multisomatoform disorder (MSD), and 2) the concordance between MSD and somatization disorder. The optimal threshold for pursuing a diagnosis of MSD was seven or more physical symptoms. The majority (88%) of the patients who met criteria for MSD had either full or abridged somatization disorder. MSD was intermediate between abridged and full somatization disorder in terms of its association with functional impairment, psychiatric comorbidity, family dysfunction, and health care utilization and charges.

Adolescent↗
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Gender differences in the reporting of physical and somatoform symptoms.

OBJECTIVE: Women have consistently been shown to report greater numbers of physical symptoms. Our aim in this study was to assess gender differences for specific symptoms and to assess how much of these differences were attributable to psychiatric comorbidity. METHOD: Data from the PRIME-MD 1000 study (1000 patients from four primary case sites evaluated with the Primary Care Evaluation of Mental Disorders interview) were analyzed to determine gender differences in the reporting of 13 common physical symptoms. The effect of gender on symptom reporting was assessed by multivariate analysis, adjusting for depressive and anxiety disorders as well as age, race, education, and medical comorbidity. RESULTS: All symptoms except one were reported more commonly by women, with the adjusted odds ratios (typically in the 1.5-2.5 range) showing statistically significant differences for 10 of 13 symptoms. Somatoform (ie, physically unexplained) symptoms were also more frequent in women. Although depressive and anxiety disorders were the strongest correlate of symptom reporting, gender had an independent effect that persisted even after adjusting for psychiatric comorbidity. Gender was the most important demographic factor associated with symptom reporting, followed by education. CONCLUSIONS: Most physical symptoms are typically reported at least 50% more often by women than by men. Although mental disorders are also more prevalent in women, gender influences symptom reporting in patients whether or not there is psychiatric comorbidity.

Adolescent↗
PubMedDate not supplied

Validation and utility of the patient health questionnaire in diagnosing mental disorders in 1003 general hospital Spanish inpatients.

OBJECTIVE: To determine whether the Spanish version of the patient health questionnaire (PHQ) has validity and utility for diagnosing mental disorders in general hospital inpatients. METHODS: Participants in the study were 1003 general hospital inpatients, randomly selected from all admissions over an 18-month period. All of them completed the PHQ, the Beck Depression Inventory (BDI), and measures of functional status, disability days, and health care use, including length of hospital stay. They also had a structured interview with a mental health professional. RESULTS: A total of 416 (42%) of the 1003 general hospital inpatients had a PHQ diagnosis. There was good agreement between PHQ diagnoses and those of an independent mental health professional (for the diagnosis of any PHQ disorder, kappa = 0.74; overall accuracy, 88%; sensitivity, 87%; specificity, 88%), similar to the original English version of the PHQ in primary care patients. Patients with PHQ diagnoses had more functional impairment, disability days, and health care use than did patients without PHQ diagnoses (group main effects for functional status measures and disability days, p < .001; group main effects for health care use, p < .01). The group main effect for hospital length of stay was not significant. An index of depression symptom severity calculated from the PHQ correlated significantly both with the number of depressive symptoms detected at interview and the total BDI score. PHQ administration was well accepted by patients. CONCLUSIONS: The Spanish version of the PHQ has diagnostic validity in general hospital inpatients comparable to the original English version in primary care.

Adolescent↗
PubMedDate not supplied

Binge eating disorder: clinical features and treatment of a new diagnosis.

This review will describe the diagnostic criteria for the recently proposed diagnosis of binge eating disorder and provide an overview of its prevalence, clinical characteristics, and treatment approaches. Studies indicate that binge eaters represent a substantial proportion (18-46%) of the obese in weight control programs. Normal-weight patients with bulimia nervosa, obese binge eaters, and obese nonbinge eaters appear to represent three distinct populations, with obese nonbinge eaters showing the least psychological disturbance and patients with bulimia nervosa exhibiting the most. Preliminary findings indicate that obese binge eaters may be more likely than nonbinge eaters to drop out of treatment when treated by conventional weight loss programs, although weight losses achieved by binge eaters and nonbinge eaters who finish treatment do not differ significantly. Treatment programs that focus on the disturbed eating behavior appear to be effective to some degree in reducing binge eating frequency and related pathology, but patients tend to relapse after completion of treatment. Operationalized criteria such as the proposed DSM-IV criteria for binge eating disorder could facilitate coordinated research on binge eaters who do not meet criteria for bulimia nervosa.

Behavior Therapy↗
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[Schedule for Affective Disorders and Schizophrenia (SADS)].

This article represents the French translation of the Schedule for Affective Disorders and Schizophrenia (SADS), developed by researchers at the New York State Psychiatric Institute and Columbia University (New York) to permit the selection of homogeneous samples of patients presenting with a defined psychiatric illness. The SADS was developed in the mid-1970s in an effort to provide research investigators with a clinical procedure which would reduce information variance in both diagnostic and descriptive evaluations of subjects. It provides: 1. A detailed description of the features of the current episode of illness when they were at their most severe; 2. A similar description of the major features during the week prior to the evaluation; 3. A detailed description of past psychopathology and functioning relevant to the evaluation of prognosis and overall severity of disturbance; and 4. A series of questions and criteria which enable one to make diagnoses using the Research Diagnostic Criteria. These criteria currently represent the most widely used nosologic system for clinical research in psychiatry, allowing for comparison of results and facilitation of replication by different research teams.

Humans↗
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[Diagnostic criteria for psychiatric research: RDC (Research Diagnostic Criteria). French translation and adaptation by M. Ansseau].

This article represents the French translation of the Research Diagnostic Criteria, a set of operational criteria for 24 psychiatric disorders developed by researchers at the New York State Psychiatric Institute and Columbia University (New York) to permit the selection of homogeneous samples of patients presenting with a defined psychiatric illness. The Research Diagnostic Criteria are especially focussed on depressive disorders, defining the major depressive disorder, which comprises 10 non exclusive subtypes. These criteria currently represent the most widely used nosologic system for clinical research in psychiatry, allowing for comparison of results and facilitation of replication by different research teams.

Affective Disorders, Psychotic↗