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PubMed1979

A comparison of DSM-II and DSM-III in the diagnosis of childhood psychiatric disorders. II. Interrater agreement.

A case-history format was utilized to compare interrater agreement on childhood and adolescent psychiatric disorders, using DSM-II and DSM-III. The average interrater agreement was 57% for DSM-II and 54% for axis I (clinical psychiatric syndrome) of DSM-III. There was high agreement in both systems on cases of psychosis, conduct disorder, hyperactivity, and mental retardation, with DSM-III appearing slightly better. There was noteworthy interrater disagreement in both systems for "anxiety" disorders, complex cases, and in the subtyping of depression. Overall, the reliability of DSM-III appears to be good and is comparable with that of DSM-II and other classification systems of childhood psychiatric disorders.

Adolescent↗

PubMed1993

Comparison of DSM-II and DSM-III schizophrenics: a longitudinal perspective.

Patients who meet DSM-III criteria for schizophrenia were compared with those who meet DSM-II, but not DSM-III, criteria. Comparisons included measures of positive symptoms, negative symptoms, and social competence both before extended hospitalization and during a 7-year follow-up. The measure of positive symptoms was the only variable that differed significantly between groups at initial assessment. Positive symptoms were more stable and predictive for DSM-III schizophrenics than for DSM-II schizophrenics. The measure of negative symptoms was the most stable and predictive variable for the DSM-II schizophrenics. Increased homogeneity for the DSM-III schizophrenics was not found for most measures.

Adult↗

PubMed2005

Endorsement frequencies and factor structure of DSM-III-R and DSM-IV Generalized Anxiety Disorder symptoms in women: implications for future research, classification, clinical practice and comorbidity.

UNLABELLED: We investigated dimensions of liability to Generalized Anxiety Disorder (GAD) and whether evidence exists for distinct pathological versus normal clusters in the population. Structured interviews were administered to a general population sample of 2,163 female twins in a cross-sectional design. Endorsement rates were estimated using full information maximum likelihood factor analyses of the DSM-III-R and DSM-IV GAD symptoms, which provides appropriate treatment of the stem-probe structure of the clinical interview. Endorsement rates were highest for symptoms retained in DSM-IV. For both DSM-III-R and DSM-IV, a two-factor model fit the data better than a single-factor model. There was no evidence for non-normality in the liability to GAD. For DSM-III-R, autonomic symptoms loaded on a factor with panic disorder, while fatiguability, difficulty concentrating and hypervigilance loaded on a factor with major depression. For DSM-IV, all items loaded on one factor, and muscle tension also loaded on a second. Major depression, panic, phobias and alcohol dependence diagnoses also loaded on the first factor. CONCLUSIONS: Future research involving structured interviews should take into account the stem-and-probe format and focus on common factors rather than separate disorders; GAD is not a unidimensional construct and pathological anxiety may differ only quantitatively from normal anxiety.

Adolescent↗

PubMedDate not supplied

Consumers' attitudes toward DSM-III and DSM-III-R: a 1989 survey of psychiatric educators, researchers, practitioners, and senior residents.

To understand how DSM-III and DSM-III-R are used and perceived by educators, researchers, practitioners, and trainees, in the spring of 1989 we surveyed all US psychiatric residency training directors (N = 197), 337 active psychiatrist researchers, a nationwide random sample of 952 practicing psychiatrists, and all PGY-3 and -4 residents. We describe the factors influencing the use of DSM-III and DSM-III-R and the perceptions of strengths and weaknesses of the DSMs from various perspectives (training, research, and practice). A modest increase in the acceptance of the DSM system was noted in comparing the results from the current survey and a similar 1984 survey about DSM-III. The implications of these findings for the development of DSM-IV are discussed.

Attitude of Health Personnel↗

PubMed2001

Values and assumptions in the development of DSM-III and DSM-III-R: an insider's perspective and a belated response to Sadler, Hulgus, and Agich's "On values in recent American psychiatric classification".

It is widely acknowledged that the approach taken in the development of a classification of mental disorders is guided by various values and assumptions. The author, who played a central role in the development of DSM-III (American Psychiatric Association [1980] Diagnostic and statistical manual of mental disorders, 3rd ed. Washington, DC:Author) and DSM-III-R (American Psychiatric Association [1987] Diagnostic and statistical manual of mental disorders, 3rd ed, rev. Washington, DC:Author) will explicate the basic values and assumptions that guided the development of these two diagnostic manuals. In so doing, the author will respond to the critique of DSM-III and DSM-III-R made by Sadler et al. in their 1994 paper (Sadler JZ, Hulgus YF, Agich GJ [1994] On values in recent American psychiatric classification. JMed Phil 19:261-277). The author will attempt to demonstrate that the stated goals of DSM-III and DSM-III-R are not inherently in conflict and are easily explicated by appealing to widely held values and assumptions, most of which appeared in the literature during the development of the manuals. Furthermore, we will demonstrate that it is not true that DSM-III places greater emphasis on reliability over validity and is covertly committed to a biological approach to explaining psychiatric disturbance.

Biological Psychiatry↗

PubMed1993

The dimensionality of alcohol abuse and dependence: factor analysis of DSM-III-R and proposed DSM-IV criteria in the 1988 National Health Interview Survey.

Decisions on the final version of the DSM-IV alcohol abuse and dependence criteria will be determined largely by the APA's substance abuse field trials, conducted primarily in treated, clinical samples. Among the major objectives of the field trials are to study the boundaries between abuse and dependence, and to identify specific criteria that define the abuse category. The decisions on revisions of the abuse and dependence criteria in DSM-IV should, however, be informed by data from non-treated or general population samples as well. The present study addresses the field trial objectives using recent data from a large general population survey, the 1988 National Health Interview Survey (NHIS88). The paper reports on factor analyses to assess the dimensions underlying the DSM-III-R and DSM-IV dependence and abuse criteria as operationalized in the NHIS88. The focus of the analyses is on whether models with more than one dimension are needed and if so, the correspondence of the dimensions to criteria sets defined in the DSM-III-R and DSM-IV. The analyses show that a two-dimensional model is required. The dimensions are interpreted as abuse and dependence, but the sets of criteria that define each of the dimensions show important deviations from the criteria sets used in the DSM definitions.

Ethanol↗

PubMed1992

DSM-III-R and proposed DSM-IV alcohol abuse and dependence, United States 1988: a nosological comparison.

The purpose of the present study was to compare DSM-III-R and the proposed DSM-IV (options 1 and 2) diagnostic criteria for alcohol abuse and dependence in a representative sample of the United States general population. Alcohol abuse and dependence diagnostic categories were contrasted in terms of prevalence and overlap. The prevalences of DSM-III-R and DSM-IV diagnoses of alcohol abuse and dependence combined were remarkably similar. However, disaggregation of abuse and dependence diagnoses showed that there were major discrepancies between the classification systems. Reasons for these discrepancies are discussed in terms of differences in the number of diagnostic criteria and the content of the DSM-III-R and DSM-IV abuse and dependence categories, the requirement for physiological dependence in DSM-IV classifications, the relationship between the abuse and dependence categories, and the impact of the duration criteria.

Adolescent↗

PubMed1992

DSM-III-R and the proposed DSM-IV alcohol use disorders, United States 1988: a nosological comparison.

The purpose of the present study was to compare DSM-III-R and the proposed DSM-IV diagnostic criteria for alcohol abuse and dependence in a representative sample of the United States general population. Alcohol abuse and dependence diagnostic categories were contrasted in terms of prevalence and overlap. The prevalence of DSM-III-R diagnoses of alcohol abuse and dependence combined (8.63%) was greater than the corresponding DSM-IV diagnoses (6.00%). Disaggregation of abuse and dependence diagnoses showed that the major discrepancy between the classification systems resided between the abuse categories. Reasons for the discrepancies are discussed in terms of differences in the content of the DSM-III-R and DSM-IV abuse categories, in the relationship that each abuse category shares with its respective dependence category, and the impact of the DSM-III-R duration criterion.

Adolescent↗

PubMed1996

DSM-IV, DSM-III-R, and ICD-10 alcohol and drug abuse/harmful use and dependence, United States, 1992: a nosological comparison.

This study assessed agreement between DSM-IV, DSM-III-R, and ICD-10 diagnoses of alcohol and drug use disorders using data from a large representative sample of the United States population. Agreement between the three diagnostic systems for dependence was good to excellent for past year, prior to the past year, and life-time diagnoses, for both genders, each ethnic group, and younger and older respondents. Cross-system comparisons between DSM-IV and DSM-III-R abuse were good to excellent, but concordance was consistently poor when ICD-10 harmful use diagnoses were compared with DSM-IV and DSM-III-R abuse diagnoses. Implications of these results are discussed in terms of the degree to which future research findings could be integrated with one another and the results from earlier studies using older versions of the DSM, to advance scientific knowledge in the drug and alcohol fields.

Adolescent↗

PubMed1993

The semantic status of diagnostic criteria for organic mental syndromes and disorders in DSM-III and DSM-III-R.

After a general introduction referring to the contemporary debate about psychiatric classification, the nature of so-called "diagnostic criteria" in psychiatry is discussed with special reference to DSM-III(-R) and to organic mental syndromes and disorders. A set of diagnostic criteria for a disease category can be intended alternatively (i) as stating logically necessary and/or sufficient conditions for the diagnostic concept in question, or (ii) as providing contingent (probabilistic) indicators of the disease. In one possible interpretation, a main aim of DSM-III and DSM-III-R has been to formulate type (i), logical criteria, which amounts to an attempt to strictly identify syndromes or disorders with complex (polythetic) sets of easily observable symptoms and signs. It is shown that a logical interpretation would lead to such unwanted consequences for clinical and scientific practice that it could not possibly have been intended by the authors of DSM-III and DSM-III-R. But neither can the alternative interpretation in terms of type (ii), contingent or probabilistic indicators be consistently upheld. The conclusion of the essay is that the semantic status of the diagnostic criteria in DSM-III and DSM-III-R is fundamentally blurred. This unclarity may very well lead to divergent interpretations of the concepts and to corresponding uncertainties in their clinical and scientific application.

Delirium↗

PubMed1989

Comparison between personality disorder diagnoses in DSM-III and DSM-III-R: reliability, diagnostic overlap, predictive validity.

97 nonpsychotic consecutive day patients were diagnosed by the axis 1 and 2 in the DSM-III and DSM-III-R system, and their treatment response during their stay was measured by the Health Sickness Rating Scale. The interrater reliability was equally good for both diagnostic systems. On axis 1, there were only minor differences between DSM-III and DSM-III-R. On axis 2, the frequency of schizotypal disorder was reduced by 40% and the frequency of histrionic disorder by two-thirds. The number of schizoid disorders increased from zero to five. Of the DSM-III schizotypals who lost this diagnosis in DSM-III-R (n = 8), 4 got a new diagnosis of schizoid personality and 4 maintained their borderline diagnoses. In DSM-III-R there was a sharper demarcation between patients with severe and nonsevere personality disorder with regard to treatment outcome, indicating an increased validity of these categories. There was also a sharper demarcation between borderline versus histrionic and schizotypal, and between schizotypal and schizoid diagnoses.

Adult↗

PubMed2000

Toward the DSM-V: the Withdrawal-Gate Model versus the DSM-IV in the diagnosis of alcohol abuse and dependence.

The Diagtnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) classifies as dependent many cases of mild alcohol problems. DSM-IV diagnoses have modest relationships with predictive and some concurrent validators and often improperly sequence the onset of abuse versus dependence, perhaps due to insufficient emphasis on physiological features. Testing reliability, syndrome prevalence, syndrome sequencing, and concurrent and predictive validity, this study contrasted the DSM-IV with the Withdrawal-Gate Model (WGM), in which alcohol withdrawal is necessary and sufficient for the dependence diagnosis. Clinical samples of adults (baseline n = 318) and adolescents (baseline n = 214) meeting abuse or dependence were assessed for DSM-IV alcohol symptoms and external measures of problem severity and reinterviewed at 6 (adults) and 12 months (adults and adolescents). Among DSM-IV dependent cases, the WGM shifted 32% of adults and 80% of adolescents to the abuse category, making both categories more symptomatically severe, but had a negligible effect on the prevalence of total alcohol diagnoses. The WGM was more reliable than the DSM-IV and temporally sequenced abuse before dependence in a greater number of cases. The WGM was superior to the DSM-IV in concurrent and predictive validity on most measures. Future diagnostic systems may be more reliable and valid if they require evidence of withdrawal for substance dependence.

Adolescent↗

PubMed1989

Diagnostic criteria for melancholia. The comparative validity of DSM-III and DSM-III-R.

The psychometric properties and validity of the DSM-III and DSM-III-R definitions of melancholia were examined in 60 depressed inpatients. The prevalence of melancholia was significantly higher according to the DSM-III-R criteria, and the kappa-coefficient of agreement between the two definitions was .40. For both criteria sets, the internal consistencies and item-scale correlations were low. Both definitions were associated with overall symptom severity and the melancholia symptom subscale; however, only DSM-III melancholics scored higher on the nonmelancholia symptom subscale. The DSM-III-R criteria were associated with more of the predicted correlates of endogenous subtyping. According to both definitions, melancholics were characterized by less stress, greater symptom severity, and less frequent nonserious suicide attempts prior to admission. The DSM-III-R melancholic subtyping was additionally associated with a family history of antisocial personality and substance abuse, presence of a premorbid personality disorder, age, and a tendency to blame others for the depression.

Adult↗

PubMedDate not supplied

Development of a screening questionnaire for tobacco/nicotine dependence according to ICD-10, DSM-III-R, and DSM-IV.

A 10-item questionnaire (the Tobacco Dependence Screener; TDS) for screening of tobacco/nicotine dependence according to ICD-10, DSM-III-R, and DSM-IV was newly developed. The reliability and validity were assessed in three samples of smokers in Japan. A total of 58 male smokers completed the TDS and the Fagerstrom Tolerance Questionnaire (FTQ), and they were interviewed using the World Health Organization's Composite International Diagnostic Interview (Sample 1). A total of 118 male and 36 female smoking outpatients completed the TDS and the FTQ and provided a breath sample for carbon monoxide measurement (Sample 2). A total of 194 male smokers joined a health education program using a health risk appraisal (HRA) and reported their smoking status and completed the TDS 6 months after receiving the HRA results (Sample 3). The Cronbach's alpha coefficients for the TDS ranged from .74 to .81 among the samples, whereas those for the FTQ ranged from .41 to .64. Receiver operator characteristic analyses indicated that the TDS had a better screening performance for ICD-10, DSM-III-R, and DSM-IV diagnoses than did the FFQ. The TDS score significantly and positively correlated with the severity of the diagnoses, the carbon monoxide levels, number of cigarettes smoked per day, and years of smoking. The TDS score was significantly lower in those who quit smoking than in those who did not quit smoking after the HRA. It is suggested that the TDS is a reliable and useful screening questionnaire for tobacco/nicotine dependence according to ICD-10, DSM-III-R, and DSM-IV.

Adult↗

PubMed2006

Comorbidity of substance use with depression and other mental disorders: from Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) to DSM-V.

AIMS: To arrive at recommendations for addressing co-occurring psychiatric and substance use disorders in the development of the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-V) criteria. METHODS: Synthesis of findings of other papers from a consensus conference and from the literature on diagnosis and treatment of co-occurring psychiatric and substance use disorders. Most of the relevant studies examine co-occurring depression. RESULTS: The diagnosis and treatment of psychiatric syndromes that co-occur with substance use disorders has been a source of controversy, fueled in part by limitations of pre-DSM-IV nosologies. The DSM-IV scheme of classifying co-occurring disorders as primary (also referred to as independent) or substance-induced has promise in terms of good predictive validity, although pertinent longitudinal and treatment studies are limited. The substance-induced category answers the need of clinicians for a way to categorize patients with clinically significant psychiatric symptoms that occur in the setting of ongoing substance use. CONCLUSIONS: DSM-V should retain the primary (independent) and substance-induced categories. In DSM-IV these categories are broadly defined and leave much to clinical judgement. Existing data sets should be brought to bear to refine the criteria, making them more detailed with clearer anchor points and more specificity around particular substances and psychiatric syndromes. More longitudinal studies and clinical trials are also needed. Looking beyond DSM-V, co-occurring psychiatric syndromes are likely to be important in the quest for a nosology founded on pathophysiology.

Comorbidity↗

PubMed2000

Comparison of different clinical criteria (DSM-III, ADDTC, ICD-10, NINDS-AIREN, DSM-IV) for the diagnosis of vascular dementia. National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences.

BACKGROUND AND PURPOSE: The criteria for vascular dementia (VaD) include definition of the cognitive syndrome and the vascular cause. Different criteria for dementia identify different frequencies and clusters of patients. In addition, variation in defining the cause and etiology may have an effect. We compared different clinical criteria for VaD in series of patients with poststroke dementia. METHODS: The study group comprised 107 patients fulfilling the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) definition for dementia from a cohort of consecutive patients with ischemic stroke who completed a comprehensive neuropsychological test battery and MRI. The mean age (SD) of the patients was 71.4 (7.6) years. The definitions of vascular cause of VaD were those of the DSM-III (1980), Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC; 1992), International Statistical Classification of Diseases, 10th Revision (ICD-10; 1992), National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN; 1993), and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; 1994). RESULTS: The number of cases that could be classified as VaD according to the different criteria varied considerably: 36.4% (n=39) by DSM-III, 86.9% (n=93) by ADDTC, 32.7% (n=35) by NINDS-AIREN, 36.4% (n=39) by ICD-10, and 91.6% (n=98) by DSM-IV criteria. The concordance between DSM-III/ICD-10 was perfect (100%; kappa=1.0), between ICD-10/NINDS-AIREN and ADDTC/DSM-IV good to moderate (85.0% and 87. 3%; kappa=0.87 and 0.37, respectively), but otherwise poor between the other criteria. Only 31 patients fulfilled all the criteria for VaD applied. Major discriminating factors between the criteria were requirement of (1) focal neurological signs, (2) unequal distribution of deficits in higher cortical functions, and (3) evidence of relevant CVD based on brain imaging findings. CONCLUSIONS: Current criteria of VaD identify different frequencies and clusters of patients and are not interchangeable. Optimally, prospective studies with clinicopathological correlation could identify new criteria. Meanwhile, focus on more homogeneous subtypes (eg, small-vessel subcortical VaD) and detailed neuroimaging criteria could improve the diagnostics.

Aged↗

PubMed2006

From CBCL to DSM: a comparison of two methods to screen for DSM-IV diagnoses using CBCL data.

The screening efficiency of 2 methods to convert Child Behavior Checklist (CBCL) assessment data into Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) diagnoses was compared. The Machine-Aided Diagnosis (MAD) method converts CBCL input data directly into DSM-IV symptom criteria. The Achenbach System of Empirically Based Assessment (ASEBA) proceeds more indirectly and uses DSM-oriented scales. The power of the 2 methods to predict DSM-IV diagnoses obtained via administration of the structured Diagnostic Interview Schedule for Children (DISC-IV) interview in a clinical sample was examined. DISC-IV interviews and CBCL reports from parents of 44 children, 25 boys, and 19 girls, ages 6 to 17 were used. The results showed comparable levels of predictive power for the 2 methods. Both methods were able to predict DSM-IV diagnoses and therefore can be used for screening DSM-IV diagnoses.

Adolescent↗

PubMed1995

Schizophrenia in hospitalized adolescents: clinical diagnosis, DSM-III-R, DSM-IV, and ICD-10 criteria.

The DSM-III-R, DSM-IV, and ICD-10 criteria were tested in hospitalized adolescents diagnosed with schizophrenia and other psychotic disorders employing a retrospective chart review. The charts of 111 patients, ages 11 to 17 years, representing consecutive admissions to Bellevue Hospital Center over a period of 18 months were reviewed. Thirty patients had a clinical diagnosis of schizophrenia or other psychotic disorders on admission and were selected for the present study. The 30 patients were independently rediagnosed using the criteria of DSM-III-R, DSM-IV, and ICD-10. Schizophrenia was diagnosed clinically in 6 patients, 10 met DSM-III-R criteria, 9 met DSM-IV criteria, and 12 met the ICD-10 criteria. Agreement for schizophrenia was high across the diagnostic systems. The clinical diagnosis of psychotic disorder, not otherwise specified (NOS) was overinclusive. The mean number of psychotic symptoms per subject was 2.66 (range 1-6). We found no significant relationship between the frequency or type of symptoms and the age or gender of subjects.

Adolescent↗