Cross system agreement for substance use disorders: DSM-III-R, DSM-IV and ICD-10

This report presents results of a field trial of Substance Use Disorders as defined by DSM-III-R, DSM-IV (proposed) and ICD-10. Diagnoses based on the three systems were derived from interviews using the Composite International Diagnostic Interview (CIDI) in a heterogeneous sample of 521 adults drawn from clinical and community settings. Two issues are addressed: (1) cross system agreement; and (2) syndrome coherence of proposed criterion sets for Substance Dependence in each of the three systems. Findings were as follows: (1) Cross system agreement for Dependence was generally high, especially between DSM-III-R and DSM-IV. (2) Cross system agreement was lower for DSM-III-R and DSM-IV Abuse and very low for DSM-IV Abuse and ICD-10 Harmful Use. (3) Agreement varied across drug categories with lowest DSM-III-R/DSM-IV agreement for alcohol abuse and DSM-IV/ICD-10 agreement for marijuana use disorders. (4) Overall prevalence differed for the three systems with DSM-IV yielding highest rates followed by DSM-III-R and ICD-10 in that order. (5) Factor analysis of Dependence criteria showed high loadings of all items on a single factor across the three diagnostic systems and for all categories of drugs. Implications for validity of the dependence syndrome construct and for revisions in DSM-IV are discussed.     

Nosological comparisons of DSM-III-R and DSM-IV alcohol abuse and dependence in a clinical facility: comparison with the 1988 National Health Interview Survey results

The purpose of this study was to compare DSM-III-R and proposed formulations of DSM-IV diagnoses of alcohol use disorders in a clinical sample with the same assessment methods used in a large national survey previously reported. Issues included the number of symptoms required for abuse and dependence diagnoses, the effects of requiring evidence of physiological dependence to make the dependence diagnosis (Option 1 vs. Option 2), whether to require a duration criterion, and the concept of alcohol abuse. The diagnostic criteria proposed in the 1991 DSM-IV options book were the criteria investigated in this study. Concordance between DSM-III-R and DSM-IV was closest when the form of DSM-IV used was most similar to DSM-III-R. The duration criterion had much less effect on a dependence diagnosis in this clinical sample than in the general population. DSM-IV Option 2 for alcohol dependence excluded a number of cases from the dependence diagnosis who received such a diagnosis under DSM-III-R and DSM-IV Option 1. Abuse continued to function as a residual category, especially noticeable under increasingly restrictive definitions of dependence, and was rare in both the clinical and general population sample. Implications of the findings for research and other purposes are discussed.     

Construct validity of the dependence syndrome as measured by DSM-IV for different psychoactive substances

The Diagnosis of Drug Dependence in the Official Psychiatric Nomenclatures (DSM-III-R, DSM-IV, and ICD 10) are based on the Drug Dependence Syndrome construct. Although the validity and utility of the dependence syndrome has been widely documented for alcohol, the generalizability of the dependence syndrome to other psychoactive substances is still not clear. Thus, this article examines the construct validity of the drug dependence syndrome, as measured by diagnostic criteria for DSM-IV, using both internal consistency analyses and confirmatory factor analyses. Data were obtained from non-mutually exclusive groups of abusers for five drugs (alcohol, cocaine, marijuana, opioids, sedatives, stimulants) drawn from a pool of 521 subjects obtained from drug treatment, general psychiatric and community samples. As predicted by the theory, drug dependence items were found to be unidimensional and factorially distinct from measures of the consequences of substance abuse (e.g. legal problems) for all drug groups. Moreover, the drug dependence items yielded internally consistent scales that produced a distribution of scores reflecting a continuum from low to high severity of abuse for all drugs.     

DSM-III-R tobacco dependence and quitting during late adolescence

Previous studies of tobacco dependence have tended not to examine adolescent samples. In a cohort of 18-year-olds, the 12-month prevalence rate of dependence based on DSM-III-R criteria was found to be 19.3%. Cotinine levels in saliva were positively related to level of cigarette consumption but not to tobacco dependence and may not be a suitable measure of dependence. Measures of behavioral and psychological aspects of smoking supported the utility of DSM-III-R criteria for tobacco dependence among young smokers. As a large number of young smokers are dependent on tobacco. the results support the development of treatment programmes for youth that take into consideration their degree of dependence.     

DSM-IV field trials for oppositional defiant disorder and conduct disorder in children and adolescents

OBJECTIVE: The purpose of the field trials for oppositional defiant disorder and conduct disorder was to select valid diagnostic thresholds for these disorders and to compare the psychometric properties of DSM-IV criteria for oppositional defiant disorder and conduct disorder with previous DSM diagnostic formulations. METHOD: Structured diagnostic interviews, standardized clinician's validation diagnoses, and multiple measures of impairment were obtained for 440 clinic-referred children and adolescents aged 4-17 years. RESULTS: A diagnostic threshold of four symptoms of oppositional defiant disorder optimized identification of impaired children, improved agreement somewhat with the clinician's validation diagnosis, and had somewhat better test-retest agreement than DSM-III-R. In the case of conduct disorder, the optimal time window for ascertainment of symptoms was clarified. A diagnostic threshold of three symptoms of conduct disorder maximized accurate identification of impaired children and agreement with the clinician's validation diagnosis and resulted in slightly better test-retest agreement than DSM-III-R. Compared with the DSM-III-R definition, the DSM-IV definition of oppositional defiant disorder was somewhat more prevalent, but the prevalence of conduct disorder was essentially unchanged. CONCLUSIONS: DSM-IV definitions of oppositional defiant disorder and conduct disorder are somewhat better than DSM-III-R definitions in terms of internal consistency and test-retest agreement, and the validity of the DSM-IV definition of oppositional defiant disorder is slightly better than that of DSM-III-R.     

Correspondence between DSM-III-R and DSM-IV attention-deficit/hyperactivity disorder

OBJECTIVE: To evaluate the correspondence between DSM-III-R and DSM-IV definitions of attention-deficit/hyperactivity disorder (ADHD) in clinically referred children. Results of the field trials led to the hypothesis that there would be a strong correspondence between DSM-III-R and DSM-IV subtypes. METHOD: The sample consisted of all children and adolescents consecutively referred to a pediatric psychopharmacology clinic (N = 405). Children were comprehensively evaluated with structured diagnostic interviews assessing both DSM-III-R and DSM-IV ADHD. DSM-III-R symptoms were used to approximate DSM-IV subtypes. Kappa statistics and conditional probabilities were used to examine the correspondence between DSM-III-R and DSM-IV ADHD. RESULTS: Ninety-three percent of children who received a DSM-III-R diagnosis of ADHD also received a DSM-IV ADHD diagnosis. The kappa coefficient assessing the agreement between DSM-III-R and DSM-IV ADHD was .73 (z = 14.6, p < .0001). The kappa coefficient assessing the agreement between the DSM-III-R-approximated subtypes and the actual DSM-IV subtypes was .71 (z = 15, p < .0001). CONCLUSION: These results confirm previous findings and indicate that the change from DSM-III-R to DSM-IV results in minimal changes in case identification and provides support for diagnostic continuity between the two classification systems.     

The latent dimensionality of DIS/DSM-III-R nicotine dependence: exploratory analyses

Decisions on DSM-IV criteria for alcohol dependence were based in part on latent structure analyses of field survey data on alcohol problems. Analogously, to investigate the latent structure of nicotine dependence in an epidemiological sample, we carried out a dichotomous item factor analysis of DSM-III-R symptom data gathered from 394 young adults who reported a history of sustained daily smoking. Smokers and their dependence symptoms were identified by means of the NIMH Diagnostic Interview Schedule version III revised, administered to a random sample of 1007 21-30-year-olds who were members of a health maintenance organization in the Detroit area. Comparing different latent structure models using LISCOMP software with bootstrap re-sampling, followed by multiple logistic regression, we found that a two-factor model indicating a 'general dependence' and a 'failed cessation' dimension best accounted for the observed data. Current smoking status (persistent vs. past smoking) was associated with the two factors independently. Replication and additional research on construct, discriminant and convergent validity are needed.     

Fractures of the calcaneus. Part I: Anatomy, injury mechanism, and classification

From 1987 to 1994, seasonal affective disorder (SAD) has been diagnosed using the Rosenthal or DSM-III-R criteria. No major differences between them have been found, except that the DSM-III-R criteria were more stringent and difficult to implement. Little attention has been paid to differences in the criterion of the quality of improvement in summer. This study compared two groups of winter depressives characterized by complete or incomplete summer remission. Incomplete summer remission is associated with increased heterogeneity of the demographic and clinical profile of the disorder and a shift of this profile to that of classical depression. The data support clinical use of the DSM-IV criterion 'full remission' in the diagnosis of SAD.     

Leptin activates hypothalamic CART neurons projecting to the spinal cord

Interviews were conducted with 265 orthopedic and chronic pain patients, using a structured diagnostic instrument (ADDIS/SUDDS) concerning their use of analgesics. Twenty-two percent of the patients met criteria for analgesic use disorders in accordance with DSM-III-R; 18.5% fulfilled DSM-IV criteria. Dextropropoxyphene was the most common analgesic prescribed and was used by 47% of the patients who met criteria for analgesic use disorders. It is concluded that patients with chronic pain using narcotic analgesics are at considerable risk of developing analgesic use disorders. Assessment of the use of analgesics should be offered to pain patients taking narcotic drugs.     

Quick identification and localization of CpG islands in large genomic fragments by partial digestion with Hpa II and Hha I

This study examined features of patients that clinicians identified as good examples of Passive-Aggressive Personality Disorder to identify core features of the disorder and to determine which set of criteria (DSM-III-R, two definitions in the DSM-IV Options Book, or DSM-IV Negativistic) best characterized the identified patients. A national sample of licensed psychologists (N = 68) identified a patient who (based on symptoms) was a good example of Passive-Aggressive Personality Disorder. They then rated the patient on a symptom checklist composed of the Passive-Aggressive and Negativistic criteria, as well as other personality-disorder symptoms that overlap with Passive-Aggressive. Clinicians identified patients they considered exemplars for Passive-Aggressive Personality Disorder, and there was moderate consensus about their characteristic symptoms. DSM-III-R symptoms received the highest ratings, and there was little overlap with other personality disorders. Principal-component factor analysis suggested that a general pattern of passive resistance, along with a behavioral manifestation of procrastination and a second group of symptoms suggesting interpersonal difficulties, were the features of these passive-aggressive patients. More male patients were identified as good examples of the disorder, and female patients presented a more heterogeneous diagnostic picture. Implications and directions for future research are discussed, including the need to integrate research findings from the differing perspectives on personality disorders.     

FGF4 dissociates anti-tumorigenic from differentiation signals of retinoic acid in human embryonal carcinomas

OBJECTIVE: The authors previously observed an increase in striatal dopamine transmission following amphetamine challenge in 15 untreated patients with schizophrenia compared to 15 matched healthy subjects. The purpose of this study was to replicate this finding in a new cohort of schizophrenic patients and healthy subjects. METHOD: Fifteen patients with schizophrenia and 15 healthy subjects matched for age, gender, ethnicity, and parental socioeconomic status were recruited for this study. Patients fulfilled DSM-IV criteria for schizophrenia, had no history of alcohol or substance abuse or dependence, and were neuroleptic free for a minimum of 21 days. Amphetamine-induced dopamine release was assessed by the reduction in dopamine D2 receptor availability induced by an acute amphetamine challenge (0.3 mg/kg, intravenous bolus). Reduction in D2 receptor availability was measured with single photon emission computed tomography and the D2 receptor radiotracer [123I]IBZM. RESULTS: No differences were observed between patients with schizophrenia and the comparison group in D2 receptor availability at baseline. Patients with schizophrenia exhibited a significantly larger reduction in D2 receptor availability following acute amphetamine challenge than the comparison group. In this study, the effect size was smaller than in the first study. Excess dopamine release following amphetamine was associated with transient emergence or worsening of positive symptoms. CONCLUSIONS: In this new cohort of subjects the authors replicated their initial observation of a dysregulation of striatal dopamine release in schizophrenia.     

Fission yeast cut mutations revisited: control of anaphase

Alcohol Use Disorder and Associated Disabilities Interview Schedule - Alcohol/Drug-Revised (AUDADIS-A/D-R) is a fully structured, standardized and precoded instrument designed to evaluate alcohol and drug use disorders according to DSM-III-R, DSM-IV, and ICD-10 criteria. The AUDADIS-A/D-R has shown good to excellent reliability in both large clinical and general population samples, but prior to the conduct of the present study no data on the reliability of the Romanian version of the AUDADIS-A/D-R existed. The purpose of the present study was to examine the test-retest reliability of the alcohol module of the AUDADIS-A/D-R in a general population and clinical sample in Romania. The overall reliability of ICD-10 and DSM-IV abuse, harmful and dependence diagnoses, was found to be good to excellent, but was somewhat lower for abuse and harmful use diagnoses. The results are discussed in terms of the cultural applicability of the symptom items and within the context of the analysis of discrepant responses between the test and retest interviews.     

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

The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) 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 vs 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 (baselinen?=?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 mo (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 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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of use and their relationship to DSM-IV abuse and dependence of alcohol among adolescents and young adults

First use and initiation of regular alcohol use has been frequently found to start in adolescence. However, only few studies have also investigated how many adolescents proceed during ages 14-24 to harmful drinking or even develop alcohol use disorders. This paper - using the EDSP baseline sample of 3,021 community respondents from the Munich area - examines the prevalence of use, abuse and dependence and investigates the dose/disorder relationship. Alcohol abuse was reported by 9.7% of respondents and alcohol dependence by 6.2%. Men were more likely to report an alcohol disorder than women, prevalence also increased in the older age cohorts. However, even among 14- to 17-year-olds a substantial proportion of respondents report high and regular consumption rates, the occurrence of abuse and dependence criteria and even a full dependence syndrome. There is however only a moderate association between average number of standard drinks consumed with the risk of developing abuse and dependence. In light of the substantial rates among adolescents and young adults the validity of DSM-IV alcohol disorder criteria is discussed.     

Signs and symptoms of mania in pure and mixed episodes

BACKGROUND: Debate continues about the diagnosis of mixed mania and the restrictiveness of the DSM-III-R and DSM-IV criteria for Bipolar Disorder, mixed. Although awareness of dysphoric features during mania continues to grow, standard mania rating instruments do not adequately assess mixed states and there is a striking disparity between the dysphoric signs and symptoms emphasized in research studies and the commonly employed DSM criteria. METHODS: Three hundred sixteen inpatients meeting DSM-III-R criteria for Bipolar Disorder, manic or mixed, were evaluated by rating 20 signs and symptoms. The frequencies of these signs and symptoms were computed for both diagnostic subtypes and compared using chi2 statistics and conditional probability parameters. RESULTS: The most frequently noted signs and symptoms in mania are motor activation, accelerated thought process, pressured speech and decreased sleep. Although euphoric mood was present in a large portion of the cohort, irritability, dysphoric mood and mood lability were also prominent in the entire cohort. Dysphoric mood, mood lability, anxiety, guilt, suicidality, and irritability were the only symptoms significantly more common in the mixed group. In contrast, grandiosity, euphoric mood, and pressured speech were significantly more often observed in the pure manic group. Contrary to popular belief, paranoia did not differ significantly between the two groups. Suicidality was present in a non-trivial 7% of the entire cohort, including some subjects who did not meet the criteria for mixed mania. LIMITATIONS: The comparison of mixed and manic episodes requires the appropriate definition of mixed states. In the current report we use the DSM-III-R definition of Bipolar Disorder, mixed, which may be too rigid. CONCLUSIONS: The data underscore that mania is not a purely euphoric state. Substantial rates of dysphoria, lability, anxiety and irritability were noted in the "pure" manic patients, as well as in those who meet the full DSM criteria for Bipolar Disorder, mixed, suggesting, that perhaps a less restrictive definition of mixed states would be more appropriate.     

Alcohol dependence and abuse in three groups at varying familial alcoholism risk.

Three groups of young men varying in familial alcoholism risk were compared for lifetime and current Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) diagnoses. A withdrawal gate diagnostic model (WGM) requiring withdrawal for a dependence diagnosis was also evaluated. Extremely high lifetime DSM-IV diagnostic rates were found for all groups (≥78%), with the highest rate in the highest risk group. Similar group differences obtained for individual criteria or symptoms. Although lifetime diagnostic rates were similar for the WGM and DSM-IV, virtually all cases of dependence were preceded by abuse for the WGM, unlike DSM-IV. The findings underline the importance of distinguishing degrees of familial alcoholism risk. The WGM model temporal onset findings versus DSM-IV and the high lifetime diagnostic rates obtained suggest some limitations of the DSM-IV diagnoses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Field trial of the Global Assessment of Functioning Scale--Modified

OBJECTIVE: A field trial of the Global Assessment of Functioning Scale--Modified was conducted to test its construct validity. A slightly altered form of the scale, the Social and Occupational Functioning Assessment Scale, was used in DSM-IV. METHOD: Social, occupational, and clinical data on 196 subjects receiving outpatient mental health services were analyzed. RESULTS: Six significant predictors were found that accounted for 51.75% of the variation in scores on the Global Assessment of Functioning Scale--Modified. Scores were independent of axis I, axis II, and psychoactive substance dependence diagnoses from DSM-III-R. CONCLUSIONS: The construct validity of the Global Assessment of Functioning Scale--Modified and the Social and Occupational Functioning Assessment Scale is supported by these findings.     

Empirical evaluation of DSM-IV generalized anxiety disorder criteria in children and adolescents

Evaluated the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994) generalized anxiety disorder (GAD) criteria in children and adolescents. Clinic-referred children meeting criteria for DSM-IV GAD, those meeting criteria for another DSM-IV anxiety disorder, and normal children participated in a structured interview and completed self-report questionnaires. Groups were compared in terms of interview and self-report measures to examine convergent and discriminant validity. In addition, developmental differences, cross-informant symptom and syndrome agreement, and validity of parent and child report were determined. Finally, the symptoms comprising the GAD associated symptom criterion (Criterion C) were examined in terms of rate of endorsement and predictive power. Results showed that parameters of worry differentiated children with GAD from those with other anxiety disorders and controls. Developmental differences in the sample did not appear to necessitate a separate criteria set for the classification of generalized anxiety in children of this age. Symptoms from GAD Criterion C evidenced moderately high rates of endorsement and acceptable predictive power. Overall, the DSM-IV GAD criteria for children and adolescents are supported, but further evaluation is necessary before firm conclusions can be drawn.     

How should we revise diagnostic criteria for substance use disorders in the DSM-V?

This article reviews literature on the validity and performance characteristics of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) diagnostic criteria for substance use disorders (SUDs) and recommends changes in these criteria that should be considered for the next edition of the DSM (DSM-V). Substantial data indicate that DSM-IV substance abuse and substance dependence are not distinct categories and that SUD criteria are best modeled as reflecting a unidimensional continuum of substance-problem severity. The conceptually and empirically problematic substance abuse diagnosis should be abandoned in the DSM-V, with substance dependence defined by a single set of criteria. Data also indicate that various individual SUD criteria should be revised, dropped, or considered for inclusion in the DSM-V. The DSM-V should provide a framework that allows the integration of categorical and dimensional approaches to diagnosis. Important areas for further research are noted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)