DSM-III criteria for affective disorders and schizophrenia : A preliminary appraisal using family interview findings

1988 ◽  
Vol 3 (3) ◽  
pp. 159-169
Author(s):  
H.G. Pope ◽  
B.M. Cohen ◽  
J.F. Lipinski ◽  
D. Yurgelun-Todd
Keyword(s):  
Bipolar Disorder ◽  
Affective Disorder ◽  
Schizoaffective Disorder ◽  
Psychotic Disorders ◽  
Diagnostic Interview ◽  
Diagnostic Categories ◽  
Family Interview ◽  
Small Test ◽  
Test Retest Reliability ◽  
Interview Studies

SummaryWe performed a blind family interview study of 226 first-degree relatives of 63 probands meeting DSM-III criteria for schizophrenia, schizoaffective disorder, and bipolar disorder, as diagnosed by the National Institute ot Mental Health Diagnostic Interview Schedule (DIS). A small test-retest reliability study demonstrated good agreement between the proband interviewer and the principal family interviewer for the major diagnostic categories of psychotic disorders. Excellent compliance was obtained, with 85% of living relatives interviewed personally.Three principal findings emerged front the study. First, as expected, bipolar disorder, as defined by DSM-III, displayed a strong familial comportent, comparable to that found by many studies using criteria other than those of DSM-III. Second, patients meeting DSM-III criteria for schizophrenia and schizoaffective disorder displayed a low familial prevalence of schizophrenia. Although initially suprising, this finding is in agreement with the results of several other recent lantily studies of schizophrenia. Upon comparing our results with those of other recent family studies of schizophrenia, it appears that the familial component in schizophrenia tnay be less than was estimated by earlier studies using older and “broader” definitions of schizophrenia.Third, we found that patients meeting DSM-III criteria for schizophrenia appeared genetically heterogeneous. Those who had displayed a superimposed full affective syndrome at some tinte in the course of their illness, together with those probands meeting DSM-III criteria for schizoaffective disorder, displayed a high familial prevalence of major affective disorder, similar to that found in the families of the bipolar probands. On the other hand, “pure” DSM-III schizophrenie probands, who had never experienced a superimposed full affective syndrome, displayed a low familial prevalence of major affective disorder, similar to that found in the general population. These findings favor the possibility that probands meeting DSM-III criteria for schizophrenia, but displaying a superimposed full affective syndrome, may in sonie cases have a disorder genetically relatcd to major affective disorder.Further prospective family interview studies, using DSM-III criteria and larger samples, will be necessary to test these preliminary impressions.

Diagnostic accuracy and confusability analyses: an application to the Diagnostic Interview for Genetic Studies

1996 ◽  
Vol 26 (2) ◽  
pp. 401-410 ◽  
Author(s):  
S. V. Faraone ◽  
M. Blehar ◽  
J. Pepple ◽  
S. O. Moldin ◽  
J. Norton ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Diagnostic Accuracy ◽  
Schizoaffective Disorder ◽  
Diagnostic Interview ◽  
Diagnostic Systems ◽  
Psychiatric Interview ◽  
Genetic Studies ◽  
Diagnostic Categories ◽  
Latent Structures ◽  
Low Sensitivity

SynopsisThe dominant, contemporary paradigm for developing and refining diagnoses relies heavily on assessing reliability with kappa coefficients and virtually ignores a core component of psychometric practice: the theory of latent structures. This article describes a psychometric approach to psychiatric nosology that emphasizes the diagnostic accuracy and confusability of diagnostic categories. We apply these methods to the Diagnostic Interview for Genetic Studies (DIGS), a structured psychiatric interview designed by the NIMH Genetics Initiative for genetic studies of schizophrenia and bipolar disorder. Our results show that sensitivity and specificity were excellent for both DSM-III-R and RDC diagnoses of major depression, bipolar disorder, and schizophrenia. In contrast, diagnostic accuracy was substantially lower for subtypes of schizoaffective disorder – especially for the DSM-III-R definitions. Both the bipolar and depressed subtypes of DSM-III-R schizoaffective disorder had excellent specificity but poor sensitivity. The RDC definitions also had excellent specificity but were more sensitive than the DSM-III-R schizoaffective diagnoses. The source of low sensitivity for schizoaffective subtypes differed for the two diagnostic systems. For RDC criteria, the schizoaffective subtypes were frequently confused with one another; they were less frequently confused with other diagnoses. In contrast, the DSM-III-R subtypes were often confused with schizophrenia, but not with each other.

P01-200-Validation of the french version of the affective disorder evaluation (ADE)

2011 ◽  
Vol 26 (S2) ◽  
pp. 201-201
Author(s):  
C. Delmas ◽  
V. Bourgeois ◽  
S. Haouzir ◽  
F. Bretel ◽  
D. Campion ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Affective Disorder ◽  
Rating Scales ◽  
Age At Onset ◽  
Structured Interview ◽  
Diagnostic Interview ◽  
Panic Attacks ◽  
French Version ◽  
Compulsive Disorder ◽  
Bipolar Patients

ObjectiveDespite the number of rating scales for mood disorder and semi-structured interview in psychiatry, they are few evaluations focused on bipolar disorder. Here, we report the validation of the French version of the ADE used in STEP-BD (Systematic Treatment Enhancement Program for Bipolar Disorder) studies.MethodA total of 63 bipolar patients completed the ADE and French version of the DIGS (Diagnostic Interview for Genetic Studies). We compared the results between the two evaluations.ResultsThere was a very good concordance between the two interview for the diagnosis of the type of bipolar diagnosis (κ = 1) and non-significative difference between the age at onset. The concordance coefficient was weak for addictions: alcohol (κ = 0.22) and cannabis (κ = 0.16), for anxiety disorder: panic attacks (κ = 0.35), phobia (κ = 0.36), obsessive-compulsive disorder (κ = 0) and anorexia (κ = 0.04), but stronger for psychosis: delusion (κ = 0.78), hallucinations (κ = 0.69), suicidal attempts (κ = 0.97), violence (κ = 0.47) and bulimia (κ = 0.47).ConclusionsThe affective disorder evaluation seems to be a useful instrument in clinical practice and in psychopharmacological studies, but not when the diagnosis of comorbities is necessary.

scholarly journals T82. THE IMPACT OF SMOKING ON LIFE EXPECTANCY IN PSYCHOTIC DISORDERS, AN ELECTRONIC CASE REGISTER COHORT STUDY

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S263-S263
Author(s):  
Edward Chesney ◽  
Deborah Robson ◽  
Rashmi Patel ◽  
Hitesh Shetty ◽  
Sol Richardson ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Affective Disorder ◽  
Schizoaffective Disorder ◽  
Psychotic Disorders ◽  
Smoking Status ◽  
Bipolar Affective Disorder ◽  
Case Register ◽  
Risk Of Death ◽  
Life Expectancy At Birth ◽  
The Impact

Abstract Background Schizophrenia, schizoaffective disorder and bipolar affective disorder are associated with a life expectancy at birth that is 10–20 years shorter than in the general population. The prevalence of cigarette smoking in people with these disorders is very high, but the extent to which this accounts for differences in mortality is unclear. We addressed this issue by examining the effect of smoking on life expectancy and survival in a large electronic healthcare database of patients receiving secondary mental healthcare in South East London. Methods Data on all patients with a diagnosis of schizophrenia, schizoaffective disorder or bipolar affective disorder from 1st January 2007 to 31st December 2018 was obtained. Smoking status was determined using unstructured text data extracted from electronic health records. Chiang’s method of abridged life tables was used to calculate estimates of life expectancy at birth according to gender and most commonly recorded smoking status. Cox proportional hazards models were used to estimate mortality risk and adjusted for a broad range of demographic and clinical variables. Results 21,588 patients were included in the study of which 20,155 (93.4%) were classified as either smokers (16,717 [77.4%]) or non-smokers (3,438 (15.9%]). 2,434 (11.3%) participants died by the end of the observation period. In female patients, life expectancy at birth was 67.6 years in current smokers (95% CI: 66.4 to 68.8) and 74.9 years in non-smokers (95% CI: 72.8 to 77.0). In male patients, life expectancy at birth was 63.5 years in current smokers (95% CI: 62.5 to 64.5) and 68.5 years in non-smokers (95% CI: 64.4 to 72.6). Adjusted survival models showed that current smoking was associated with an increased risk of death, in both females (aHR = 1.42; 95% CI: 1.21–1.66) and males (aHR = 1.49; 95% CI: 1.25–1.79). Discussion Smoking may account for a substantial proportion of the reduced life expectancy in patients with psychotic disorders. Interventions to reduce tobacco smoking in patients with psychosis may therefore improve life expectancy in this group.

scholarly journals Recent findings in bipolar affective disorder

2004 ◽  
Vol 34 (5) ◽  
pp. 767-776 ◽  
Author(s):  
PAUL BEBBINGTON
Keyword(s):  
Bipolar Disorder ◽  
Affective Disorder ◽  
Psychotic Disorders ◽  
Attempted Suicide ◽  
Bipolar Affective Disorder ◽  
Unipolar Depression ◽  
Natural Mortality ◽  
Affective Psychosis ◽  
Great Excess

Goodwin (2000) famously argued that bipolar disorder was the Cinderella of psychiatry. It certainly should not be: there is no doubt of the anguish caused by the condition, in particular the excess of natural mortality and the great excess of death by suicide (Ösby et al. 2001). In this issue, Mitchell et al. (2004) report that 26% of their cases of bipolar disorder had attempted suicide at some point. This reflects the sheer persistence of personal suffering: Judd and colleagues (2002, 2003) demonstrated in a long and detailed follow-up that patients with bipolar disorder were symptomatic at least half the time. The Australian National Survey of Psychotic Disorders found levels of disability in affective psychosis equal to those of schizophrenia (Jablensky et al. 2000), and bipolar cases are more likely to score highly on measures of disability than unipolar cases (Mitchell et al. 2004). People with bipolar disorder are more likely to be single, widowed or divorced than both the general populace and those with unipolar depression (Mitchell et al. 2004).

The Occurrence of Secondary Affective Disorder in an In-patient Population with Severe and Recurrent Affective Disorder

1984 ◽  
Vol 144 (6) ◽  
pp. 630-635 ◽  
Author(s):  
Harvey C. Stancer ◽  
Emmanuel Persad ◽  
Thecla Jorna ◽  
Christine Flood ◽  
Diane K. Wagener
Keyword(s):  
Bipolar Disorder ◽  
Psychiatric Disorder ◽  
Affective Disorder ◽  
Affective Disorders ◽  
Patient Population ◽  
Clinical Symptoms ◽  
Age Of Onset ◽  
Diagnostic Interview ◽  
Treatment Resistant ◽  
Previous Assumption

SummaryOne hundred and eighty nine consecutive in-patients with treatment-resistant affective disorder were administered the Renard Diagnostic Interview to determine whether the 45 with secondary affective disorder (SAD) differed from the 144 with primary affective disorder (PAD). The SAD group, including 15 subjects with bipolar disorder, had an earlier mean age of onset of depression and contained more unmarried individuals. The total secondary group could not usefully be differentiated by assessment of clinical symptoms or discriminating analysis of social and clinical variables. While the present study of a severely depressed population does not lend itself to generalisability, this combined sample does have characteristics of patients used in biological investigations. No significant inter-group discrimination was found to support a previous assumption that identification of a prior psychiatric disorder provides the most suitable mechanism for selecting a population for research in affective disorders.

scholarly journals Do the Trajectories of Bipolar Disorder and Schizophrenia Follow a Universal Staging Model?

2016 ◽  
Vol 62 (2) ◽  
pp. 115-122 ◽  
Author(s):  
Anne Duffy ◽  
Gin S. Malhi ◽  
Paul Grof
Keyword(s):  
Bipolar Disorder ◽  
Psychiatric Disorders ◽  
Psychotic Disorders ◽  
Risk Indicators ◽  
Empirical Literature ◽  
Future Research ◽  
Diagnostic Categories ◽  
Staging Model ◽  
Robust Evidence ◽  
Illness Progression

Objective: The purpose of this study is to address the question of whether a universal staging model of severe psychiatric disorders is a viable direction for future research by examining the extant literature. Method: A narrative review was conducted of the relevant historical, conceptual, and empirical literature pertaining to the clinical trajectory of bipolar disorder and schizophrenia and issues relevant to staging. Results: There is substantive evidence that classic recurrent bipolar disorder is separable from schizophrenia on the basis of family history, developmental and clinical course, treatment response, and neurobiological findings. However, because of the intrinsic heterogeneity of diagnostic categories that has been amplified by recent changes in psychiatric taxonomy, key distinctions between the groups have become obfuscated. While mapping risk and illness markers to emerging psychopathology is a logical approach and may be of value for some psychiatric disorders and/or their clinical subtypes, robust evidence supporting identifiable stages per se is still lacking. Presently, even rudimentary stages such as prodromes cannot be meaningfully applied across different disorders and no commonalities can be found for the basis of universal staging. Conclusions: Advances in the prediction of risk, accurate early illness detection, and tailored intervention will require mapping biomarkers and other risk indicators to reliable clinical phases of illness progression. Given the capricious nature of mood and psychotic disorders, this task is likely to yield success only if conducted in narrowly defined subgroups of individuals at high risk for specific illnesses. This approach is diametrically opposite to that being promulgated by proponents of a universal staging model.

scholarly journals Genetic utility of broadly defined bipolar schizoaffective disorder as a diagnostic concept

2009 ◽  
Vol 195 (1) ◽  
pp. 23-29 ◽  
Author(s):  
M. L. Hamshere ◽  
E. K. Green ◽  
I. R. Jones ◽  
L. Jones ◽  
V. Moskvina ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Schizoaffective Disorder ◽  
Case Control ◽  
Data Set ◽  
Bipolar Ii Disorder ◽  
Diagnostic Categories ◽  
Genome Wide ◽  
Bipolar Ii ◽  
Bipolar Type ◽  
Association Data

BackgroundPsychiatric phenotypes are currently defined according to sets of descriptive criteria. Although many of these phenotypes are heritable, it would be useful to know whether any of the various diagnostic categories in current use identify cases that are particularly helpful for biological–genetic research.AimsTo use genome-wide genetic association data to explore the relative genetic utility of seven different descriptive operational diagnostic categories relevant to bipolar illness within a large UK case–control bipolar disorder sample.MethodWe analysed our previously published Wellcome Trust Case Control Consortium (WTCCC) bipolar disorder genome-wide association data-set, comprising 1868 individuals with bipolar disorder and 2938 controls genotyped for 276 122 single nucleotide polymorphisms (SNPs) that met stringent criteria for genotype quality. For each SNP we performed a test of association (bipolar disorder group v. control group) and used the number of associated independent SNPs statistically significant at P<0.00001 as a metric for the overall genetic signal in the sample. We next compared this metric with that obtained using each of seven diagnostic subsets of the group with bipolar disorder: Research Diagnostic Criteria (RDC): bipolar I disorder; manic disorder; bipolar II disorder; schizoaffective disorder, bipolar type; DSM–IV: bipolar I disorder; bipolar II disorder; schizoaffective disorder, bipolar type.ResultsThe RDC schizoaffective disorder, bipolar type (v. controls) stood out from the other diagnostic subsets as having a significant excess of independent association signals (P<0.003) compared with that expected in samples of the same size selected randomly from the total bipolar disorder group data-set. The strongest association in this subset of participants with bipolar disorder was at rs4818065 (P = 2.42 × 10–7). Biological systems implicated included gamma amniobutyric acid (GABA)A receptors. Genes having at least one associated polymorphism at P<10–4 included B3GALTS, A2BP1, GABRB1, AUTS2, BSN, PTPRG, GIRK2 and CDH12.ConclusionsOur findings show that individuals with broadly defined bipolar schizoaffective features have either a particularly strong genetic contribution or that, as a group, are genetically more homogeneous than the other phenotypes tested. The results point to the importance of using diagnostic approaches that recognise this group of individuals. Our approach can be applied to similar data-sets for other psychiatric and non-psychiatric phenotypes.

scholarly journals Diagnostic Stability of Primary Psychotic Disorders in a Research Sample

2021 ◽  
Vol 12 ◽  
Author(s):  
Andrea J. Wood ◽  
Amber R. Carroll ◽  
Ann K. Shinn ◽  
Dost Ongur ◽  
Kathryn E. Lewandowski
Keyword(s):  
Bipolar Disorder ◽  
Schizoaffective Disorder ◽  
Psychotic Disorders ◽  
Clinical Care ◽  
Total Sample ◽  
Initial Diagnosis ◽  
Schizophreniform Disorder ◽  
Change Rate ◽  
Diagnostic Stability ◽  
Not Otherwise Specified

Psychiatric diagnosis is often treated as a stable construct both clinically and in research; however, some evidence suggests that diagnostic change may be common, which may impact research validity and clinical care. In the present study we examined diagnostic stability in individuals with psychosis over time. Participants with a diagnosis of any psychotic disorder (n = 142) were assessed at two timepoints using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders. We found a 25.4% diagnostic change rate across the total sample. People with an initial diagnosis of psychosis not otherwise specified and schizophreniform disorder had the highest rates of change, followed by those with schizophrenia and schizoaffective disorder; people with bipolar disorder had the lowest change rate. Most participants with an unstable initial diagnosis of schizophrenia, schizophreniform disorder, bipolar disorder, or psychosis not otherwise specified converted to a final diagnosis of schizoaffective disorder. Participants with an unstable initial diagnosis of schizoaffective disorder most frequently converted to a diagnosis of schizophrenia. Our findings suggest that diagnostic change is relatively common, occurring in approximately a quarter of patients. People with an initial diagnosis of schizophrenia-spectrum disorder were more likely to have a diagnostic change, suggesting a natural stability of some diagnoses more so than others.

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