scholarly journals Simulation study to demonstrate biases created by diagnostic criteria of mental illnesses: major depressive episodes, dysthymia, and manic episodes

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e037022
Author(s):  
Yi-Sheng Chao ◽  
Kuan-Fu Lin ◽  
Chao-Jung Wu ◽  
Hsing-Chien Wu ◽  
Hui-Ting Hsu ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Mental Illnesses ◽  
Dysthymic Disorder ◽  
Prevalence Rates ◽  
Real World Data ◽  
Major Depressive ◽  
Data Censoring ◽  
Intermediate Variables ◽  
Major Depressive Episodes ◽  
Depressive Episodes

ObjectivesComposite diagnostic criteria alone are likely to create and introduce biases into diagnoses that subsequently have poor relationships with input symptoms. This study aims to understand the relationships between the diagnoses and the input symptoms, as well as the magnitudes of biases created by diagnostic criteria and introduced into the diagnoses of mental illnesses with large disease burdens (major depressive episodes, dysthymic disorder, and manic episodes).SettingsGeneral psychiatric care.ParticipantsWithout real-world data available to the public, 100 000 subjects were simulated and the input symptoms were assigned based on the assumed prevalence rates (0.05, 0.1, 0.3, 0.5 and 0.7) and correlations between symptoms (0, 0.1, 0.4, 0.7 and 0.9). The input symptoms were extracted from the diagnostic criteria. The diagnostic criteria were transformed into mathematical equations to demonstrate the sources of biases and convert the input symptoms into diagnoses.Primary and secondary outcomesThe relationships between the input symptoms and diagnoses were interpreted using forward stepwise linear regressions. Biases due to data censoring or categorisation introduced into the intermediate variables, and the three diagnoses were measured.ResultsThe prevalence rates of the diagnoses were lower than those of the input symptoms and proportional to the assumed prevalence rates and the correlations between the input symptoms. Certain input or bias variables consistently explained the diagnoses better than the others. Except for 0 correlations and 0.7 prevalence rates of the input symptoms for the diagnosis of dysthymic disorder, the input symptoms could not fully explain the diagnoses.ConclusionsThere are biases created due to composite diagnostic criteria and introduced into the diagnoses. The design of the diagnostic criteria determines the prevalence of the diagnoses and the relationships between the input symptoms, the diagnoses, and the biases. The importance of the input symptoms has been distorted largely by the diagnostic criteria.

Early- versus late-onset dysthymic disorder: comparison in out-patients with superimposed major depressive episodes

1999 ◽  
Vol 52 (1-3) ◽  
pp. 187-196 ◽  
Author(s):  
Daniel N Klein ◽  
Alan F Schatzberg ◽  
James P McCullough ◽  
Martin B Keller ◽  
Frank Dowling ◽  
...  
Keyword(s):  
Late Onset ◽  
Dysthymic Disorder ◽  
Major Depressive ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Lifetime and Twelve-Month Prevalence Rates of Major Depressive Episodes and Dysthymia Among Chinese Americans in Los Angeles

1998 ◽  
Vol 155 (10) ◽  
pp. 1407-1414 ◽  
Author(s):  
David T. Takeuchi ◽  
Rita Chi-Ying Chung ◽  
Keh-Ming Lin ◽  
Haikang Shen ◽  
Karen Kurasaki ◽  
...  
Keyword(s):  
Los Angeles ◽  
Chinese Americans ◽  
Prevalence Rates ◽  
Major Depressive ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Suicidal Attempts in Primary Care: Prevalence and Correlates in a Tunisian Area

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
Y. El Kissi ◽  
G. Amara ◽  
S. Bannour ◽  
S. Ben Nasr ◽  
B. Ben Hadj Ali
Keyword(s):  
Primary Care ◽  
Depressive Disorders ◽  
Composite International Diagnostic Interview ◽  
Female Gender ◽  
Dysthymic Disorder ◽  
Major Depressive ◽  
Primary Care Population ◽  
Suicidal Attempts ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Aims:This study aimed to determine prevalence and correlates of suicidal attempts in an adult primary care population in Sousse (Tunisia).Method:Sampling followed a stratified multistage probability cluster design from witch a representative sample of adult primary care population of Sousse was obtained. The sample was composed of 1249 subjects aged 18 years or more. Subjects were interviewed by trained clinicians using the Tunisian version of Composite International Diagnostic Interview 2.1.General and clinical characteristics of subjects who had reported previous suicidal attempts were compared with those of the remainder using t test and Chi-2 test.Results:Mean age in our sample was 43.4 ± 17.62 years, with female gender (70.9%) and urban residency (67.8%) predominance. 62.3% of participants were married, 27.3% celibates and 10.4% divorced or widowed. 68.4% of them had low educational level and 70% were out of work during the last 12 months. Suicidal attempts were found in 2.9% of participants. They were correlated to less than 40 years age (p=0.036) and to the diagnosis of major depressive episodes (p< 10-3), recurrent major depressive disorder (p=0.005) and dysthymic disorder (p< 10-3). Among major depressive episodes, only severe ones were associated to higher prevalence of suicidal attempts (p< 10-3).Conclusion:Prevalence of suicidal attempts in Sousse primary care population was 2.9%. It was correlated to low age and to depressive disorders.

scholarly journals Major depressive disorder: reification and (maybe) rheostasis

2015 ◽  
Vol 24 (6) ◽  
pp. 473-475 ◽  
Author(s):  
S. B. Patten
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Diagnostic Criteria ◽  
Major Depressive ◽  
Clinical Syndromes ◽  
Prediction Of Prognosis ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Selection Of

The heterogeneity of clinical syndromes subsumed by diagnostic criteria for major depressive disorder (MDD) is regarded by some as a reason to abandon or modify the criteria. However, heterogeneity may be unavoidable because of the biopsychosocial complexity of depression. MDD may be characterised by complexities that cannot be distilled down to any brief set of diagnostic criteria. Psychiatrists and psychiatric epidemiologists may need to revise their expectations of this diagnosis in order to avoid over-estimating its ability to guide the selection of treatments and prediction of prognosis. An opposing perspective is that of reification, in which the diagnosis is viewed as being more real than it really is. The concept of rheostasis may help to explain some features of this condition, such as why major depressive episodes sometimes seem understandable or even adaptive (e.g. in the context of bereavement) whereas at other times such episodes are inexplicable and maladaptive.

scholarly journals A Controlled Study of Major Depressive Episodes in Long-Term Childhood, Adolescence, and Young Adult Cancer Survivors (The NOR-CAYACS Study)

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5800
Author(s):  
Alv A. Dahl ◽  
Cecilie Essholt Kiserud ◽  
Sophie D. Fosså ◽  
Jon Håvard Loge ◽  
Kristin Valborg Reinertsen ◽  
...  
Keyword(s):  
Young Adult ◽  
Cancer Survivors ◽  
Controlled Study ◽  
Prevalence Rates ◽  
Major Depressive ◽  
Adult Cancer Survivors ◽  
Young Adult Cancer ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Background: A major depressive episode (MDE) is typically self-rated by screening forms identifying probable MDE (pMDE). This population-based cross-sectional questionnaire study examined the prevalence rates of pMDE identified by the PHQ-9 screener in long-term survivors of childhood and adolescence (CACSs) and young adult cancer (YACSs) and a normative sample (NORMs). Methods: Data from 488 CACSs, 1202 YACSs, and 1453 NORMs were analyzed, and pMDE was defined both by cut-off ≥10 on the total PHQ-9 score and by an algorithm. Results: The prevalence rates of pMDE among CACSs were 21.5%, 16.6% in YACSs, and 9.2% among NORMs using the cut-off definition. With the algorithm, the prevalence rates of pMDE were 8.0% among CACSs, 8.1% among YACSs, and 3.9% among NORMs. Independent of definition, CACSs and YACSs had significantly increased prevalence rates of pMDE compared to NORMs. Psychosocial factors and self-rated health were significantly associated with both definitions of pMDE in multivariable analyses, while survivor groups, cancer types, and adverse events were not. Conclusion: Since pMDE has negative health consequences and is amenable to treatment, healthcare providers should be attentive and screen for pMDE in young cancer survivors. For PHQ-9, the preferred type of definition of pMDE should be determined.

What is the role of conventional antidepressants in the treatment of major depressive episodes with Mixed Features Specifier?

CNS Spectrums ◽  
2016 ◽  
Vol 22 (2) ◽  
pp. 120-125 ◽  
Author(s):  
Gianni L. Faedda ◽  
Ciro Marangoni
Keyword(s):  
Clinical Trials ◽  
Unipolar Depression ◽  
Preliminary Evidence ◽  
Major Depressive ◽  
Pharmacological Management ◽  
Diagnostic And Statistical Manual ◽  
Mixed Features ◽  
Effective Use ◽  
Major Depressive Episodes ◽  
Depressive Episodes

The newly introduced Mixed Features Specifier of Major Depressive Episode and Disorder (MDE/MDD) is especially challenging in terms of pharmacological management. Prior to the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the symptoms of the mixed features specifier were intradepressive hypomanic symptoms, always and only associated with bipolar disorder (BD).Intradepressive hypomanic symptoms, mostly referred to as depressive mixed states (DMX), have been poorly characterized, and their treatment offers significant challenges. To understand the diagnostic context of DMX, we trace the nosological changes and collocation of intradepressive hypomanic symptoms, and examine diagnostic and prognostic implications of such mixed features.One of the reasons so little is known about the treatment of DMX is that depressed patients with rapid cycling, substance abuse disorder, and suicidal ideation/attempts are routinely excluded from clinical trials of antidepressants. The exclusion of DMX patients from clinical trials has prevented an assessment of the safety and tolerability of short- and long-term use of antidepressants. Therefore, the generalization of data obtained in clinical trials for unipolar depression to patients with intradepressive hypomanic features is inappropriate and methodologically flawed.A selective review of the literature shows that antidepressants alone have limited efficacy in DMX, but they have the potential to induce, maintain, or worsen mixed features during depressive episodes in BD. On the other hand, preliminary evidence supports the effective use of some atypical antipsychotics in the treatment of DMX.

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