Psychopathology: description and classification

The prospective effect of purpose in life on gambling disorder and psychological flourishing among university students

BACKGROUND AND AIMS

Gambling disorder (GD) is a mental disorder with a relatively higher prevalence in university students compared to adolescents and adults. Its reciprocity with mental being indicators, such as psychological flourishing, would be expected, but prior to this study had not yet been empirically examined. In addition, the predictive value of purpose in life (PIL) on university students' GD and psychological flourishing also remained unknown. This 1-year longitudinal study was the first to test the potential bidirectional relationships among PIL, self-reported GD symptoms, and psychological flourishing.

METHODS

In this study, a total of 283 university students (39.6% females; age = 18-27 years, M = 20.47, SD = 1.15) completed an anonymous questionnaire at both baseline and a year later in a follow-up study.

RESULTS

The results of our cross-lagged analysis did not show the hypothesized reciprocity between GD symptoms and psychological flourishing (P > 0.05). However, PIL significantly predicted fewer GD symptoms (β = -0.23, P < 0.001) and higher levels of psychological flourishing (β = 0.30, P < 0.001) in the follow-up study. Moreover, psychological flourishing predicted PIL a year later.

CONCLUSION

The findings demonstrate the potential efficacy of purpose/meaning oriented interventions in gambling prevention and in well-being promotion programs.

Symptom diagnostics based on clinical records: a tool for scientific research in child psychiatry?

INTRODUCTION

Child psychiatric diagnoses are generally based on a clinical examination and not on standardized questionnaires. The present study assessed whether symptom diagnostics based on clinical records facilitates the use of non-standardized clinical material for research.

METHOD

Six hundred and eighty-five children, referred to a third level child psychiatric centre in the Netherlands, were, after extensive multidisciplinary examination, classified according to the multi-axial classification scheme for psychiatric disorders in childhood and adolescence (MAC-ICD-9). By two raters 44 behavioural symptoms were scored based on the clinical records of these children. Interrater agreement on symptoms in 50 records was performed. Principal components analysis on symptom scores of all children was performed; factor scores were related with MAC-ICD-9 classifications.

RESULTS

Interrater reliability for behavioural symptoms was excellent (kappa = 0.88). Many children with psychiatric problems suffer from a large number of behavioural symptoms. Factor scores of the symptoms revealed recognizable and well interpretable entities and indicated overlap in symptomatology and comorbidity.

CONCLUSION

A symptom-based diagnostic approach based on extensive clinical patient files may provide a special dimension to improve the reliability of psychiatric classification.

Weakness of will, akrasia, and the neuropsychiatry of decision making: an interdisciplinary perspective

This article focuses on both daily forms of weakness of will as discussed in the philosophical debate (usually referred to as akrasia) and psychopathological phenomena as impairments of decision making. We argue that both descriptions of dysfunctional decision making can be organized within a common theoretical framework that divides the decision making process in three different stages: option generation, option selection, and action initiation. We first discuss our theoretical framework (building on existing models of decision-making stages), focusing on option generation as an aspect that has been neglected by previous models. In the main body of this article, we review how both philosophy and neuropsychiatry have provided accounts of dysfunction in each decision-making stage, as well as where these accounts can be integrated. Also, the neural underpinnings of dysfunction in the three different stages are discussed. We conclude by discussing advantages and limitations of our integrative approach.

ORIGINAL RESEARCH—EJACULATORY DISORDERS: Changing Paradigms from a Historical DSM‐III and DSM‐IV View Toward an Evidence‐Based Definition of Premature Ejaculation. Part I—Validity of DSM‐IV‐TR

BACKGROUND

In former days, information obtained from randomized well-controlled clinical trials and epidemiological studies on premature ejaculation (PE) was not available, thereby hampering the efforts of the consecutive DSM Work Groups on Sexual Disorders to formulate an evidence-based definition of PE. The current DSM-IV-TR definition of PE is still nonevidence based. In addition, the requirement that persistent self-perceived PE, distress, and interpersonal difficulties, in absence of a quantified ejaculation time, are necessary to establish the diagnosis remains disputable.

AIM

To investigate the validity and reliability of DSM and ICD diagnosis of premature ejaculation.

METHODS

The historical development of DSM and ICD classification of mental disorders is critically reviewed, and two studies using the DSM-IV-TR definition of PE is critically reanalyzed.

RESULTS

Reanalysis of two studies using the DSM-IV-TR definition of PE has shown that DSM-diagnosed PE can be accompanied by long intravaginal ejaculation latency time (IELT) values. The reanalysis revealed a low positive predictive value for the DSM-IV-TR definition when used as a diagnostic test. A similar situation pertains to the American Urological Association (AUA) definition of PE, which is practically a copy of the DSM-IV-TR definition.

CONCLUSION

It should be emphasized that any evidence-based definition of PE needs objectively collected patient-reported outcome (PRO) data from epidemiological studies, as well as reproducible quantifications of the IELT.

Triagem em saúde mental infantil

Este estudo foi conduzido para comparar os resultados de um procedimento grupal aberto e um procedimento individual estruturado para avaliação do comportamento da criança conforme o relato materno. Participaram deste estudo 29 mães que buscavam atendimento para seus filhos em uma unidade de saúde mental infanto-juvenil. As primeiras 15 mães que procuraram o serviço foram entrevistadas individualmente conforme um roteiro estruturado desenvolvido a partir do CBCL e depois foram entrevistadas em grupo, em formato aberto. As outras 14 mães participaram da entrevista grupal aberta e em seguida participaram da entrevista individual estruturada. Os resultados das entrevistas foram comparados tomando como referência as 67 categorias comportamentais identificadas a partir do roteiro individual e quatro variáveis contextuais relatadas nos dois procedimentos. Os resultados mostram que um número substancialmente maior de comportamentos-problema foi identificado através de entrevista individual estruturada do que através de entrevista grupal aberta realizada com os mesmos informantes. É possível que o uso de um roteiro estruturado em entrevistas grupais possa oferecer mais informações com otimização do tempo de avaliação.

Externalizing psychopathology in adulthood: a dimensional-spectrum conceptualization and its implications for DSM-V

Mental disorders involving antisocial behavior and substance use are genetically linked and vary continuously. The authors present a review and integrative conceptualization of these observations in terms of a dimensional and hierarchically organized externalizing spectrum. As a foundation for this conceptualization, the authors introduce a quantitative, model-based approach to comparing categorical and continuous conceptions of psychopathology and apply this approach in an empirical study of patterns of comorbidity among externalizing disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders. The authors present evidence that comorbidity among externalizing disorders is best modeled by an underlying normally distributed continuum of risk for multiple disorders within the externalizing spectrum. The authors conclude by discussing implications of the externalizing spectrum conceptualization for classification of disorders in the upcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders.

Comparing the validity of clinician-generated diagnosis of conduct disorder to the diagnostic interview schedule for children

Clinician diagnoses of conduct disorder (CD) were compared to the diagnoses of CD generated by a structured interview against an observed criterion. Participants were 534 youth from a large residential program in the Midwest for delinquent youth. Rates of in-program CD behaviors were gathered from staff observations of the youth over a 9-month time period. Youth diagnosed with CD by the Diagnostic Interview Schedule for Children (DISC) displayed significantly more CD behaviors in the first 6 months of treatment compared to both youth without an externalizing disorder and youth diagnosed with CD by a clinician. Youth diagnosed with CD by a clinician had rates of CD identical to youth without an externalizing disorder. Clinicians may have weighted contextual information more heavily, as this group was significantly more likely to have an arrest record. Results support the use of structured interviews and provide evidence that typical clinician diagnoses may lack adequate validity.

A hierarchy of gambling disorders in the community

AIMS

To help refine the definition and diagnosis of gambling disorders, we investigated the distribution among US gamblers of the 10 DSM-IV criteria for Pathological Gambling.

DESIGN

We drew data from two stratified random surveys (n = 2417, n= 530) of gambling behavior and consequences among community-based samples of US adults. A fully structured questionnaire, administered by trained lay interviewers, screened for the life-time prevalence of problem and Pathological Gambling. Per DSM-IV definitions, anyone meeting five or more of 10 itemized criteria was considered a pathological gambler. We analyzed these criteria among all gamblers who met one or more criteria (n = 399).

FINDINGS

Most gamblers who met only one or two criteria reported 'chasing their losses'. At subclinical levels (three to four criteria), gamblers also reported elevated rates of gambling-related fantasy: lying, gambling to escape and preoccupation. Pathological gamblers with five to seven criteria reported marked elevations of loss of control, withdrawal symptoms and tolerance (internalizing dimensions of dependence); risking their social relationships and needing to be bailed out financially (externalizing dimensions). Most of the highest-level pathological gamblers (eight to 10 criteria) reported committing illegal acts to support gambling.

CONCLUSION

Dependence in a biobehavioral sense appears to be a hallmark of Pathological Gambling, but it marks only one threshold in a qualitative hierarchy of disorders beginning with a common subclinical behavior, 'chasing'. Epidemiological assessments and future DSM revisions might consider explicit recognition of a problem gambling disorder, identifying people presenting some cognitive symptoms of Pathological Gambling but not clear signs of dependence. Pathological gamblers in turn appear to have two distinct levels of severity.

Alcohol Use Disorders: Screening and Diagnosis

The purpose of this article is to provide an overview of empirically supported, primarily self-report methods of screening and diagnosis related to alcohol use disorders (AUDs). The discussion of screening instruments focuses on the primary care setting, and the diagnosis instruments discussion centers on the alcohol (and other drug) treatment setting. The literature shows that the AUDIT and the CAGE are the most widely validated methods of screening for AUDs in primary care and may be applied readily in that context. Similarly, a number of instruments designed to derive DSM-IV (and ICD-10) AUD diagnoses, as well as constructs related to how AUDs are defined, are available and can meet a variety of clinical needs. Future research priorities include further development of brief methods to identify hazardous drinkers or individuals who have an AUD, as well as refinement of diagnosis instruments to increase their application across treatment settings and subpopulations.

Multivariate Diagnostik in der Frühförderung

Zusammenfassung. Die traditionelle normorientierte Diagnostik ist bei der frühen Förderung von Kindern mit Entwicklungsverzögerungen und Behinderungen in die Kritik geraten. Im Hinblick auf die Ziele der Frühförderung und angesichts ökologisch-systemischer und transaktionaler Entwicklungsmodelle sind multivariate Diagnoseansätze erforderlich, die die individuelle Situation des Kindes in seiner Familie und seiner unmittelbaren Lebenswelt in besonderer Weise berücksichtigen und valide Informationen für eine multimodale Kindförderung, die Kooperation mit den Familien und die Evaluation der Frühförderprozesse bereitstellen. Mit Blick auf eine in Zukunft zu leistende multivariate Frühförderdiagnostik, wird auf der Basis entwicklungspsychologischer und frühförderspezifischer Literatur die heutige Situation in der Entwicklungs-, Eltern-Kind-Interaktions- und Familiendiagnostik reflektiert.

Linkage analysis in psychiatric disorders: the emerging picture

Gene finding in genetically complex diseases has been difficult as a result of many factors that have diagnostic and methodologic considerations. For bipolar disorder and schizophrenia, numerous family, twin, and adoption studies have identified a strong genetic component to these behavioral psychiatric disorders. Despite difficulties that include diagnostic differences between sample populations and the lack of statistical significance in many individual studies, several promising patterns have emerged, suggesting that true susceptibility loci for schizophrenia and bipolar disorder may have been identified. In this review, the genetic epidemiology of these disorders is covered as well as linkage findings on chromosomes 4, 12, 13, 18, 21, and 22 in bipolar disorder and on chromosomes 1, 6, 8, 10, 13, 15, and 22 in schizophrenia. The sequencing of the human genome and identification of numerous single nucleotide polymorphisms (SNP) should substantially enhance the ability of investigators to identify disease-causing genes in these areas of the genome.

Toward a dimensional and psychometrically-informed approach to conceptualizing psychopathology

Most modern research on psychopathology is framed by the categorical model of mental disorders embodied in the Diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994). Nevertheless, the categorical model of the DSM is incompatible with robust empirical observations about psychopathological variation, such as the tendency for multiple, putatively distinct mental disorders to occur in the same persons. The goal of this invited essay is to outline a potential alternative to the DSM's categorical approach: a dimensional and psychometrically-informed approach to conceptualizing and studying psychopathology. We discuss the advantages of the dimensional approach, some modern statistical technologies that can be recruited in the service of the dimensional approach, and ways of integrating the dimensional approach with a behavioral approach to psychopathology assessment and research.

Rates and patterns of comorbidity of adolescent behavioral syndromes as reported by parents and teachers in a Taiwanese nonreferred sample

OBJECTIVE

To evaluate the rates and patterns of comorbidity between behavioral syndromes in adolescents as reported by parents and teachers. Whether the patterns of comorbidity were "epiphenomenal" was also assessed.

METHOD

Parents of 854 randomly selected students (response rate = 88%) in Taipei in 1996 completed the Child Behavior Checklist; among them, 240 also were randomly selected to have the Teacher's Report Form completed by their teachers. In addition to bidirectional comorbidity rates, odds ratios with and without other comorbid pairs controlled for were estimated via multiple logistic regressions.

RESULTS

High comorbidity rates between behavioral syndromes were found in adolescents as reported both by parents and teachers except for that of Somatic Complaints with other syndromes. When other comorbidity pairs were controlled for, the comorbidity rates between Anxious/Depressed with externalizing syndromes turned out to be epiphenomenal, whereas those between externalizing syndromes remained high for both informants' reports. Attention Problems also remained significantly comorbid with other syndromes in the multiple logistic regressions except for that of Aggressive Behavior in the Teacher's Report Form sample.

CONCLUSION

High comorbidity rates between adolescent behavioral syndromes exist in both parents' and teachers' reports, and it is important to control for the epiphenomenal condition when assessing such comorbidity rates.

Specificity of information processing styles to depressive symptoms in youth psychiatric inpatients

Although information processing has been widely studied with depressed adults, little emphasis has been placed on the specificity of resultant findings to depression, as opposed to other psychological disorders. Analogously, even less effort has been directed toward examining the information processing styles of depressed children and adolescents. The present study investigated the specificity of information processing styles to depression and anxiety among 58 youth psychiatric inpatients. To assess information processing, we used a self-referent encoding task, in which participants were presented with positive and negative adjectives; participants were asked whether these adjectives described them or not, and were then tested on recall of the adjectives. After controlling for age and gender, lower rates of positive adjective endorsement and lower rates of positive adjective recall were found to be associated with depression, but not anxiety. Additionally, negative adjective endorsement was associated with anxiety symptoms. These results suggest specific cognitive features of depressive symptoms.

Adult psychopathology: issues and controversies

This review discusses issues and controversies with respect to the construct of a mental disorder, models of etiology and pathology, and domains of psychopathology. Fundamental to the science of psychopathology is a conceptualization of mental disorder, yet inadequate attention is being given to the differentiation of normal and abnormal psychological functioning in current research. The boundaries between mental and physical disorders are equally problematic. Neurophysiological models are receiving particular emphasis in large part because of the substantial progress being made in documenting and clarifying the important role of neurophysiological structures and mechanisms in etiology and pathology. However, this attention might be at the expense of the recognition of equally valid psychological models. Problematic diagnostic boundaries are also considered, including those within and between different classes of disorder. Dimensional models may offer a more precise and comprehensive classification of psychopathology.

Toward DSM-V and the classification of psychopathology

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) developed by the American Psychiatric Association (1994) is a compelling effort at a best approximation to date of a scientifically based nomenclature, but even its authors have acknowledged that its diagnoses and criterion sets are highly debatable. Well-meaning clinicians, theorists, and researchers could find some basis for fault in virtually every sentence, due in part to the absence of adequate research to guide its construction. Some points of disagreement, however, are more fundamental than others. The authors discuss issues that cut across individual diagnostic categories and that should receive particular attention in DSM-V: (a) the process by which the diagnostic manual is developed, (b) the differentiation from normal psychological functioning, (c) the differentiation among diagnostic categories, (d) cross-sectional vs. longitudinal diagnoses, and (e) the role of laboratory instruments.