Therapists' recognition of psychopathology: a model for quality review of psychotherapy

Diagnosis of obsessive-compulsive illness

Obsessive-compulsive illness has long been subject to diagnostic neglect. Moreover, obsessive-compulsive features often underlie or are intercurrent with other symptom pictures and may be quite debilitating. Diagnostic dilemmas are discussed regarding obsessive-compulsive illness and its relation to eating disorders, generalized anxiety disorder, mood disorders, alcohol abuse, and adult attention deficit disorder. Some difficulties in eliciting and recognizing obsessive-compulsive illness are presented. These include patient secrecy, shame, and social and personality features of health professionals. Specific pharmacologic and therapeutic interventions are effective when directed at the intercurrent or underlying obsessive-compulsive illness.

Depression and hypochondriasis in family practice patients with somatization disorder

The relationships specified in DSM-III between somatization disorder and depression, and somatization disorder and hypochondriasis require further validation and easier methods of detection for use by primary care physicians. The authors investigated hypochondriacal and depressive symptoms in 13 family practice outpatients with somatization disorder. Pain complaints and depressive symptomatology were present in over 75% of this group, while hypochondriacal symptoms were present in 38%. The mean score on the somatization scale of the Hopkins Symptom Check List (HSCL-90) was greater than that reported for any other group. These findings support the separation of somatization disorder and hypochondriasis and suggest the need for better delineation of depressive subtypes in somatization disorder. The somatization scale of the HSCL-90 should be a useful screen for somatization disorder in future research.

PSRO, quality review and mental health--a political and practical guide

Quality assessment of mental health care is distinguished by it defensive character. The field has been sensitive to the criticisms of outside agencies and groups to the point of studying the quality of care it provides far more than other health providers have done. The result has been productive leadership in matters of practical evaluation. The author details the impact of PSRO, the JCAH, DRGS, and other formal review mechanisms upon the quality assessment process. He catalogs a shift in emphasis to take into account organizational dynamics and concludes that the JCAH seems to be propelling alcohol, drug, and mental health treatment programs into creative new directions.

Classification and diagnosis of depression

There is no general consensus how to classify and diagnose depressive disorders. The main reason is disagreement regarding etiology. This is reflected in the several theoretical models of depression which has been proposed. On the other hand, a reliable way of characterizing groups of patients that can be used by both clinicians and researchers, is necessary both for communication and progress of research. Facing this situation, the inclusion of etiological theories in classification of depression obviously would be an obstacle to the use of such a classification system by clinicians of various theoretical orientation at current. Thus, a classification system which describes the clinical features of the mental disorders comprehensively and at the lowest order of inference necessary to identify the disorder in a reliable way is needed. The third edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM-III) represents such a classification system. By providing operational diagnostic criteria for each diagnosis, DSM-III represents a major achievement of classification in clinical psychiatry and research. This paper will present the classification of depression and the problem of differential diagnosis as outlined in DSM-III. Further, the validity of the DSM-III classification of depression will be discussed with reference to some recent research findings on biopsychosocial and treatment aspects of depressive disorders.