The multidimensional assessment of psychopathology in mood and psychotic disorders. A proposal for Axis II in DSM-V/ICD-11

The inclusion of dimensional elements in the psychiatric diagnostic systems have been advocated for many years, however it has been resisted due to concerns about clinical utility. Recent suggestions have been for a combination of categorical and dimensional data in future diagnostic classification systems. In this paper we discuss the overlap in symptom complexes between mood disorders and schizophrenia and a multi-dimensional model of the mood-psychosis interface. We propose that the personality diagnoses should be included in Axis I and suggest the inclusion of a five factor dimensional diagnosis of mood and psychotic disorders on Axis II of DSM-V/ICD-11.

Changing the course of schizophrenia - predictors of treatment outcome revisited

<p>Multiple factors play a role in determining the outcome of schizophrenia. However, the role of these factors is poorly understood, and research findings so far have been inconclusive and sometimes contradictory. Various demographic and baseline clinical factors have been reported to be associated with treatment outcome. Also, early symptom reduction after initiation of antipsychotic therapy is closely related to later treatment response. However, associations as such do not necessarily imply predictive value, and none of these factors can be regarded as clinically useful in predicting treatment outcome. This article discusses selected aspects of treatment outcome and its prediction in schizophrenia, focusing particularly on early treatment response, ethnicity, neurological soft signs, and the predictive value of a discriminant functional analysis model utilising a combination of putative predictors. Such a model holds promise, and it is to be hoped that future refinements will lead to a clinically useful model for predicting outcome.</p>

A comparison of the effects of citalopram and moclobemide on resting brain perfusion in social anxiety disorder

INTRODUCTION

The serotonin specific reuptake inhibitor (SSRI) citalopram and the reversible mono-amine oxidase-A inhibitor (RIMA) moclobemide have both been used successfully for the treatment of social anxiety disorder (SAD). In this study we investigate the effects of these compounds on resting brain function using single photon emission computed tomography (SPECT).

METHODS

Subjects meeting DSM-IV criteria for SAD underwent regional cerebral blood flow (rCBF) SPECT using Tc-HMPAO at baseline and after 8 weeks of treatment with either citalopram or moclobemide. Using statistical parametric mapping brain SPECT studies were analysed to determine the effects of treatment on rCBF, to compare the effects of citalopram and moclobemide, and to detect correlations between changes in rCBF and clinical response.

RESULTS

Subjects received citalopram (n=17) or moclobemide (n=14) as therapy. Subjects in both treatment groups demonstrated a significant improvement of SAD symptoms as measured by the Liebowitz Social Anxiety Scale total score. All subjects demonstrated a decrease in rCBF in the insulae post therapy. Subjects receiving citalopram had decreased superior cingulate rCBF after therapy compared to those receiving moclobemide.

CONCLUSION

Both SSRI's and RIMA's decreased rCBF in the insulae during treatment of SAD; an effect that may be consistent with the role of these regions in processing internal somatic cues evoked by emotional stimuli. Citalopram had a greater effect on superior cingulate perfusion, an effect that is consistent with evidence of high levels of 5-HT transporters in this region.

Comparison of obsessive-compulsive disorder patients with and without comorbid putative obsessive-compulsive spectrum disorders using a structured clinical interview

Increasing attention has been paid to the possibility that a range of disorders, the putative obsessive-compulsive spectrum disorders (OCSDs), may share overlapping phenomenological and neurobiological features with obsessive-compulsive disorder (OCD). The development of a structured clinician-administered interview for the putative OCSDs (SCID-OCSD) is described. This instrument was used to investigate differences between OCD patients with a comorbid putative OCSD and OCD patients without a comorbid putative OCSD. A sample of 85 adult patients (38 men and 47 women) presenting for treatment of OCD was interviewed with the SCID-OCSD. OCD patients without comorbid putative OCSDs (n = 36) were compared to patients with comorbid OCSDs (n = 49) in terms of demographic features, clinical characteristics, and associated comorbidity with other non-OCSD DSM-IV axis I disorders. Of the OCD patients, 57.6% currently met criteria for at least one putative OCSD and 67.1% had a lifetime history of at least one comorbid OCSD. The OCSDs with the highest prevalence rates were compulsive self-injury (22.4%), compulsive buying (10.6%), and intermittent explosive disorder (10.6%). There was a significantly larger proportion of women in the group with comorbid OCSDs. Although the two groups did not differ in terms of severity of OCD symptoms, the group with comorbid OCSDs had significantly more obsessions and compulsions. The two groups did not differ significantly in terms of associated psychopathology other than OCSDs. We conclude that the SCID-OCSD provides clinicians and researchers with an instrument for the diagnosis of putative OCSDs. Our findings suggest that putative OCSDs have a relatively high prevalence rate in OCD patients. In addition, OCD patients with comorbid OCSDs differ with regard to certain demographic and clinical features. Further research, particularly genetic and neuroimmunological work, may ultimately be useful in validating the obsessive-compulsive spectrum.