Clinical Instruments for Primary Care Settings

Returning to the first landmark, it is now possible to trace the development of instruments for use in primary care settings. The link between the Second World War and primary care came about because the Cornell Selectee Index was modified for use in general medicine and renamed the Cornell Medical Index (CMI) (Brodman et al., 1949). The developers of the CSI, Harold Wolff and colleagues, had a strong commitment to the whole person orientation and to studying the relationships between emotional...

Presenting Clinical Features And Case Definitions

By comparison with typically more short-lived or acute problems such as drug intoxication, dependence on one of the internationally controlled drugs can be a chronic and debilitating mental and behavioral disorder (e.g., see Hser et al., 2001). Dependence almost always develops insidiously over a time course of months or years, part and parcel with repeated bouts of drug intoxication. In the largest available epidemiologic sample of cases with a history of drug dependence and or drug abuse, the...

Subsyndromal Depression

The concept of subsyndromal depression has received much attention in the last decade. Data from community studies of the elderly have found depressive symptoms not meeting DSM criteria may be clinically significant. Minor depression that is clinically significant may be more common in older adults, suggesting that major depression does not fully capture the spectrum of depression seen in late life (Blazer, 1994). In elders from the North Carolina ECA study, the overall prevalence of depressive...

Epidemiologic Instruments United States and Canada

The first two instruments published after the war were scales for screening large populations. One was the Health Opinion Survey (HOS) (Macmillan, 1957) and the other was the Twenty-Two Item Scale (22IS) (Langner, 1962). Each was designed as part of the first psychiatric epidemiologic investigations to utilize structured interviews administered by lay interviewers the Stirling County Study (Leighton, 1959) and the Midtown Manhattan Study (Srole et al., 1962). There were several similarities in...

The Baseline Ncs Results Lifetime and Recent Prevalences

As reported in more detail elsewhere (Kessler et al., 1994), the NCS found that DSM-III-R disorders are more prevalent than previously thought to be the case. The results in Table 1 show prevalence estimates for the 14 lifetime and 12-month disorders assessed in the core NCS interview. Lifetime prevalence is the proportion of the sample who ever experienced a disorder, while 12-month prevalence is the proportion who experienced the disorder at some time in the 12 months prior to the interview....

Risk Factors

Clinical and epidemiological studies in the Western world have consistently documented an increased risk for major depression in women. Studies reporting differential rates of major depression by sex and proposed explanations for this difference have been reviewed by Weissman and Klerman (1977, 1985), who concluded that the difference is not simply due to a tendency for women to report distress or to seek help more readily than men. This conclusion is supported by the observation...

Precipitating Factors Stress

Earlier we noted that environmental stress was seen as one possible explanation for the relationship between social class and schizophrenia. Two lines of research have addressed the role of stress as an etiologic factor in schizophrenia exposure to adverse life events and expressed emotion in the family. Stressful Life Events. Although there is continued interest in the contribution of life events stressors to the onset of mental disorders, their role in increasing the risk of onset of...

Definitions and Assessment of the Anxiety Disorders

In this chapter, we consider the anxiety disorders as defined by the DSM-IV criteria including panic, phobias, and general anxiety. The major subtypes of anxiety include panic disorder (with or without agoraphobia), specific phobia, social phobia, and generalized anxiety disorder (GAD). Although obsessive -compulsive disorder and post-traumatic stress disorder are also included as anxiety disorders in the DSM-IV, they will not be included here due to differences in their prevalence rates and...

Lay Administered Diagnostic Schedules

A diagnostic schedule does not lend itself to a test of internal consistency in the same manner as pertains when Cronbach's alpha is applied to a scale. This stems from the fact that the schedules focus on multiple, discrete diagnoses involving skip-outs. Because many subjects do not answer all the questions, it is not possible to calculate internal consistency in the conventional way. Grade of Membership (GOM) analysis has, however, been employed for a somewhat similar purpose. Among those who...

Overlap Between Mood And Anxiety Disorders

Although this review considered the magnitude and risk factors for anxiety and depression independently, there is compelling evidence from prospective longitudinal studies, family studies, twin studies, and treatment studies that anxiety and depression have a common diathesis. There are now several reviews of comorbidity of anxiety and depression in youth that provide a comprehensive summary of the evidence for comorbidity as well as of the possible sources of comorbidity (Caron and Rutter,...

Temperament and Personality

One of the earliest indicators of vulnerability to the development of anxiety is behavioral inhibition, characterized by increased physiological reactivity or behavioral withdrawal in the face of novel stimuli or challenging situations (Kagan and Reznick, 1986). Behavioral inhibition may be a manifestation of a biological predisposition characterized by both overt behavioral (e.g. cessation of play, reluctance to interact in the presence of unfamiliar objects and people)...

Acknowledgments

The baseline National Comorbidity Survey (NCS) was supported by National Institute of Mental Health (NIMH) grants MH46376, MH49098, and MH52861, with supplemental support from the W.T. Grant Foundation (Grant 90135190). Ronald Kessler was the Principal Investigator of the baseline NCS. His participation in the survey was supported by NIMH Research Scientist Award MH00507. NCS-2 is funded by National Institute of Drug Abuse (NIDA) grant DA12058, with supplemental support from NIMH. NCS-R is...

Categorical Assessments

Categorical assessments are measures that provide discrete classifications of psy-chopathology according to prespecified diagnostic criteria, most often the DSM. These measures are usually in the form of structured interviews (see Chapter 11 for a more general discussion of structured interviews and their application). In general, these tools require an interviewer to present scripted questions to a research participant that elicit either a yes no or more detailed response. These questions...

Familial and Genetic Factors

The familial aggregation of all of the major subtypes of anxiety disorders has been well established (Merikangas et al., 1998c). The results of more than a dozen controlled family studies of probands with specific subtypes of anxiety disorders converge in demonstrating a 3 to 5-fold increased risk of anxiety disorders among first-degree relatives of affected probands compared to controls. The importance of the role of genetic factors in the familial clustering of...

Pathogenesis Natural History And Clinical Course Of Drug Dependence

There now are several competing conceptual models for the pathogenesis of drug dependence and its natural history, as well as for the clinical course of drug dependence, which is natural history modified by one or more clinical interventions intended to be more than palliative in character. The Jellinek curve'' with its notion of bottoming out'' was among the first of these conceptions a concept applied originally to alcohol, with later extension to other drugs (e.g., in Narcotics Anonymous...

Adverse Effects of Psychiatric Medications

Answering the question Do psychiatric medications cause unanticipated adverse effects '' remains a mainstay for psychopharmacoepidemiologists. One area in which there has been considerable work has been the adverse effects of sedative-hypnotic use among older patients. Studies from the 1980s by Ray and colleagues (1989) identified that benzodiazepine users had significantly increased rates of hip fracture, a frequently disabling outcome in the elderly. However, the clinical implications of...

Case Definitions Of Bipolar Disorder

According to the Diagnostic and Statistical Manual of Mental Disorder, fourth edition, revised (DSM-IV) (American Psychiatric Association APA , 1994), the essential feature of mood disorders is disturbance of mood that is defined as a sustained emotion that colors the perception of the world. Although elevated mood may be considered the characteristic of a manic episode, the predominant mood may also be irritability. Patients with mania have inflated self-esteem, which may range from unusual...

Predisposing Factors

Schizophrenia aggregates strongly in families (Jones and Cannon, 1998). Over the past two decades, there have been numerous reviews of the genetic epidemiology of schizophrenia (cf. Murray et al., 1986). In their classic book on this topic, Gottesman and Shields (1982) calculated that the morbid risk in first-degree relatives was 5.6 in the parents of schizophrenics, 12.8 in the children of one schizophrenic parent, and 46.3 in the children of two schizophrenic...

Landmarks And Trends

Over the 50 years of this review, three important landmarks influenced the field. The Second World War was the first in that it revealed the magnitude of the number suffering from a psychiatric disorder that had never been diagnosed or treated. Initial efforts in both the United States and the United Kingdom were carried out to create scales appropriate for assessing recruits into the armed forces. In the postwar era, similar scales were designed for general population studies. The next...

The DIS

DSM-III was the first edition of the DSM with a fully spelled out set of symptoms for each disorder, and criteria for how many symptoms had to be present for how long. It set priorities specifying how to choose among disorders when criteria were met for more than one. Publication of DSM-III radically changed the opportunities for the construction of an epidemiological diagnostic interview. For the first time it was possible to consider face validity that is, does each question adequately serve...