The prevalence of comorbid alcohol, other drug, and mental disorders in the US total community and institutional population was determined from 20 291 persons interviewed in the National Institute of Mental Health Epidemiologic Catchment Area Program. Estimated US population lifetime prevalence rates were 22.5% for any non—substance abuse mental disorder, 13.5% for alcohol dependence-abuse, and 6.1% for other drug dependence-abuse. Among those with a mental disorder, the odds ratio of having some addictive disorder was 2.7, with a lifetime prevalence of about 29% (including an overlapping 22% with an alcohol and 15% with another drug disorder). For those with either an alcohol or other drug disorder, the odds of having the other addictive disorder were seven times greater than in the rest of the population. Among those with an alcohol disorder, 37% had a comorbid mental disorder. The highest mental-addictive disorder comorbidity rate was found for those with drug (other than alcohol) disorders, among whom more than half (53%) were found to have a mental disorder with an odds ratio of 4.5. Individuals treated in specialty mental health and addictive disorder clinical settings have significantly higher odds of having comorbid disorders. Among the institutional settings, comorbidity of addictive and severe mental disorders was highest in the prison population, most notably with antisocial personality, schizophrenia, and bipolar disorders. (JAMA. 1990;264:2511-2518)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=383975&pdfFileName=jama_264_19_026.pdf

Comorbidity of Mental Disorders With Alcohol and Other Drug Abuse. Results From the Epidemiologic Catchment Area (ECA) Study

OBJECTIVE Somatization is prevalent in primary care and is associated with substantial functional impairment and healthcare utilization. However, instruments for identifying and monitoring somatic symptoms are few in number and not widely used. Therefore, we examined the validity of a brief measure of the severity of somatic symptoms. METHODS The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-15 comprises 15 somatic symptoms from the PHQ, each symptom scored from 0 ("not bothered at all") to 2 ("bothered a lot"). The PHQ-15 was administered to 6000 patients in eight general internal medicine and family practice clinics and seven obstetrics-gynecology clinics. Outcomes included functional status as assessed by the 20-item Short-Form General Health Survey (SF-20), self-reported sick days and clinic visits, and symptom-related difficulty. RESULTS As PHQ-15 somatic symptom severity increased, there was a substantial stepwise decrement in functional status on all six SF-20 subscales. Also, symptom-related difficulty, sick days, and healthcare utilization increased. PHQ-15 scores of 5, 10, 15, represented cutoff points for low, medium, and high somatic symptom severity, respectively. Somatic and depressive symptom severity had differential effects on outcomes. Results were similar in the primary care and obstetrics-gynecology samples. CONCLUSIONS The PHQ-15 is a brief, self-administered questionnaire that may be useful in screening for somatization and in monitoring somatic symptom severity in clinical practice and research.

The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms.

https://psychiatry-training.wiki.otago.ac.nz/images/a/ae/Wuttchen1994.pdf

Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): A critical review

PurposeTo systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students.MethodMedline and PubMed were searched to identify peer-reviewed English-language studies published between January 1980 and May 2005 reporting on depression, anxie

http://www.medical-mastermind-community.com/uploads/63-Systematic_Review_of_Depression_Anxiety_and.9.pdf

Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students.

Preface.Chapter 1: Introduction.Organization of the Handbook.Role of the Clinician.Patterns of Test Usage in Clinical Assessment.Evaluating Psychological Tests.Validity in Clinical Practice.Clinical Judgment.Phases in Clinical Assessment.Recommended Reading.Chapter 2: Context of Clinical Assessment.Types of Referral Settings.Ethical Practice of Assessment.Test Bias and Use with Minority Groups.Selecting Psychological Tests.Computer-Assisted Assessment.Recommended Reading.Chapter 3: The Assessment Interview.History and Development.Issues Related to Reliability and Validity.Assets and Limitations.The Assessment Interview and Case History.Mental Status Examination.Interpreting Interview Data.Structured Interviews.Recommended Reading.Chapter 4: Behavioral Assessment.History and Development.Issues Related to Reliability and Validity.Assets and Limitations.Strategies of Behavioral Assessment.Recommended Reading.Chapter 5: Wechsler Intelligence Scales.Testing of Intelligence: Pro and Con.History and Development.Reliability and Validity.Assets and Limitations.Meaning of IQ Scores.Cautions and Guidelines in Administration.WAIS-III /WISC-III Successive Level Interpretation Procedure.Wechsler Subtests.Assessing Brain Damage.Assessing Additional Special Populations.Short Forms.Recommended Reading.Chapter 6: Wechsler Memory Scales.History and Development.Reliability and Validity.Assets and Limitations.Interpretation Procedure.Recommended Reading.Chapter 7: Minnesota Multiphasic Personality Inventory.History and Development.Reliability and Validity.Assets and Limitations.Administration.Interpretation Procedure.Computerized Interpretation.Validity Scales.Clinical Scales.Two-Point Codes.MMPI-2 Content Scales.MMPI-A Content Scales.Harris-Lingoes and Si Subscales.Critical Items.MMPI-2 and MMPI-A Supplementary Scales.Recommended Reading.Chapter 8: Millon Clinical Multiaxial Inventory.History and Development.Reliability and Validity.Assets and Limitations.Interpretation Procedure.Modifying Indices (Validity Scales).Clinical Personality Patterns.Severe Personality Pathology.Clinical Syndromes.Severe Syndromes.Recommended Reading.Chapter 9: California Psychological Inventory.History and Development.Comparison with the MMPI.Reliability and Validity.Assets and Limitations.Interpretation Procedures.Vector Scale Interpretation.Individual Scales.Special Purpose Scales.Configural Interpretation.Recommended Reading.Chapter 10: Rorschach.History and Development.Reliability and Validity.Assets and Limitations.Approaching Consensus on Rorschach Validity.Administration.Scoring.Structural Summary.Interpretation.Recommended Reading.Chapter 11: Thematic Apperception Test.History and Development.Theoretical Perspectives.Reliability and Validity.Assets and Limitations.Administration.Typical Themes Elicited.Scoring Procedures.Interpretation.Recommended Reading.Chapter 12: Screening and Assessing for Neuropsychological Impairment.History and Development.Interviewing for Brain Impairment.Tests for Screening and Assessing for Neuropsychological Impairment.Tests of Visuoconstructive Abilities.Mental Activities (Attention and Speed of Information Processing).Memory and Learning.Verbal Functions and Academic Skills.Tests of Motor Ability.Executive Functions.Emotional Status and Level of Adjustment.Recommended Reading.Chapter 13: Brief Instruments for Treatment Planning, Monitoring, and Outcome Assessment.Selecting Brief Instruments.Symptom Checklist-90-R (SCL-90-R) and Brief Symptom Inventory (BSI).The Beck Depression Inventory.State Trait Anxiety Inventory (STAI).Recommended Reading.Chapter 14: Psychological Assessment and Treatment Planning.Development and Approaches to Treatment Planning.A Systematic Approach to Treatment Selection.Functional Impairment.Social Support.Problem Complexity/Chronicity.Coping Style.Resistance.Subjective Distress.Problem-Solving Phase.Recommended Reading.Chapter 15: Psychological Report.General Guidelines.Format for a Psychological Report.Sample Reports.Recommended Reading.Appendix A: Test Publishers/Distributors.Appendix B: Percentile Rankings for Wechsler Deviation IQS.Appendix C: Conversion Formulas and Difference Scores for Determining Magnitude (.05 Level) of Fluctuations for Wechsler Adult Intelligence Scale (3rd ed. WAIS-III) Additional Groupings.Appendix D: Conversion Formulas and Difference Scores for Determining Magnitude (.05 Level) of Fluctuations for Wechsler Intelligence Scale for Children (3rd ed. WISC-III) Factor Scores and Additional Groupings.Appendix E: Directions for Completing Appendix E: Worksheet for Determining Magnitude of WISC-III Subtest Fluctuations.Appendix F: Guidelines for Hypothesizing Subtest Strengths and Weaknesses.Appendix G: Directions for Hand Scoring the Minnesota Multiphasic Personality Inventory (MMPI-2) Validity and Clinical Scales.Appendix H: Feedback Statements for the MMPI-2 Clinical Scales.Appendix I: Descriptive Statistics for Nonpatient Adults (N = 600).Appendix J: Maturational Guidelines for Bender Gestalt Designs.Appendix K: Rey Auditory-Verbal Learning Test Scoring Sheet.Appendix L: Norms for the Standard Administration of the RAVLT.WISC-IV Supplement.References.Author Index.Subject Index.

Handbook of psychological assessment

The prevalence of psychiatric syndromes among 565 male alcoholic VA inpatients was examined using the structured Psychiatric Diagnostic Interview (PDI). Almost two-thirds fulfilled criteria for one or more additional psychiatric syndromes. Subjects positive only for alcoholism reported a significantly later onset of problem drinking and fewer first-degree relatives who abused alcohol than those positive for one or more additional syndromes. The most frequent additional syndromes were affective disorders and antisocial personality. The possible significance of subtyping alcoholics by the presence or absence of coexisting psychiatric syndromes is discussed.

Prevalence of additional psychiatric syndromes among male alcoholics.

For the diagnosis of somatization disorder, DSM-III requires the assessment of 37 specific symptoms, a time-consuming and cumbersome task. The authors describe a procedure by which the clinician can assess the presence of somatization disorder by screening for only seven symptoms, three of which must be present for a preliminary diagnosis of somatization disorder. The test was developed on female psychiatric outpatients (N = 85) who had multiple unexplained physical complaints beginning before the age of 30 years; it was validated on an independent sample (N = 47). The accuracy of this screening procedure is 80%-90%.

A screening test for somatization disorder (hysteria).

A structured interview that identified 78 female psychiatric outpatients as having Briquet's syndrome also indicated that 77 of the 78 fulfilled inclusive diagnostic criteria for one or more other psychiatric syndromes. If, as this finding suggests, Briquet's syndrome represents a heterogeneous disorder, its various components should be evaluated and patient responses to treatments should be assessed. Until such studies are done, the general and psychiatric physician should be aware that the diagnosis of Briquet's syndrome does not rule out the possibility of other psychiatric illnesses that may be more amenable to treatment.

Is Briquet's syndrome a heterogeneous disorder?

After one adaptation night, intramuscular doses of methadone (7.5, 15, 30 mg/70 kg), morphine (10 or 20 mg/70 kg), or placebo were given to seven male nondependent opiate addicts at weekly intervals in a randomized cross-over design. After three adaptation nights, heroin (3, 6, 12 mg/70 kg) was compared with morphine and placebo by means of a similar design in seven other subjects. Using electroencephalogram (EEG) bisector analysis, tape recordings of sleep were analyzed for two beta, three alpha, three theta, and two delta EEG patterns, as well as for detections of sleep spindles, K-complexes, eye movements, body movements, average electromyogram (EMG), and calculation of seven sleep-waking stages. All three opioids produce a dose-related arousal: they increase EMG and EEG measures of muscle activity, as well as body movements and EEG alpha, while decreasing EEG theta and spindling. These opioids also increase measures of waking state and decrease measures of spindle sleep and REM sleep. Although the 1974 version of the EEG bisector analysis is not exactly comparable to visual analysis, in this design it defined significant drug effects on sleep and EEG. Distinctive bisector analysis patterns are positively correlated with each sleep--waking stage.

Opioid effects on computer-derived sleep and EEG parameters in nondependent human addicts.

After 4 weeks' treatment with buspirone, sexual function was normalized in 8 of 10 patients with generalized anxiety disorder. Nine of the patients had reported decreased sexual function before treatment. Buspirone appears to offer a clinical advantage over existing anxiolytics, which are usually associated with impairment of sexual function.

Ekkehard Othmer

Papers

Prevalence of additional psychiatric syndromes among male alcoholics.

A screening test for somatization disorder (hysteria).

Is Briquet's syndrome a heterogeneous disorder?

Opioid effects on computer-derived sleep and EEG parameters in nondependent human addicts.

Effect of buspirone on sexual dysfunction in patients with generalized anxiety disorder.