Showing papers by "Janet B. W. Williams published in 1988"

A structured interview guide for the Hamilton Depression Rating Scale.

Abstract: • The Hamilton Depression Rating Scale (HDRS) is the most widely used scale for patient selection and follow-up in research studies of treatments of depression. Despite extensive study of the reliability and validity of the total scale score, the psychometric characteristics of the individual items have not been well studied. In the only reliability study to report agreement on individual items using a test-retest interview method, most of the items had only fair or poor agreement. Because this is due in part to variability in the way the Information is obtained to make the various rating distinctions, the Structured Interview Guide for the HDRS (SIGH-D) was developed to standardize the manner of administration of the scale. A test-retest reliability study conducted on a series of psychiatric inpatients demonstrated that the use of the SIGH-D results in a substantially improved level of agreement for most of the HDRS items.

The Personality Diagnostic Questionnaire: Development and Preliminary Results

Abstract: The PDQ (Personality Diagnostic Questionnaire) is a self–report questionnaire derived from the personality disorders section of the original DSM–III. The authors report the results of a study to determine the extent to which a PDQ index of overall personality disturbance agrees with clinicians' assessments in 552 patients with and without personality disorder. The results showed that the PDQ–derived total PDQ score may be used to differentiate patients with a high likelihood for personality disturbance from those with a lower likelihood of personality disturbance.

The DSM-III-R personality disorders: an overview

Abstract: The revision of DSM-III (DSM-III-R) includes substantial changes in the axis II personality disorders. The authors present and critically review these revisions and suggest directions for further research. The issues discussed include the multiaxial system, the use of a categorical rather than a dimensional format, the change from monothetic to polythetic criteria sets, the reduction in overlap among criteria sets, the decrease in the amount of unnecessary inferential clinical judgment required to make diagnoses, and the addition of two new personality disorders in an appendix. The criteria sets for many of the DSM-III personality disorders were also substantially revised in DSM-III-R. Changes in each of these are discussed in turn.

The relationship of serotonin to depression in Parkinson's disease.

Abstract: We have previously reported a correlation between depression in patients with idiopathic Parkinson's disease and decreased concentrations of the cerebrospinal fluid content of the serotonin metabolite, 5-HIAA. To further examine this relationship, we repeated the study in a new cohort of patients while they remained on dopaminergic medications, conducted follow-up interviews and examinations in our original cohort, and conducted an open trial of the serotonin precursor, 5-hydroxytryptophan in a group of new patients with depression. We were again able to demonstrate a significant reduction in cerebrospinal 5-HIAA in depressed patients in comparison to controls and patients without depression. Demented patients with Parkinson's disease, particularly those with concurrent depression, had the lowest values of 5-HIAA. No new cases of depression occurred in our orignial cohort after 21/2 years of follow-up, and depression remitted following conventional or experimental treatment in four patients. Depression improved in six of the seven new patients following oral 5-hydroxytryptophan. Three of these patients allowed a repeat lumbar puncture, and the concentration of 5-HIAA increased following 5-hydroxytryptophan. These three studies support our hypothesis that depression in idiopathic Parkinson's disease is associated with a reduction in brain serotonin. However, it also suggests that other factors, biological or environmental, may be causal factors.

DSM-III-R criteria for posttraumatic stress disorder.

Abstract: The authors describe the changes in DSM-III criteria for posttraumatic stress disorder (PTSD) that have been included in DSM-III-R DSM-III-R includes specification of generic characteristics of traumatic stressors, clearer organization of symptoms around three dimensions of stress response (reexperiencing, avoidance and numbing, and physiological arousal), inclusion of symptoms specific to children, and specification of onset and duration of the disorder The importance of these changes in the evolution of the diagnosis of PTSD is discussed

Having a Dream: A Research Strategy for DSM-IV

Abstract: • Psychiatric research has had a major impact on both DSM-III and its revision ( DSM-III-R ). We propose a strategy to maximize the impact of psychiatric research on DSM-IV . This strategy is an elaboration of a study design that was particularly helpful in developing criteria for several of the problematic diagnostic categories of DSM-III-R . The strategy, called a "multiplex study design," employs (1) multiple collaborating centers, (2) multiple experts in the diagnoses being studied at each site, and (3) multiple diagnostic criteria sets so that alternative definitions of disorders can be compared in terms of (4) multiple external validity criteria, such as familial aggregation, course, and differential response to treatment. This strategy is a particularly efficient method for providing an empiric base for further revisions in our official classification of mental disorders.