Showing papers by "Janet B. W. Williams published in 1992"

The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description.

Abstract: • The history, rationale, and development of the Structured Clinical Interview for DSM-III-R (SCID) is described. The SCID is a semistuctured interview for making the major Axis I DSM-III-R diagnoses. It is administered by a clinician and includes an introductory overview followed by nine modules, seven of which represent the major axis I diagnostic classes. Because of its modular construction, it can be adapted for use in studies in which particular diagnoses are not of interest. Using a decision tree approach, the SCID guides the clinician in testing diagnostic hypotheses as the interview is conducted. The output of the SCID is a record of the presence or absence of each of the disorders being considered, for current episode (past month) and for lifetime occurrence.

Reliability of dual diagnosis. Substance dependence and psychiatric disorders

Abstract: The Structured Clinical Interview for DSM-III-R was used to examine the effects of the co-occurrence of psychiatric and substance dependence disorders on diagnostic reliability. The test-retest reliability over a 1-week period was studied in groups of: a) individuals with current substance abuse diagnoses (N = 97), b) individuals with past, but not current, drug histories (N = 146), and c) individuals without substance abuse diagnoses (N = 356; primarily psychiatric patients). A measurement of reliability (Kappa coefficients) was estimated for four general psychiatric categories (psychotic, mood, anxiety, and eating disorders), along with specific most-frequent diagnoses in each category (schizophrenia, major depression, panic disorders, and bulimia nervosa, respectively). Past use and non-drug-use groups were similar in their generally reliable reporting of current and past psychiatric disorders. However, current mood and psychotic disorders were less reliably diagnosed in the group with current substance use disorders.

A structured diagnostic interview for hypochondriasis. A proposed criterion standard.

Abstract: We developed a structured diagnostic interview for DSM-III-R hypochondriasis (SDIH) that is the first such clinician-administered instrument. The SDIH was administered to 88 general medical outpatients who scored above a predetermined cutoff on a hypochondriacal symptom questionnaire, and to 100 com

Bereavement reactions among homosexual men experiencing multiple losses in the AIDS epidemic.

Abstract: Objective: The authors examined whether deaths of lovers and close friends from AIDS increased the frequency ofdepressive symptoms and depressive disorder in a group of homosexual men. Method: Two hundred seven volunteer male homosexual subjects were interviewed in New York City in 1 988 and 1 989. Depressive symptoms were measured with the Hamilton Rating Scale for Depression, administered by a clinician, and two self-report symptom checklists. Subjects were evaluated for major depression with the Structured Clinical Interview for DSM-III-R. Each subject also reported the number of lovers and close friends who had died ofAIDS 1) since the beginning ofthe epidemic in 1 981 and 2) in the 6 months preceding the interview. Results: Neither the overall level ofdepressive symptoms, the presence ofspecific symptom clusters, nor the presence ofa diagnosed depressive disorder was related to the number ofAIDS deaths a subject reported in either time frame. In contrast, bereavement reactions specific to loss, namely, preoccupation with and searching for the deceased, were more common in subjects with greater numbers of losses. The findings for depressive symptoms and major depression are not readily explained by measurement artifact, overrepresentation of asymptomatic subjects among study volunteers, habituation effects, numbness, or shallowness ofattachments in the subjects. Conclusions: Changes in normative expectations regarding AIDS deaths and mobilization against AIDS within the gay community may account f or the lack ofassociation between the number oflosses resulting from AIDS and the presence of depressive symptoms and depressive disorder. (Am J Psychiatry 1992; 149:1374-1379)

Coping strategies and health beliefs of AIDS longterm survivors

Abstract: The goal of this study was to identify ways of coping with protracted illness and extended and “unanticipated” survival following an AIDS diagnosis. Subjects were 53 clients at Gay Men's Health Crisis (GMHC) who had been diagnosed with an opportunistic infection at least three years prior to assessment. Comparisons were made with two groups of gay men who were similar demographically, but did not have AIDS (115 HIV+, 54 HIV-). No single coping style emerged as contributing to positive survival; rather, the longterm survivors made use of numerous ways of coping, such as taking personal action with regard to medical care, re-evaluating and modifying personal, professional and interpersonal goals and relationships, community involvement, and pursuing pleasurable activities. A belief that “personal” and/or “chance” factors are associated with health outcome, as opposed to a reliance on “powerful others,” was associated with level of hopefulness. Availability of a confidante was also related to the ma...

Now is the time to retire the term "organic mental disorders".

Abstract: The organic/nonorganic distinction in contemporary classifications of mental disorders such as DSM-III and DSM-III-R has important prognostic and treatment implications, because it directs the clinician to pay special attention to the possibility of an underlying "physical" disorder as the cause of the mental disturbance However, the term "organic" raises serious and intractable problems, since the connotative meaning of the term always returns to its historical roots, which imply an outmoded functional/structural, psychological/biological, and mind/body dualism The authors present a proposal being considered for DSM-IV that would eliminate the term "organic" and reorganize the classification of organic mental disorders Disorders previously referred to as "organic mental disorders" would be renamed as either "secondary disorders" (if they are due to "physical" disorders) or "substance-induced disorders" The entire classification of mental disorders would be reorganized to distribute the secondary and substance-induced disorders into the major groups with which they share phenomenology The traditional organic mental disorders--delirium, dementia, and amnestic disorder--would be grouped together under the rubric of "cognitive impairment disorders" While acknowledging problems with the suggested new terminology and reorganization of the classification, the authors argue that the potential benefits of the proposal for clarity and for facilitating differential diagnosis justify putting to rest the familiar but now anachronistic term "organic mental disorders"

Neurologic and neuropsychological manifestations of human immunodeficiency virus infection in intravenous drug users without acquired immunodeficiency syndrome. Relationship to head injury.

Abstract: • We examined 99 human immunodeficiency virus (HIV)—negative and 122 HIV-positive intravenous drug users (IVDUs) without acquired immunodeficiency syndrome (AIDS) to determine whether HIV-positive IVDUs had more neurologic and neuropsychological impairment than their HIV-negative counterparts. Controlling for age, education, drug use, history of head injury, and interactions between head injury and HIV status and drug use, HIV-positive subjects had more extrapyramidal signs and frontal release signs. These findings persisted when asymptomatic HIV-positive subjects without systemic signs of infection and HIV-negative subjects were compared. Neurologic findings were more severe in those with more systemic illness. Among those reporting a history of head injury with loss of consciousness, neuropsychological performance was significantly worse in the HIV-positive subjects, and this increased with severity of illness. This was not true in the group without head injury, suggesting an interaction between history of head injury and the seropositive state. No relationship was noted between head injury and either drug use or HIV state. Therefore, subtle neurologic and neuropsychological abnormalities may precede clinical evidence of AIDS in IVDUs and may be more evident in those with head injury.

International reliability of a diagnostic intake procedure for panic disorder.

Abstract: Test-retest diagnostic reliability interviews using the Upjohn version of the Structured Clinical Interview for DSM-III (SCID) were conducted with 72 patients at 13 international sites of the Cross-National Collaborative Panic Study. Agreement on the diagnosis of panic disorder was very good. For the subtypes (uncomplicated, with limited phobic avoidance, and agoraphobia), agreement was fair to good.