Showing papers in "Archives of General Psychiatry in 1982"
TL;DR: The developed Scale for the Assessment of Negative Symptoms has excellent interrater reliability and the five symptom complexes defined by the scale have good internal consistency, which indicates that the conceptual organization of the scale is also cohesive.
Abstract: • Recently, a renaissance of interest in "negative symptoms," eg, affective flattening or impoverishment of speech and language, has occurred. Although some investigators believe that these symptoms are important indicators of outcome, of response to treatment, and perhaps of a distinct, underlying pathologic process, research on the negative-symptom syndrome in schizophrenia has been handicapped because no standard instrument existed to assess it. This investigation reports on the developed Scale for the Assessment of Negative Symptoms. When symptoms are defined by objective behavioral indices, they have excellent interrater reliability. Furthermore, the five symptom complexes defined by the scale (affective flattening, alogia, avolition, anhedonia, and attentional impairment) have good internal consistency, which indicates that the conceptual organization of the scale is also cohesive.
2,136 citations
TL;DR: Criteria for dividing the schizophrenic syndrome into three subtypes was developed: positive, negative, and mixed schizophrenia, and significant differences were noted using external validators such as premorbid adjustment, indices of cognitive dysfunction, ventricular brain ratio, and course in hospital.
Abstract: • We developed criteria for dividing the schizophrenic syndrome into three subtypes: positive, negative, and mixed schizophrenia. Positive schizophrenia is characterized by prominent delusions, hallucinations, positive formal thought disorder, and persistently bizarre behavior; negative schizophrenia, by affective flattening, alogia, avolition, anhedonia, and attentional impairment. In mixed schizophrenia either both negative and positive symptoms are prominent, or neither is prominent. We explored the validity of these criteria in a variety of ways. Significant differences between the three types were noted using external validators such as premorbid adjustment, indices of cognitive dysfunction, ventricular brain ratio, and course in hospital. The correlational structure of the symptom complexes also provided further support for our approach to subtyping.
2,010 citations
TL;DR: It is shown that it is possible to make lifetime best estimate diagnoses reliably among both interviewed and noninterviewed individuals for most diagnostic categories and that diagnoses based on interview data alone are an adequate substitute for best estimate prescriptions based on all available information in a limited number of diagnostic categories.
Abstract: It is important for genetic, epidemiologic, and nosological studies to determine accurate rates of lifetime psychiatric diagnoses in patient and nonpatient populations. As part of a case-control family study of major depression, lifetime psychiatric diagnoses were made for 1,878 individuals. Sources of information used in making diagnostic estimates included direct interview, medical records, and family history data systematically obtained from relatives. Diagnostic estimates were made by trained interviewers, experienced clinicians, and by computer program. The results indicate that it is possible to make lifetime best estimate diagnoses reliably among both interviewed and noninterviewed individuals for most diagnostic categories and that diagnoses based on interview data alone are an adequate substitute for best estimate diagnoses based on all available information in a limited number of diagnostic categories.
1,407 citations
TL;DR: In a family study of 1,254 adult relatives of patients and controls, lifetime prevalences of major affective disorder (including schizoaffective) were 37%, 24%, 25%, 20% and 7% in relatives of probands with schizoAffective, bipolar I, bipolar II, and unipolar disease, and normal controls.
Abstract: • In a family study of 1,254 adult relatives of patients and controls, lifetime prevalences of major affective disorder (including schizoaffective) were 37%, 24%, 25%, 20% and 7% in relatives of probands with schizoaffective, bipolar I, bipolar II, and unipolar disease, and normal controls. These data were compatible with the different affective disorders representing thresholds on a continuum of underlying multifactorial vulnerability. In this model, schizoaffective illness represents greatest vulnerability, followed by bipolar I and bipolar II, then unipolar illnesses. Alcoholism, drug abuse, and sociopathy were not more frequent in relatives of patients v relatives of controls. Sex-related transmission of morbid risk was not present. Morbid risk was 74% to offspring of two ill parents, and 27% to offspring of one ill parent. Nationality and age at time of interview seem to be nongenetic factors that affect frequency of diagnosis.
939 citations
TL;DR: There has not yet been a systematic effort to reduce the diagnostic heterogeneity that is found within the range of patients who are identified as having tardive dyskinesia.
Abstract: To the Editor —The recent publication by the American Psychiatric Association of its Task Force report on tardive dyskinesia (TD) 1 provides a summary of the state of the art in both clinical practice and research-based knowledge that addresses issues of both phenomenology of the disorder and differential diagnosis. However, there has not yet been a systematic effort to reduce the diagnostic heterogeneity that is found within the range of patients who are identified as having TD. The diagnosis reported in the literature frequently represents nothing more than a score on a rating scale. Furthermore, investigators use a variety of terms to modify the primary diagnosis (eg, covert dyskinesia, masked dyskinesia, presumptive TD, withdrawal emergent symptoms, or widhrawal dyskinesia), making communication and comparison of results among investigators difficult.
902 citations
TL;DR: Lowest levels of adolescent depressive mood correlated with high levels of attachment both to parents and to peers, and sex differences in depressive mood in adolescents may be accounted for by masked depression and increased delinquency among boys as compared with girls.
Abstract: The epidemiology and correlates of depressive mood were measured in a representative sample of public high school students in New York State and a subsample matched to their parents. Depressive mood was measured by a self-reported scale validated in a clinical sample. Adolescents with a diagnosis of major depressive disorder scored higher than those with other psychiatric diagnoses. In the general adolescent sample, ex differences in depressive mood paralleled those previously reported for adults, with girls scoring higher than boys. Adolescents reported higher depressive mood than their parents, with the differences greater in daughter-mother than in son-father pairs. If judged by mood differences, adolescence was a stressful period in the life cycle. Lowest levels of adolescent depressive mood correlated with high levels of attachment both to parents and to peers. Sex differences in depressive mood in adolescents may be accounted for by masked depression and increased delinquency among boys as compared with girls.
902 citations
TL;DR: Prevalence surveys of tardive dyskinesia in neuroleptic-treated patients are reviewed and it is suggested that advancing age and female sex are the two variables most consistently associated with increased prevalence.
Abstract: • Fifty-six prevalence surveys of tardive dyskinesia (TD) in neuroleptic-treated patients are reviewed, yielding an average prevalence of 20% as compared with 5% prevalence of "spontaneous" dyskinesia in 19 samples of untreated individuals. Reported prevalence has increased during the past two decades and is not attributable simply to the more widespread use of rating scales. Controlled studies of a variety of risk factors are reviewed and suggest that advancing age and, to a lesser extent, female sex are the two variables most consistently associated with increased prevalence. There are relatively few data supporting the assumption that the risk of TD development continues to increase with increasing neuroleptic exposure, CNS dysfunction, or exposure to antiparkinsonism medication.
615 citations
TL;DR: A survey evaluated current and lifetime rates of psychiatric disorders in 533 opiate addicts in treatment at a multimodality program, suggesting the importance of detecting and attending to psychopathology associated with opiate addiction.
Abstract: A survey evaluated current and lifetime rates of psychiatric disorders in 533 opiate addicts in treatment at a multimodality program. Information was gathered using a structured interview format, the Schedule for Affective Disorders and Schizophrenia-Lifetime version, and the criteria were the Research Diagnostic Criteria. Most were give the diagnosis of at least one psychiatric disorder in addition to opiate addiction. The most common diagnoses were major depressive disorder, alcoholism, and antisocial personality, and rates of chronic minor mood disorders and anxiety disorders also were found to be elevated in comparison with those found in a community population. In contrast, rates of schizophrenia and mania were very low and did not exceed those reported for the general population. The findings are interpreted as suggesting the importance of detecting and attending to psychopathology associated with opiate addiction.
564 citations
TL;DR: Discrepancies between the symptoms of depression, as found in a self-report questionnaire, and the diagnosis of major depression as made by the Research Diagnostic Criteria occurred in a community survey.
Abstract: • Discrepancies between the symptoms of depression, as found in a self-report questionnaire (Center for Epidemiologic Studies-Depression Scale [CES-D]), and the diagnosis of major depression as made by the Research Diagnostic Criteria (RDC) occurred in a community survey. The discrepancies can be explained by the subject's psychiatric or medical disorders other than depression, by nay saying during the interview, or by the exclusion criteria of the RDC (duration of symptoms, role impairment, or help seeking) that are not part of the CES-D. Results show that the discrepancies can be readily explained.
540 citations
TL;DR: Local cerebral uptake of deoxyglucose labeled with fluorine 18 was measured by positron-emission tomography in eight patients with schizophrenia and in six age-matched normal volunteers, indicating relatively lower glucose use than normal control subjects.
Abstract: • Local cerebral uptake of deoxyglucose labeled with fluorine 18 was measured by positron-emission tomography in eight patients with schizophrenia who were not receiving medication and in six age-matched normal volunteers. Subjects sat in an acoustically treated, darkened room with eyes closed after injection of 3 to 5 mCi of deoxyglucose18F. After uptake, seven to eight horizontal brain scans parallel to the canthomeatal line were done. Scans were treated digitally, with a 2.3-cm strip peeled off each slice and ratios to whole-slice activity computed. Patients with schizophrenia showed lower ratios in the frontal cortex, indicating relatively lower glucose use than normal control subjects; this was consistent with previously reported studies of regional cerebral blood flow. Patients also showed diminished ratios for a 2.3-cm square that was positioned over central gray-matter areas on the left but not on the right side. These findings are preliminary; issues of control of mental activity, brain structure identification, and biologic and anatomic heterogeneity of schizophrenia remain to be explored.
509 citations
TL;DR: All predictors were shown to have high specificity for bipolar outcome, whereas pharmacologic hypomania and symptom cluster permitted the highest confidence of prediction, 100% and 80%, respectively.
Abstract: • Sixty adolescents, aged 13 to 16 years, hospitalized for major depression were studied prospectively for three to four years to determine the utility of clinical, genetic, and pharmacologic response variables in predicting a bipolar course of illness. Bipolar outcome was observed in 20% of the cohort. Statistical analyses showed that bipolarity was predicted by (1) a depressive symptom cluster comprising rapid symptom onset, psychomotor retardation, and mood-congruent psychotic features; (2) a "loading" of affective disorder in the family pedigree, a family history of bipolar illness, and the presence of illness in three successive generations of the pedigree; and (3) pharmacologically induced hypomania. All predictors were shown to have high specificity for bipolar outcome, whereas pharmacologic hypomania and symptom cluster permitted the highest confidence of prediction, 100% and 80%, respectively. Even in juvenile depression, careful attention to clinical and biologic variables may aid in the predictive differentiation of meaningful diagnostic subtypes.
TL;DR: Although few differences were apparent in material from schizophrenic and nonpsychiatric cases in sections stained for cellular structures, myelin, or axis cylinders, Holzer's stain for glial fibrils demonstrated increased flbrillary gliosis that affected principally the periventricular structures of the diencephalon, the periaqueductal region of the mesencephalons, or the basal forebrain in three fourths of the brains from schizophreniaic subjects.
Abstract: Histologic sections were made from selected regions of the brains of 25 schizophrenic patients aged 21 to 54 years (mean, 43.5 years) who died during their hospitalization at St Elizabeths Hospital, Washington, DC. These sections were compared with similarly prepared sections from the same brain regions of 28 nonschizophrenic patients of similar age, who were hospitalized and died at the same hospital during the same period, and with sections from 20 age-matched, nonpsychiatric patients who died in a general hospital. Although few differences were apparent in material from schizophrenic and nonpsychiatric cases in sections stained for cellular structures, myelin, or axis cylinders, Holzer's stain for glial fibrils demonstrated increased fibrillary gliosis that affected principally the periventricular structures of the diencephalon, the periaqueductal region of the mesencephalon, or the basal forebrain in three fourths of the brains from schizophrenic subjects. Hypothalamus, midbrain tegmentum, and substantia innominata were most often affected. The nature and distribution of the findings suggest previous or low-grade inflammation. Review of the clinical history and course of each case allows some correlations to be made between clinical signs and histopathologic data.
TL;DR: Starting treatment during a major or minor depressive episode was predictive of poorer outcome in the areas of illicit drug use and psychological symptoms, but unrelated to the areasof occupational functioning, legal problems, and program retention.
Abstract: • Evaluations of diagnosis and symptoms of depression were undertaken in 157 opiate addicts at entrance to a multimodality drug treatment program and six months later. While 17% were having an episode of major depression (defined by Research Diagnostic Criteria) and 60% had at least mildly elevated depressive symptoms at entrance to treatment, substantial improvement was noted at the six-month reevaluation, with the rates of major depression and elevated symptoms dropping to 12% and 31%, respectively. Symptomatic improvement, although related to retention in treatment, was not the result of specific antidepressant pharmacotherapy and did not differ across treatment modalities. Starting treatment during a major or minor depressive episode was predictive of poorer outcome in the areas of illicit drug use and psychological symptoms, but unrelated to the areas of occupational functioning, legal problems, and program retention.
TL;DR: These findings support the corollary that the lack of social support contributes to the creation of depressive symptoms and may itself be important in ameliorating depressive symptoms.
Abstract: • The buffering model of social support states that effective social support networks lessen the adverse psychological consequences of stress. Among a large community sample (N=1,000) of Los Angeles County adults interviewed in 1979, life-event losses and perceived strain were positively related to depressive symptomatology, while close relationships and perceived support were negatively related to these symptoms. In all models tested, these effects were found to be direct effects, not interaction effects as predicted by the buffering model. The effects of stress on depressive symptomatology were similar among those with low and high levels of social support. Social support, instead of merely protecting an individual against the negative impact of stress, may itself be Important in ameliorating depressive symptoms. Moreover, assuming that lack of perceived or actual social support is not just a manifestation of depression itself, our findings support the corollary that the lack of social support contributes to the creation of depressive symptoms.
TL;DR: In postmortem samples of caudate nucleus and nucleus accumbens from 48 schizophrenic patients, there were significant increases in both the maximum number of binding sites (Bmax) and the apparent dissociation constant (KD) for tritiated spiperone.
Abstract: In postmortem samples of caudate nucleus and nucleus accumbens from 48 schizophrenic patients, there were significant increases in both the maximum number of binding sites (Bmax) and the apparent dissociation constant (KD) for tritiated spiperone. The increase in apparent KD probably reflects the presence of residual neuroleptic drugs, but changes in Bmax for tritiated spiperone reflect genuine changes in receptor numbers. The increases in receptors were seen only in patients in whom neuroleptic medication had been maintained until the time of death, indicating that they may be entirely iatrogenic. Dopamine measurements for a larger series of schizophrenic and control cases (n greater than 60) show significantly increased concentrations in both the nucleus accumbens and caudate nucleus. The changes in dopamine were not obviously related to neuroleptic medication and, unlike the receptor changes, were most severe in younger patients.
TL;DR: Depression-related impairment was found on those cognitive and motor tasks that required sustained effort, suggesting a generalized deficit in the central motivational state of depressed individuals.
Abstract: • Motor performance and cognitive function were examined in depressed patients and controls. Increasing severity of depression was strongly associated with decrements in performance in both motor and memory tasks. Greatest depressionrelated impairment was found on those cognitive and motor tasks that required sustained effort. We discuss these results in terms of a generalized deficit in the central motivational state of depressed individuals.
TL;DR: In this article, a review of recent epidemiological studies involving psychosocial risk factors for affective disorders is presented, and the results of these studies are divided into the categories of depressive symptoms, bipolar depressive disorder, and non-bipolar depressive disorder.
Abstract: • Data from recent epidemiological studies involving psychosocial risk factors for affective disorders are reviewed. The results of these studies are divided into the categories of depressive symptoms, bipolar depressive disorder, and nonbipolar depressive disorder. When the data are examined using these categories, remarkable consistency in psychosocial risk factors for depressive symptoms and nonbipolar depressive disorder is observed, suggesting possible continuity between these conditions. Psychosocial risk factors for bipolar disorder differ substantially from those identified for depressive symptoms and nonbipolar depressive disorder and, therefore, provide further support for the bipolar-nonbipolar distinction.
TL;DR: It is concluded that panic disorder accounted for much of the excess mortality formerly noted in the "neuroses," and secondary depression and alcoholism may have had a role in these deaths.
Abstract: • We located 113 former inpatients with panic disorder 35 years after index admission. According to age-and sex-specific Iowa population figures, patients with panic disorder had significant excess mortality due to death by unnatural causes. Other studies suggest that secondary depression and alcoholism may have had a role in these deaths. Men with panic disorder also exhibited excess mortality due to circulatory system disease. In an age-and sex-matched patient group with primary unipolar depression, both men and women showed excess mortality. Suicide accounted for 20.0% and 16.2% of deaths in the panic disorder and primary depression groups, respectively. We conclude that panic disorder accounted for much of the excess mortality formerly noted in the "neuroses."
TL;DR: It is concluded that spontaneous involuntary disorders of movement can be a feature of severe, chronic schizophrenia unmodified by neuroleptic drugs.
Abstract: • Using two standardized recording techniques (the Abnormal Involuntary Movement Scale [AIMS] and the Rockland Scale), spontaneous involuntary movement disorder was assessed in a sample of 411 hospitalized patients with chronic schizophrenia, 47 of whom apparently had never been exposed to neuroleptic medication. Prevalence of abnormality clearly depended on the criteria of severity adopted, but overall it was high, with half of the sample on the AIMS and two thirds on the Rockland Scale rating 3 (moderate) or more on one item or more. Comparison of those with a history of treatment with neuroleptics and those with no such history showed few significant differences with regard to prevalence, severity, and distribution of abnormal involuntary movements. We concluded that spontaneous involuntary disorders of movement can be a feature of severe, chronic schizophrenia unmodified by neuroleptic drugs.
TL;DR: The results suggest that, in some schizophrenic patients, ventricular enlargement and less frequently cortical atrophy predate the onset of psychoses and are not a result of psychiatric treatment.
Abstract: • To assess whether computed tomographic findings are present at the onset of schizophrenia, we evaluated CT scans of 35 patients with first-episode schizophreniform disorder, 17 with chronic schizophrenia, 23 with affective disorders, 27 with other psychiatric disorders, and 26 controls. Both the schizophreniform and the chronic schizophrenic patients had significantly larger cerebral ventricles than did the other psychiatric or control subjects. Ventricular size in the patients with affective disorder was not significantly different than in any of the other groups. Twenty percent of the schizophreniform patients had enlarged ventricles, (ventricular-brain ratio, > 10). The only other subjects outside this limit were four chronic schizophrenic patients (24%). Five schizophreniform patients and three with affective disorder had evidence of mild cortical atrophy. The results suggest that, in some schizophrenic patients, ventricular enlargement and less frequently cortical atrophy predate the onset of psychoses and are not a result of psychiatric treatment.
TL;DR: Comparison of diagnoses based on family history with diagnosis based on direct interview indicated that the specificity for the family history method is high, but that the sensitivity is generally low; spouses and offspring provided more accurate information than parents and siblings.
Abstract: • This methodologic study assessed the accuracy of family history data in ascertaining psychiatric disorders in relatives. Comparison of diagnoses based on family history with diagnoses based on direct interview indicated that the specificity for the family history method is high, but that the sensitivity is generally low. Accuracy was better for affective disorders and alcoholism than for less severe disorders; spouses and offspring provided more accurate information than parents and siblings. The use of multiple informants increased sensitivity somewhat, with little adverse effect on specificity. However, because errors were often correlated when more than one person provided information about a particular relative, the use of multiple informants generally did not improve accuracy substantially. Analysis of family-genetic studies should take account of the differential quality of data obtained by the family history method vs direct interview.
TL;DR: Several clinical variables were statistically significant predictors of recovery when measured from entry into the study: superimposition of the acute episode on a chronic underlying depression, acuteness of onset of he depression, and severity of depression for the subgroup of patients without superimposed illness.
Abstract: • Regression models and life tables were used to describe the phenomenon of recovery from major depressive disorder for 101 patients in a naturalistic study in which treatment was not controlled by the investigators. Time to recovery from the onset of the episode was protracted, as only about 50% of patients recovered by one year. Annual rates of recovery then declined steadily to 28% in the second year, 22% in the third year, and 18% in the fourth year. In contrast, speed of recovery from entry into the study was more rapid, and 63% of patients recovered by four months. The recovery rates were about 20% each month for the first four months and then declined sharply for the remaining months of the one-year follow-up. Several clinical variables were statistically significant predictors of recovery when measured from entry into the study: superimposition of the acute episode on a chronic underlying depression, acuteness of onset of the depression, and severity of depression for the subgroup of patients without superimposed illness.
TL;DR: In a matched controlled study of 90 psychiatric patient suicides, it was found that significantly more of the suicides suffered from chronic schizophrenia or recurrent affective disorder and had made a previous suicide attempt.
Abstract: • In a matched controlled study of 90 psychiatric patient suicides, I found that significantly more of the suicides suffered from chronic schizophrenia (33.3%) or recurrent affective disorder (18.8%) and had made a previous suicide attempt (46.6%). The suicides were young and significantly more were unmarried (84.5%), unemployed (66%), living alone, (55.5%) and depressed (65.5%), and 44.4% had a primary diagnosis of depressive disorder. Of the 75 outpatient suicides, 58% had seen a psychiatrist within the previous week, 61 of the 75 (81.3%) had been admitted in their last episode of contact, and 44% of these suicided within a month of discharge.
TL;DR: The requirement that a subject be competent as a condition of valid consent to participate in research has been accepted by most students of legal and ethical problems of human experimentation but has lacked a clear and generally agreed on standard.
Abstract: • The requirement that a subject be competent as a condition of valid consent to participate in research has been accepted by most students of legal and ethical problems of human experimentation. "Competency," however, has lacked a clear and generally agreed on standard. There are four commonly used standards for competency: evidencing a choice in regard to research participation, factual understanding of the issues, rational manipulation of information, and appreciation of the nature of the situation. These standards can be arranged hierarchically such that each represents a stricter test of competency. The decision as to how rigorous a standard for competency is desirable cannot be made on psychiatric grounds. It requires consideration of the policy goals one hopes to attain. Empirical research helps demonstrate the consequences of choosing a particular standard but cannot replace the need for achieving consensus on policy goals.
TL;DR: A high risk of relapse was detected shortly after recovery and the presence of an underlying chronic depression and three or more previous affective episodes predicted a statistically significant increase in the rate of relapse.
Abstract: • With the use of life tables to describe time while patients were well and subsequent rates of relapse for 75 patients after their recovery from an episode of major depressive disorder in a naturalistic study, a high risk of relapse was detected shortly after recovery. Twenty-four percent of patients relapsed within 12 weeks at risk, and 12% of patients relapsed within four weeks at risk. The presence of an underlying chronic depression and three or more previous affective episodes predicted a statistically significant increase in the rate of relapse. These data were used to develop an exponential model of relapse probability for a subgroup of the study population.
TL;DR: A model for this disorder of information processing is created that resolves some paradoxic findings and suggests directions for future study that shows schizophrenics have a deficiency in information processing that can be characterized as conscious, serial, and limited in channel capacity.
Abstract: A disorder of information processing must be present for a person to receive the diagnosis of schizophrenia, and is present when schizophrenic symptoms occur along with other diseases We created a model for this disorder that resolves some paradoxic findings and suggests directions for future study Basically, schizophrenics have a deficiency in information processing that can be characterized as conscious, serial, and limited in channel capacity In contrast, those processes that seem automatic, unconscious, parallel, and almost unlimited in capacity seem to be normal or supernormal
TL;DR: The results suggest that in depression the of the presynaptic alpha 2-adrenergic receptor is not abnormal, and the number of postsynaptic adrenergic receptors may be decreased.
Abstract: • Several recent investigations have raised the possibility that the sensitivity of α2-adrenergic receptor may be of etiologic importance in depression. To assess whether abnormalities in the presynaptic α2-adrenergic receptor exist in depressed patients not taking drugs, the effects of an α2agonist, clonidine, on plasma 3-methoxy-4-hydroxyphenelethyleneglycol (MHPG) and on blood pressure (BP) were evaluated in 15 depressed patients and 12 healthy controls of similar age. The ability of clonidine to increase growth hormone (GH) secretion was also assessed. The effect of clonidine on plasma MHPG and BP was not different between the depressed patients and controls. However, the GH response to clonidine was blunted in the depressed patients. These results suggest that in depression (1) the sensitivity of the presynaptic α2-adrenergic receptor is not abnormal, and (2) the sensitivity of postsynaptic adrenergic receptors may be decreased.
TL;DR: The National Institute of Mental Health Diagnostic Interview Schedule (DIS) was described by its originators in the April 1981 issue of theArchives and was subject to further discussion in the correspondence from Endicott and from Heizer and Robins in the November 1981 issue.
Abstract: To the Editor. —The National Institute of Mental Health Diagnostic Interview Schedule (DIS) was described by its originators, Robins et al, in the April 1981 issue of theArchives(1981;38: 381-389) and was subject to further discussion in the correspondence from Endicott and from Heizer and Robins in the November 1981 issue (1981;38: 1300-1301). We have been using the DIS ourselves in a study of the recognition and management of depressive disorders in the psychiatric and primary medical care sectors, and have the following observations. In a completely structured interview like the DIS, we do not expect reliability to be low, and the initial data from St Louis support this. We are, however, less confident of its validity. As Endicott pointed out in her letter, agreement between computer-derived diagnoses indicat 3 high reliability but not necessarily validity because there is no external criterion of validity, such as a clinical diagnosis.
TL;DR: There appears to be a need for more emphasis on ongoing involuntary treatment for male inmates of county jail, characterized by extensive experience with both the criminal justice and mental health systems, severe acute and chronic mental illness, and poor functioning.
Abstract: • One hundred two male inmates of a county jail, randomly selected from those referred for psychiatric evaluation, were studied. Ninety percent had had psychiatric hospitalization; 92% had prior arrest records, 75% for felonies. Four fifths exhibited severe, overt psychopathology. More than three fourths met the criteria for involuntary hospitalization. When arrested, more than one third were transients and only 12% were employed. Thus, this population is characterized by extensive experience with both the criminal justice and mental health systems, severe acute and chronic mental illness, and poor functioning. More than half were currently charged with felonies and 39% with crimes of violence. We were also attempted to determine why inmates had been arrested rather than hospitalized and whether there has been "criminalization" of the mentally ill. There appears to be a need for more emphasis on ongoing involuntary treatment for this population.
TL;DR: The Penn Psychotherapy Project reports further progress in its search for the factors predicting the outcomes of psychotherapy through the construction of the Penn Helping Alliance Rating Method, based on two types of patients' statements during psychotherapy sessions.
Abstract: • The Penn Psychotherapy Project reports further progress in its search for the factors predicting the outcomes of psychotherapy through the construction of the Penn Helping Alliance Rating Method. This method is based on the following two types of patients' statements during psychotherapy sessions: type 1, that the therapist is helping the patient, and type 2, that the patient and therapist are working together in a team effort to help the patient. The scales were applied reliably to the transcripts from ten patients who had improved the most and ten who had improved the least among the 73 in the project. Significant predictive correlations were found for the early helping alliance measures (eg, with status at the termination of treatment and with the composite of "success, satisfaction, and improvement"). In contrast, other theoretically important treatment variables were not significant predictors.