摘要:

This report contains a theoretical discussion of psychiatric diagnosis and reflects a broad cross-cultural perspective. The current theory that appears to underlie psychiatric diagnosis in biomedicine is outlined and examined from the standpoint of its similarities and differences to diagnostic systems in other, more elementary, systems of medicine. Problems posed by the nature of psychiatric illness, as these relate more broadly to the theory and enterprise of diagnosis and classification, are reviewed. The report addresses the nature of category structure models in psychiatry, the differences between the classification of illness and natural objects, the influence of symbolic/cultural/historical factors in psychiatric illness ascertainment, different parameters of a measurement approach to psychiatric diagnosis, and the problem of co-occurrence of psychiatric illness. Whenever possible, the rationale and system of DSM-III is used for purposes of discussion and illustration. The aim of the report is to outline and review these and related factors to conceptualize the enterprise of psychiatric illness diagnosis in a broad comparative social medical frame of reference.

ISSN:0022-3018    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Although DSM-III personality disorder criteria have demonstrated acceptable reliability, the question of validity has not been adequately addressed. A first step in establishing the validity of diagnoses is to establish the validity of the criteria used to assess each diagnosis. The content validity of diagnostic criteria was investigated in relation to the larger set of potential criteria culled from the psychiatric literature. For each DSM-III axis II diagnosis, a panel of clinicians rated how prototypical each potential criterion was of the diagnosis in question. The results reveal problems with the organization and content of the criteria for most diagnoses. Many DSM-III criteria are composed of several statements linked by conjunctions or disjunctions. These component statements often received markedly different ratings, suggesting that criteria should be single statements. For most diagnoses, traits not included in DSM-III received higher ratings than did some DSM-III criteria. Suggestions are made to improve the distinctiveness and content validity of paranoid, schizoid, antisocial, borderline, avoidant, dependent, and compulsive personality disorders. The results for schizotypal personality disorder suggest that many clinicians are uncertain about this diagnosis. These findings provide a systematic way to modify definitions that contrasts with the more arbitrary ways in which diagnoses have previously been defined and redefined.

ISSN:0022-3018    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Parent, teacher, and child reports were used to identify situational and personal factors associated with school refusal in 114 3- to 13-year-old Venezuelan children. The sample consisted of 57 school refusers and 57 nonrefusers matched on age, school, and sex. As compared with nonrefusers, the refusers had changed schools more often, were rated as more dependent, had more school-related fears, and were perceived by their parents as more difficult to manage. Stepwise multiple regression analyses revealed that school refusal status could be predicted by both situational and personality variables including the child's fear level, dependency, depression, frequency of school changes, history of refusal in the family, and other variables. Refusal onset frequently coincided with situational stress (e.g., the beginning of the school year, a new school or teacher, or trouble with a teacher or peers). Categories of refusal resembled those of other studies and included adjustment reaction, school phobia, and emotional disturbance. In the future, these risk factors can be used to identify and treat potential school refusers

ISSN:0022-3018    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

First proposed by Kiresuk in 1968, Goal Attainment Scaling has been widely and enthusiastically accepted as an evaluation tool in service delivery and education. However, it has not been much used in controlled research, probably because its reliability and validity have been questioned by critics. The authors have used Goal Attainment Scaling as one of a number of outcome measures in a research project on the effect of family intervention on inpatients. In the course of doing so, they have developed guidelines for gathering information, constructing goal scales, selecting expected outcome levels, and categorizing subsequent outcome data. They believe that these guidelines have clinical integrity and that their use would improve the reliability of goal attainment scaling without detracting from its value as an individualized measure. With these modifications, Goal Attainment Scaling can be made more systematic and therefore more reliable without losing its intrinsic value as an individually targeted outcome measure.

ISSN:0022-3018    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The relationship to treatment outcome (as measured by the National Institute of Drug Abuse Client-Oriented Data Acquisition Process [NIDA-CODAP] Reasons for Discharge classification) of specific characteristics and elements of 22 drug-free residential programs for adolescents is reported. Admission and discharge data were obtained from NIDACODAP on 2,532 adolescents in the 22 programs. A partial cross-validation study was conducted by analyzing separately for two annual client subsamples. The program, not the individual client, was the unit of analysis. When three differences between programs in their client populations were “partialed out” the following characteristics of programs were found to predict positively to outcome (a lower treatment failure rate) to a statistically significant degree: a) the number of years that the counselors had worked in the programs; b) the number of volunteer staff in direct service (client contact); c) the proportion of clients receiving bodily and mental relaxation techniques; d) the counselors' perceptions that their programs accept or encourage relatively more spontaneous personal expressiveness, including expression of anger by clients, in staff-client relationships, but encourage less client “autonomy” (to be self-sufficient and independent with regard to making their own decisions); e) the counselors report that providing practical assistance in solving clients' real-life problems is useful. There was a high degree of replication of these findings across the two annual subsamples of clients. These findings for adolescents in residential programs are compared with findings reported in a parallel study of treatment outcome for adolescents in outpatient programs.

ISSN:0022-3018    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

There is evidence that adult substance abusers tend to have high rates of psychiatric symptomatology and diagnosable psychiatric disorders and that those with more severe psychiatric problems show lower levels of improvement. This paper examines whether these same two findings also hold for adolescent substance abusers. The outcome of treatment, in a day treatment center in a private vocational high school setting, for 130 court-referred substance-abusing delinquent boys aged 14 to 18 years was studied in relation to their psychic symptomatology at admission, as measured by the Brief Symptom Inventory and the Emotional Reaction Inventory. The unexpected finding, although not conclusive, shows that there is a slight tendency among these young clients for those who report more psychiatric symptoms to improve more, rather than less, with treatment. For example, a greater score on the borderline psychotic subscale of the Emotional Reaction Scale predicted to more improvement as measured by reduction in drug use. A response set explanation was postulated for this finding: those clients who were more self-evaluative and more open and self-revealing about their disturbing inner thoughts and feelings might have been more trusting, more ready, and better motivated for counseling. The following are some possible explanations for the fact that the findings are different from those of some studies reported for adult substance abusers: (a) adolescent drug abusers have, or are aware of having, or report, less psychiatric symptomatology, than adult abusers or addicts; (b) our study sample included only court-referred delinquents; and (c) there are differences in research methodology, specifically in the types of instruments and measures used. In any event, further research with adolescent drug abusers on the relationships between psychiatric status at admission and treatment outcome is indicated.

ISSN:0022-3018    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Cocaine is a potent dopamine agonist that frequently stimulates the central nervous system and is often manifested by increased psychomotor activity, impulsivity, euphoria, and rapid thoughts. Attention deficit disorder (ADD) and bipolar disorder also present with physical restlessness, racing thoughts, distractibility, and mood instability. Although these three disorders rarely appear in the same individual, they are important differential diagnoses when considering any one illness with the above symptom complexes. We report two cases of cocaine abuse with ADD residual type in patients who were previously diagnosed as having atypical bipolar disorder. The adverse effects were reversed by the dopamine agonist bromocriptine.

ISSN:0022-3018    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A case of a rare form of delusional misidentification, the Fregoli syndrome, is described. Although usually occurring in the setting of primary or secondary schizophrenic psychoses, delusional misidentification has been reported in affective, neurological, and toxic-metabolic disorders. In this instance a diagnosis of paranoia (delusional disorder) secondary to predominantly right hemisphere pathology, rather than schizophrenia, seemed more appropriate.

ISSN:0022-3018    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1987

数据来源: OVID