2/15/13 Systematic evaluation of Axis I DSM diagnoses in delayed sleep phase disorder and evening type circadian preference

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Systematic evaluation of Axis I DSM diagnoses in delayed sleep phase disorder and evening type circadian

Search results for: Systematic evaluation of Axis I DSM diagnoses in delayed sleep phase
disorder and evening type circadian preference
Total sleep deprivation study in delayed sleep-phase syndrome
2011 Apr - Manzar MD, Hameed UA, Hussain ME - Indian journal of medical sciences
delayed sleep-phase syndrome (DSPS) is characterized by delayed sleep onset against the desired
clock time. It often presents with symptoms of sleep-onset insomnia or difficulty in awakening at the
desired time. We report the finding of sleep studies after 24 h total sleep deprivation (TSD) in a 28-year-
old DSPS male patient. He had characteristics of mild chronic DSPS, which may have been precipitated
by his frequent night shift assignments. The TSD improved the patients sleep latency and efficiency but all
other sleep variables showed marked differences.
PMID: 23250347

Prevalence, Incidence, Impairment, and Course of the Proposed DSM-5 Eating Disorder
diagnoses in an 8-Year Prospective Community Study of Young Women
2012 Nov 12 - Stice E, Marti CN, Rohde P - Journal of abnormal psychology
We examined prevalence, incidence, impairment, duration, and course for the proposed DSM-5 eating
disorders in a community sample of 496 adolescent females who completed annual diagnostic interviews
over 8 years. Lifetime prevalence by age 20 was 0.8% for anorexia nervosa (AN), 2.6% for bulimia
nervosa (BN), 3.0% for binge eating disorder (BED), 2.8% for atypical AN, 4.4% for subthreshold BN,
3.6% for subthreshold BED, 3.4% for purging disorder (PD), and combined prevalence of 13.1% (5.2%
had AN, BN, or BED; 11.5% had feeding and eating disorders not elsewhere classified; FED-NEC). Peak
onset age was 19-20 for AN, 16-20 for BN, and 18-20 for BED, PD, and FED-NEC. Youth with these
eating disorders typically reported greater functional impairment, distress, suicidality, mental health
treatment, and unhealthy body mass index, though effect sizes were relatively smaller for atypical AN,
subthreshold BN, and PD. Average episode duration in months ranged from 2.9 for BN to 11.2 for atypical
AN. One-year remission rates ranged from 71% for atypical AN to 100% for BN, subthreshold BN, and
BED. Recurrence rates ranged from 6% for PD to 33% for BED and subthrehold BED. Diagnostic
progression from subthreshold to threshold eating disorders was higher for BN and BED (32% and 28%)
than for AN (0%), suggesting some sort of escalation mechanism for binge eating. Diagnostic crossover
was greatest from BED to BN. Results imply that the new DSM-5 eating disorder criteria capture clinically
significant psychopathology and usefully assign eating disordered individuals to homogeneous diagnostic
categories. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
PMID: 23148784

The ability of CBCL DSM-oriented scales to predict DSM-IV diagnoses in a referred sample of
children and adolescents
2012 Nov 9 - Bellina M, Brambilla P, Garzitto M, Negri GA, Molteni M, Nobile M - European child &
adolescent psychiatry
The majority of studies examining associations between clinical-diagnostic and empirical-quantitative
approaches have concentrated only on the target diagnosis without taking into account any possible co-
variation of psychopathological traits, which is intrinsic to child psychopathology. The ability of child
behaviour checklist (CBCL) DSM-oriented scales (DOSs) to predict target and other DSM diagnoses,
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2/15/13 Systematic evaluation of Axis I DSM diagnoses in delayed sleep phase disorder and evening type circadian preference

taking into consideration the covariation of psychopathological traits, was analysed by logistic regression
analysis. Corresponding odds ratio (OR) was used as indicator of the strength of the relationship between
the clinical score in DOSs and the presence of DSM-IV diagnoses. Logistic regression allowed us to
consider multiple scales simultaneously, thus addressing the problem of co-occurrence of
psychopathological traits, and to include gender and age as covariates. The sample consisted of 360
children and adolescents aged 6-16 years, consecutively referred for behavioural and emotional
problems. As a whole, the CBCL DOSs seem to be more specific but with a weaker association with
DSM-IV diagnoses than syndrome scales, and with some distinctive features: clinical scores in the anxiety
DOS suggest a diagnosis of both anxiety and mood disorder; clinical scores in the somatic problems
DOS are very strong and specific predictors for diagnosis of separation anxiety disorder; clinical scores in
the oppositional defiant problems DOS are not only predictors of the oppositional defiant disorder but are
also strong predictors of generalized anxiety disorder; clinical scores in the conduct problems DOS are a
specific and strong predictor for oppositional defiant disorder. Results confirm the clinical usefulness of
CBCL and suggest using both syndrome and DOS scales for a complete and accurate assessment of
children and adolescents.
PMID: 23138539

Circadian and sleep disorder in Huntington's disease

2012 Oct 22 - Morton AJ - Experimental neurology
Huntington's disease is a progressive neurological disorder that starts insidiously with motor, cognitive or
psychiatric disturbance, and progresses through a distressing range of symptoms to end with a
devastating loss of function, both motor and executive. There is a growing awareness that, in addition to
cognitive and psychiatric symptoms, there are other important non-motor symptoms in HD, including sleep
and circadian abnormalities. It is not clear if sleep-wake changes are caused directly by HD gene-related
pathology, or if they are simply a consequence of having a neurodegenerative disease. From a patient
point of view, the answer is irrelevant, since sleep and circadian disturbances are deleterious to good
daily living, even in neurologically normal people. The assumption should be that, at the very least, sleep
and/or circadian disturbance in HD patients will contribute to their symptoms. At worst, they may contribute
to the progressive decline in HD. Here I review the state of our understanding of sleep and circadian
abnormalities in HD. I also outline a set of simple rules that can be followed to improve the chances of a
good night's sleep, since preventing any 'preventable' symptoms is the a logical first step in treating
disease. The long-term impact of sleep disruption in HD is unknown. There have been no large-scale
Systematic studies of in sleep in HD. Furthermore, there has never been a study of the efficacy of
pharmaceuticals that are typically used to treat sleep deficits in HD patients. Thus treatment of sleep
disturbance in HD is necessarily empirical. A better understanding of the relationship between
sleep/circadian abnormalities and HD pathology is needed, if treatment of this aspect of HD is to be
optimized.
PMID: 23099415 - DOI: 10.1016/j.expneurol.2012.10.014 - PII: S0014-4886(12)00397-4

Morning-evening type and burnout level as factors influencing sleep quality of shift nurses: a
questionnaire study

2011 Aug 15 - Demir Zencirci A, Arslan S - Croatian medical journal

AIM: To assess the relationship between sleep quality and demographic variables, morning-evening type,
and burnout in nurses who work shift.

METHODS: We carried out a cross-sectional self-administered study with forced choice and open-ended
structured questionnaires - Pittsburgh sleep Quality Index, Morningness-eveningness Questionnaire, and
Maslach Burnout Inventory. The study was carried out at Gazi University Medicine Faculty Hospital of
Ankara on 524 invited nurses from July to September 2008, with a response rate of 89.94% (n=483).
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2/15/13 Systematic evaluation of Axis I DSM diagnoses in delayed sleep phase disorder and evening type circadian preference

Descriptive and inferential statistics were applied to determine the risk factors of poor sleep quality.

RESULTS: Most socio-demographic variables did not affect sleep quality. Participants with poor sleep
quality had quite high burnout levels. Most nurses who belonged to a type that is neither morning nor
evening had poor sleep quality. Nurses who experienced an incident worsening their sleep patterns
(P<0.001) and needlestick or sharp object injuries (P=0.010) in the last month had poor sleep quality. The
subjective sleep quality and sleep latency points of evening types within created models for the effect of
burnout dimensions were high.

CONCLUSIONS: Nurses working consistently either in the morning or at night had better sleep quality than
those working rotating shifts. Further studies are still needed to develop interventions that improve sleep
quality and decrease burnout in nurses working shifts.
PMID: 21853548 - DOI: 10.1016/j.expneurol.2012.10.014 - PII: S0014-4886(12)00397-4

McLean-Harvard International First-Episode Project: two-year stability of DSM-IV diagnoses in

500 first-episode psychotic disorder patients
2009 Apr - Salvatore P, Baldessarini RJ, Tohen M, Khalsa HM, Sanchez-Toledo JP, Zarate CA Jr,
Vieta E, Maggini C - The Journal of clinical psychiatry
OBJECTIVE: Since stability of DSM-IV diagnoses of disorders with psychotic features requires validation,
we evaluated psychotic patients followed Systematically in the McLean-Harvard International First
Episode Project.

METHOD: We diagnosed 517 patients hospitalized in a first psychotic illness by SCID-based criteria at
baseline and at 24 months to assess stability of specific DSM-IV diagnoses.

RESULTS: Among 500 patients (96.7%) completing the study, diagnoses remained stable in 77.6%,
ranking as follows: bipolar I disorder (96.5%) > schizophrenia (75.0%) > delusional disorder (72.7%) >
major depressive disorder (MDD), severe, with psychotic features (70.1%) > brief psychotic disorder
(61.1%) > psychotic disorder not otherwise specified (NOS) (51.5%) >> schizophreniform disorder
(10.5%). Most changed diagnoses (22.4% of patients) were to schizoaffective disorder (53.6% of
changes in 12.0% of subjects, from psychotic disorder NOS > schizophrenia > schizophreniform disorder
= bipolar I disorder most recent episode mixed, severe, with psychotic features > MDD, severe, with
psychotic features > delusional disorder > brief psychotic disorder > bipolar I disorder most recent
episode manic, severe, with psychotic features). Second most changed diagnoses were to bipolar I
disorder (25.9% of changes, 5.8% of subjects, from MDD, severe, with psychotic features > psychotic
disorder NOS > brief psychotic disorder > schizophreniform disorder). Third most changed diagnoses
were to schizophrenia (12.5% of changes, 2.8% of subjects, from schizophreniform disorder > psychotic
disorder NOS > brief psychotic disorder = delusional disorder = MDD, severe, with psychotic features).
These 3 categories accounted for 92.0% of changes. By logistic regression, diagnostic change was
associated with nonaffective psychosis > auditory hallucinations > youth > male sex > gradual onset.

CONCLUSIONS: Bipolar I disorder and schizophrenia were more stable diagnoses than delusional
disorder or MDD, severe, with psychotic features, and much more than brief psychotic disorder, psychotic
disorder NOS, or schizophreniform disorder. Diagnostic changes mainly involved emergence of affective
symptoms and were predicted by several premorbid factors. The findings have implications for revisions
of DSM and ICD.
PMID: 19200422 - DOI: 10.1016/j.expneurol.2012.10.014 - PII: S0014-4886(12)00397-4

The joint structure of DSM-IV Axis I and Axis II disorders

2011 Feb - Røysamb E, Kendler KS, Tambs K, Orstavik RE, Neale MC, Aggen SH, Torgersen S,
Reichborn-Kjennerud T - Journal of abnormal psychology
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The Diagnostic and Statistical Manual (4th ed. [DSM-IV]; American Psychiatric Association, 1994)
distinction between clinical disorders on Axis I and personality disorders on Axis II has become
increasingly controversial. Although substantial comorbidity between axes has been demonstrated, the
structure of the liability factors underlying these two groups of disorders is poorly understood. The aim of
this study was to determine the latent factor structure of a broad set of common Axis I disorders and all
Axis II personality disorders and thereby to identify clusters of disorders and account for comorbidity within
and between axes. Data were collected in Norway, through a population-based interview study (N = 2,794
young adult twins). Axis I and Axis II disorders were assessed with the Composite International Diagnostic
Interview (CIDI) and the Structured Interview for DSM-IV Personality (SIDP-IV), respectively. Exploratory
and confirmatory factor analyses were used to investigate the underlying structure of 25 disorders. A four-
factor model fit the data well, suggesting a distinction between clinical and personality disorders as well as
a distinction between broad groups of internalizing and externalizing disorders. The location of some
disorders was not consistent with the DSM-IV classification; antisocial personality disorder belonged
primarily to the Axis I externalizing spectrum, dysthymia appeared as a personality disorder, and
borderline personality disorder appeared in an interspectral position. The findings have implications for a
meta-structure for the DSM.
PMID: 21319931 - DOI: 10.1016/j.expneurol.2012.10.014 - PII: S0014-4886(12)00397-4

Concurrent Validity of the Child Behavior Checklist DSM-Oriented Scales: Correspondence with
DSM diagnoses and Comparison to Syndrome Scales
2010 Sep - Ebesutani C, Bernstein A, Nakamura BJ, Chorpita BF, Higa-McMillan CK, Weisz JR; The
Research Network on Youth Mental Health - Journal of psychopathology and behavioral assessment
This study used receiver operating characteristic (ROC) methodology and discriminative analyses to
examine the correspondence of the Child Behavior Checklist (CBCL) rationally-derived DSM-oriented
scales and empirically-derived syndrome scales with clinical diagnoses in a clinic-referred sample of
children and adolescents (N = 476). Although results demonstrated that the CBCL Anxiety, Affective,
Attention Deficit/Hyperactivity, Oppositional and Conduct Problems DSM-oriented scales corresponded
significantly with related clinical diagnoses derived from parent-based structured interviews, these DSM-
oriented scales did not evidence significantly greater correspondence with clinical diagnoses than the
syndrome scales in all cases but one. The DSM-oriented Anxiety Problems scale was the only scale that
evidenced significantly greater correspondence with diagnoses above its syndrome scale counterpart -the
Anxious/Depressed scale. The recently developed and rationally-derived DSM-oriented scales thus
generally do not add incremental clinical utility above that already afforded by the syndrome scales with
respect to corresponding with diagnoses. Implications of these findings are discussed.

PMID: 20700377 - DOI: 10.1016/j.expneurol.2012.10.014 - PII: S0014-4886(12)00397-4

Circadian phase and sex effects on depressive/anxiety-like behaviors and HPA Axis responses
to acute stress
2010 Mar 3 - Verma P, Hellemans KG, Choi FY, Yu W, Weinberg J - Physiology &amp; behavior
Circadian dysregulation in sleep pattern, mood, and hypothalamic-pituitary-adrenal (HPA) Axis activity,
often occurring in a sexually dimorphic manner, are characteristics of depression. However, the inter-
relationships among circadian phase, HPA function, and depressive-like behaviors are not well
understood. We investigated behavioral and neuroendocrine correlates of depressive/anxiety-like
responses during diurnal ('light') and nocturnal ('dark') phases of the circadian rhythm in the open field
(OF), elevated plus maze (EPM), forced swim (FST), and sucrose contrast (SC) tests. Plasma
corticosterone (CORT) was measured after a) acute restraint and OF testing and b) FST. Both phase and
sex significantly influenced behavioral responses to stress. Males were more anxious than females on the
EPM in the light but not the dark phase. Further, the open:closed arm ratio was lower in the dark for
females, but not males. By contrast, in the FST, females showed more 'despair' (immobility) when tested
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2/15/13 Systematic evaluation of Axis I DSM diagnoses in delayed sleep phase disorder and evening type circadian preference

in the dark, while phase did not affect males. Acute restraint stress increased OF activity in the light, but
not the dark, phase. CORT levels were increased in both sexes following the FST, and in males and light
phase females post-OF. As expected, females had higher CORT levels than males, even at rest, and this
effect was more pronounced in the dark phase. Together, our data highlight the sexually dimorphic
influences of circadian phase and stress on behavioral and hormonal responsiveness.
PMID: 19932127 - DOI: 10.1016/j.expneurol.2012.10.014 - PII: S0014-4886(12)00397-4

Sensitivity and specificity: DSM-IV versus DSM-5 criteria for autism spectrum disorder
2012 Oct - Tsai LY - The American journal of psychiatry
PMID: 23032376 - DOI: 10.1016/j.expneurol.2012.10.014 - PII: S0014-4886(12)00397-4

What is a mental/psychiatric disorder? From DSM-IV to DSM-V

2010 Nov - Stein DJ, Phillips KA, Bolton D, Fulford KW, Sadler JZ, Kendler KS - Psychological
medicine
The distinction between normality and psychopathology has long been subject to debate. DSM-III and
DSM-IV provided a definition of mental disorder to help clinicians address this distinction. As part of the
process of developing DSM-V, researchers have reviewed the concept of mental disorder and
emphasized the need for additional work in this area. Here we review the DSM-IV definition of mental
disorder and propose some changes. The approach taken here arguably takes a middle course through
some of the relevant conceptual debates. We agree with the view that no definition perfectly specifies
precise boundaries for the concept of mental/psychiatric disorder, but in line with a view that the
nomenclature can improve over time, we aim here for a more scientifically valid and more clinically useful
definition.
PMID: 20624327 - DOI: 10.1016/j.expneurol.2012.10.014 - PII: S0014-4886(12)00397-4

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