Browsing by Subject "DSM-IV"

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  • Haravuori, Henna; Kiviruusu, Olli; Suomalainen, Laura; Marttunen, Mauri (2016)
    Background: The proposed posttraumatic stress disorder (PTSD) criteria for the International Classification of Diseases (ICD) 11th revision are simpler than the criteria in ICD-10, DSM-IV or DSM-5. The aim of this study was to evaluate the ICD-11 PTSD factor structure in samples of young people, and to compare PTSD prevalence rates and diagnostic agreement between the different diagnostic systems. Possible differences in clinical characteristics of the PTSD cases identified by ICD-11, ICD-10 and DSM-IV are explored. Methods: Two samples of adolescents and young adults were followed after exposure to similar mass shooting incidents in their schools. Semi-structured diagnostic interviews were performed to assess psychiatric diagnoses and PTSD symptom scores (N = 228, mean age 17.6 years). PTSD symptom item scores were used to compose diagnoses according to the different classification systems. Results: Confirmatory factor analyses indicated that the proposed ICD-11 PTSD symptoms represented two rather than three factors; re-experiencing and avoidance symptoms comprised one factor and hyperarousal symptoms the other factor. In the studied samples, the three-factor ICD-11 criteria identified 51 (22.4 %) PTSD cases, the two-factor ICD-11 identified 56 (24.6 %) cases and the DSM-IV identified 43 (18.9 %) cases, while the number of cases identified by ICD-10 was larger, being 85 (37.3 %) cases. Diagnostic agreement of the ICD-11 PTSD criteria with ICD-10 and DSM-IV was moderate, yet the diagnostic agreement turned to be good when an impairment criterion was imposed on ICD-10. Compared to ICD-11, ICD-10 identified cases with less severe trauma exposure and posttraumatic symptoms and DSM-IV identified cases with less severe trauma exposure. Conclusions: The findings suggest that the two-factor model of ICD-11 PTSD is preferable to the three-factor model. The proposed ICD-11 criteria are more restrictive compared to the ICD-10 criteria. There were some differences in the clinical characteristics of the PTSD cases identified by ICD-11, when compared to ICD-10 and DSM-IV.
  • Söderholm, John J.; Socada, J. Lumikukka; Rosenström, Tom; Ekelund, Jesper; Isometsä, Erkki T. (2020)
    ObjectiveWe investigated risk factors for suicidal ideation and behavior among currently depressed patients with major depressive disorder (MDD), major depressive episode (MDE) in bipolar disorder (BD), or MDE with comorbid borderline personality disorder (MDE/BPD). We compared current and lifetime prevalence of suicidal ideation and behavior, and investigated dimensional measures of BPD or mixed affective features of the MDE as indicators of risk.MethodsBased on screening of 1,655 referrals, we recruited 124 psychiatric secondary care outpatients with MDE and stratified them into three subcohorts (MDD, BD, and MDE/BPD) using the Structured Clinical Interview for DSM-IV I and II. We examined suicidal ideation and behavior with the Columbia Suicide Severity Rating Scale (CSSRS). In addition, we quantified the severity of BPD symptoms and BD mixed features both categorically/diagnostically and dimensionally (using instruments such as the Borderline Personality Disorder Severity Index) in two time frames.ResultsThere were highly significant differences between the lifetime prevalences of suicide attempts between the subcohorts, with attempts reported by 16% of the MDD, 30% of the BD, and 60% of the BPD subcohort. Remarkably, the lifetime prevalence of suicide attempts in patients with comorbid BD and BPD exceeded 90%. The severity of BPD features was independently associated with risk of suicide attempts both lifetime and during the current MDE. It also associated in a dose-dependent manner with recent severity of ideation in both BPD and non-BPD patients. In multinominal logistic regression models, hopelessness was the most consistent independent risk factor for severe suicidal ideation in both time frames, whereas younger age and more severe BPD features were most consistently associated with suicide attempts.ConclusionsAmong patients with major depressive episodes, diagnosis of bipolar disorder, or presence of comorbid borderline personality features both imply remarkably high risk of suicide attempts. Risk factors for suicidal ideation and suicidal acts overlap, but may not be identical. The estimated severity of borderline personality features seems to associate with history of suicidal behavior and current severity of suicidal ideation in dose-dependent fashion among all mood disorder patients. Therefore, reliable assessment of borderline features may advance the evaluation of suicide risk.
  • Lehtokari, Vilma-Lotta (Helsingfors universitet, 2015)
    Eating disorders are a group of psychiatric disorders characterized by disturbances in eating behaviors, attitudes towards food, and body image. The diagnoses of eating disorders are based on specific diagnostic criteria agreed upon by expert committees. The disorders and the diagnostic criteria are collected in diagnostic manuals. In this study, the Diagnostic and Statistical research Manual of Mental Disorders (DSM) of American Psychiatric Association was used because it is used consistently in international research into eating disorders. The current Fifth Edition of the DSM (DSM-5).was published in 2013. The previous edition was published in 1994 (DSM-IV). The eating disorders specified in DSM-IV were anorexia nervosa (AN) and bulimia nervosa (BN). The remaining disorders were categorized as Eating Disorders Not Otherwise Specified (EDNOS). EDNOS consists of binge eating disorder (BED), atypical anorexia (A-AN) and atypical bulimia (A-BN). In the updated edition, DSM-5, BED has been recognized as its own separate eating disorder, and the diagnostic criteria of AN, and BN has been revised and broadened. Those eating disorders that still remain outside these definitions are classified as Other Specified Feeding and Eating Disorders (OSFED). OSFED eating disorders are A-AN, A-BN, A-BED, purging disorder (PD) and night eating disorder. The objective of this thesis was to survey and identify atypical eating disorders among Finnish young women in the FinnTwin16-cohort, and to find out how the changes in the diagnostic criteria of the DSM affects this group of eating disorders. The FinnTwin16-cohort includes all Finnish twins born in 1975-1979. The health and well-being of the twins has been followed regularly since the age of 16 using questionnaires and interviews. The questionnaire for mental disorders, including the eating disorders was sent to the twins in 1998.The eating disorder survey focused on women. Of the female twins, 2835 returned the forms, and 548 of them were subsequently interviewed over the telephone for a more detailed picture of the person’s eating disorder. According to the survey, 185 of the women had an eating disorder. Using the diagnostic criteria of DSM-IV, 55 had AN, and 46 BN. The remaining 84 women were diagnosed as having EDNOS. The EDNOS cases were re-classified using the DSM-5 diagnostic criteria, whereby 31 of them were diagnosed with AN, 14 with BN, and one with BED. An OSFED diagnosis was established in 38 women. With the change of diagnostic criteria, the prevalence of atypical eating disorders fell from 3 % to 1.3%, and the 15-year incidence from 180 to 76 new cases per 100 000 person-years. The OSFED cases were sub-categorized as follows: 13 women had A-AN, ten A-BN, four PD 4, and five A-BED. Seven women were classified as having fluctuating OSFED: symptoms that either transformed from one subtype to another or alternated with asymptomatic periods. One patient first had A–BN, and after recovering, years later, A-AN. Night eating disorder was not assessed in this study. A-AN, or PD were more transient than other types of EDNOS: no one had an eating disorder for longer than five years. These groups also included the most underweight patients. Seventy-six percent of the women studied were of normal weight. A-BED, and fluctuating OSFED were longest in duration. The weight of the women in these groups continued to increase. Depression was linked to chronic, long-term OSFEDs and binge eating, whereas life crises lead to more severe but transient forms of OSFED.
  • Riihimaki, K.; Sintonen, H.; Vuorilehto, M.; Jylhä, P.; Saarni, S.; Isometsa, E. (2016)
    Background: Depressive disorders are known to impair health-related quality of life (HRQoL) both in the short and long term. However, the determinants of long-term HRQoL outcomes in primary care patients with depressive disorders remain unclear. Methods: In a primary care cohort study of patients with depressive disorders, 82% of 137 patients were prospectively followed up for five years. Psychiatric disorders were diagnosed with SCID-I/P and SCID-II interviews; clinical, psychosocial and socio-economic factors were investigated by rating scales and questionnaires plus medical and psychiatric records. HRQoL was measured with the generic 15D instrument at baseline and five years, and compared with an age-standardized general population sample (n = 3707) at five years. Results: Depression affected the 15D total score and almost all dimensions at both time points. At the end of follow-up, HRQoL of patients in major depressive episode (MDE) was particularly low, and the association between severity of depression (Beck Depression Inventory [BDI]) and HRQoL was very strong (r = -0.804). The most significant predictors for change in HRQoL were changes in BDI and Beck Anxiety Inventory (BAI) scores. The mean 15D score of depressive primary care patients at five years was much worse than in the age-standardized general population, reaching normal range only among patients who were in clinical remission and had virtually no symptoms. Conclusions: Among depressive primary care patients, presence of current depressive symptoms markedly reduces HRQoL, with symptoms of concurrent anxiety also having a marked impact. For HRQoL to normalize, current depressive and anxiety symptoms must be virtually absent. (C) 2016 Elsevier Masson SAS. All rights reserved.
  • Savolainen, Iina; Sirola, Anu; Kaakinen, Markus; Oksanen, Atte (2019)
    Gambling opportunities have increased rapidly during recent years. Previous research shows that gambling is a popular activity among youth, which may contribute to problem gambling. This study examined how social identification with online and offline peer groups associates with youth problem gambling behavior and if perceived social support buffers this relationship. Data were gathered with an online survey with 1212 American and 1200 Finnish participants between 15 and 25 years of age. Measures included the South Oaks Gambling Screen for problem gambling, and items for peer group identification and perceived social support. It was found that youth who identify strongly with offline peer groups were less likely to engage in problem gambling, while strong identification with online peer groups had the opposite effect. We also found that the associations between social identification and problem gambling behavior were moderated by perceived social support. Online peer groups may be a determinant in youth problem gambling. Focusing on offline peer groups and increasing social support can hold significant potential in youth gambling prevention.
  • Vuorilehto, Maria S.; Melartin, Tarja K.; Riihimaki, Kirsi; Isometsa, Erkki T. (2016)
    Background: Primary health care bears the main responsibility for treating depression in most countries. However, few studies have comprehensively investigated provision of pharmacological and psychosocial treatments, their continuity, or patient attitudes and adherence to treatment in primary care. Methods: In the Vantaa Primary Care Depression Study, 1111 consecutive primary care patients in the City of Vantaa, Finland, were screened for depression with Prime-MD, and 137 were diagnosed with DSM-IV depressive disorders via SCID-I/P and SCID-Il interviews. The 100 patients with current major depressive disorder (MDD) or partly remitted MDD at baseline were prospectively followed up to 18 months, and their treatment contacts and the treatments provided were longitudinally followed. Results: The median number of patients' visits to a general practitioner during the follow-up was five; of those due to depression two. Antidepressant treatment was offered to 82% of patients, but only 50% commenced treatment and adhered to it adequately. Psychosocial support was offered to 49%, but only 29% adhered to the highly variable interventions. Attributed reasons for poor adherence varied, including negative attitude, side effects, practical obstacles, or no perceived need. About one-quarter (23%) of patients were referred to specialized care at some time-point. Limitations: Moderate sample size. Data collected in 2002-2004. Conclusions: The majority of depressive patients in primary health care had been offered pharmacotherapy, psychotherapeutic support, or both. However, effectiveness of these efforts may have been limited by lack of systematic follow-up and poor adherence to both pharmacotherapy and psychosocial treatment. (C) 2016 Elsevier B.V. All rights reserved.
  • Saloheimo, Hannu P.; Markowitz, John; Saloheimo, Tuija H.; Laitinen, Jarmo J.; Sundell, Jari; Huttunen, Matti O.; Aro, Timo A.; Mikkonen, Tuitu N.; Katila, Heikki O. (2016)
    Background: The purpose of this study is to assess the relative effectiveness of Interpersonal Psychotherapy (IPT), Psychoeducative Group Therapy (PeGT), and treatment as usual (TAU) for patients with Major Depressive Disorder (MDD) in municipal psychiatric secondary care in one Finnish region. Methods: All adult patients (N = 1515) with MDD symptoms referred to secondary care in 2004-2006 were screened. Eligible, consenting patients were assigned randomly to 10-week IPT (N = 46), PeGT (N = 42), or TAU (N = 46) treatment arms. Antidepressant pharmacotherapy among study participants was evaluated. The Hamilton Depression Rating scale (HAM-D) was the primary outcome measure. Assessment occurred at 1, 5, 3, 6, and 12 months. Actual amount of therapists' labor was also evaluated. All statistical analyses were performed with R software. Results: All three treatment cells showed marked improvement at 12-month follow-up. At 3 months, 42 % in IPT, 61 % in PeGT, and 42 % in TAU showed a mean >= 50 % in HAM-D improvement; after 12 months, these values were 61 %, 76 %, and 68 %. Concomitant medication and limited sample size minimized between-treatment differences. Statistically significant differences emerged only between PeGT and TAU favoring PeGT. Secondary outcome measures (CGI-s and SOFAS) showed parallel results. Conclusion: All three treatments notably benefited highly comorbid MDD patients in a public sector secondary care unit.
  • Baryshnikov, I.; Suvisaari, J.; Aaltonen, K.; Koivisto, M.; Melartin, T.; Näätänen, P.; Suominen, K.; Karpov, B.; Heikkinen, M.; Oksanen, J.; Paunio, T.; Joffe, G.; Isometsä, E. (2018)
    Background: Self-reported psychosis-like experiences (PEs) may be common in patients with mood disorders, but their clinical correlates are not well known. We investigated their prevalence and relationships with self-reported symptoms of depression, mania, anxiety, borderline (BPD) and schizotypal (SPD) personality disorders among psychiatric patients with mood disorders. Methods: The Community Assessment of Psychic Experiences (CAPE-42), Mood Disorder Questionnaire (MDQ), McLean Screening Instrument (MSI), The Beck Depressive Inventory (BDI), Overall Anxiety Severity and Impairment Scale (OASIS) and Schizotypal Personality Questionnaire-Brief form (SPQ-B) were filled in by patients with mood disorders (n = 282) from specialized care. Correlation coefficients between total scores and individual items of CAPE-42 and BDI, SPQ-B, MSI and MDQ were estimated. Hierarchical multivariate regression analysis was conducted to examine factors influencing the frequency of self-reported PE. Results: PEs are common in patients with mood disorders. The "frequency of positive symptoms" score of CAPE-42 correlated strongly with total score of SPQ-B (rho = 0.63; P <0.001) and moderately with total scores of BDI, MDQ OASIS and MSI (rho varied from 0.37 to 0.56; P <0.001). Individual items of CAPE-42 correlated moderately with specific items of BDI, MDQ SPQ-B and MSI (r(phi) varied from 0.2 to 0.5; P <0.001). Symptoms of anxiety, mania or hypomania and BPD were significant predictors of the "frequency of positive symptoms" score of CAPE-42. Conclusions: Several, state- and trait-related factors may underlie self-reported PEs among mood disorder patients. These include cognitive-perceptual distortions of SPD; distrustfulness, identity disturbance, dissociative and affective symptoms of BPD; and cognitive biases related to depressive or manic symptoms. (C) 2016 Elsevier Masson SAS. All rights reserved.