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An investigation of competency to participate in legal proceedings in Canada.

https://arctichealth.org/en/permalink/ahliterature207362
Source
Can J Psychiatry. 1997 Oct;42(8):869-75
Publication Type
Article
Date
Oct-1997
Author
K E Whittemore
J R Ogloff
R. Roesch
Author Affiliation
Simon Fraser University, Burnaby, British Columbia.
Source
Can J Psychiatry. 1997 Oct;42(8):869-75
Date
Oct-1997
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Antisocial Personality Disorder - classification - diagnosis - psychology
Canada
Humans
Insanity Defense
Male
Mental Competency - legislation & jurisprudence
Mental Disorders - classification - diagnosis - psychology
Mental Status Schedule - statistics & numerical data
Middle Aged
Psychiatric Status Rating Scales - statistics & numerical data
Psychometrics
Abstract
To assess fitness to stand trial, competency to plead guilty, and competency to understand Charter cautions to determine if the level of competency varies across these domains.
The Fitness Interview Test-Revised (FIT-R) and the Test of Charter Comprehension (ToCC) were administered to a group of individuals held on remand for fitness evaluations. Additionally, several questions from the FIT-R that address the ability to make a guilty plea were assessed separately and constituted an individual measure of competency to plead guilty (CoP).
As predicted, the results indicated that the fact that an individual is competent at one juncture in the criminal proceedings does not mean that the individual necessarily is competent at all other stages of the proceedings.
These findings suggest a need for a stage-specific approach to forensic competency assessments, requiring specialized instruments designed to assess the legal issues of competency at the various stages of legal proceedings.
PubMed ID
9356777 View in PubMed
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Decision making in psychiatric civil commitment: an experimental analysis.

https://arctichealth.org/en/permalink/ahliterature227177
Source
Am J Psychiatry. 1991 Jan;148(1):28-33
Publication Type
Article
Date
Jan-1991
Author
R M Bagby
J S Thompson
S E Dickens
M. Nohara
Author Affiliation
Department of Psychology, Clarke Institute of Psychiatry, Toronto, Ont., Canada.
Source
Am J Psychiatry. 1991 Jan;148(1):28-33
Date
Jan-1991
Language
English
Publication Type
Article
Keywords
Adult
Canada
Commitment of Mentally Ill - standards
Dangerous Behavior
Decision Making
Female
Forensic Psychiatry
Humans
Male
Mental Disorders - classification - diagnosis - psychology
Mentally Ill Persons
Middle Aged
Psychotic Disorders - classification - diagnosis - psychology
Self Care - psychology
United States
Abstract
Legislation in Canada and the United States that was intended to decrease the use of civil commitment has resulted in a paradoxical increase in involuntary hospital admissions. To elucidate the reasons for this increase, this study was designed to assess the relative importance of various factors involved in the decision to commit a patient.
All psychiatrists in Ontario were sent a questionnaire asking them to make commitment decisions based on hypothetical case vignettes. Four factors were systematically varied in the vignettes: the patients' legal commitability, clinical treatability, alternative resources, and psychotic symptoms. Completed questionnaires, with three vignettes each, were returned by 495 respondents.
All four variables were statistically significant in the expected direction; legal commitability (i.e., dangerousness to self and/or others, inability to care for self) and presence of psychotic symptoms accounted for the majority of the variance in the final decision to commit.
These results suggest that psychiatrists in Ontario rely primarily on legally mandated factors (i.e., psychosis and dangerousness) in making their decisions to commit, although a considerable amount of individual variation is also evident.
PubMed ID
1984703 View in PubMed
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DSM-5 field trials in the United States and Canada, Part III: development and reliability testing of a cross-cutting symptom assessment for DSM-5.

https://arctichealth.org/en/permalink/ahliterature119334
Source
Am J Psychiatry. 2013 Jan 1;170(1):71-82
Publication Type
Article
Date
Jan-1-2013
Author
William E Narrow
Diana E Clarke
S Janet Kuramoto
Helena C Kraemer
David J Kupfer
Lisa Greiner
Darrel A Regier
Author Affiliation
American Psychiatric Association, Division of Research and American Psychiatric Institute for Research and Education, Arlington, Va., USA. wnarrow@psych.org
Source
Am J Psychiatry. 2013 Jan 1;170(1):71-82
Date
Jan-1-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Canada
Child
Cross-Cultural Comparison
Diagnostic and Statistical Manual of Mental Disorders
Humans
Mental Disorders - classification - diagnosis - psychology
Multicenter Studies as Topic
Patient Care Planning
Prognosis
Psychometrics - statistics & numerical data
Randomized Controlled Trials as Topic - methods - statistics & numerical data
Reproducibility of Results
Sampling Studies
Symptom Assessment - methods - statistics & numerical data
United States
Abstract
The authors sought to document, in adult and pediatric patient populations, the development, descriptive statistics,and test-retest reliability of cross-cutting symptom measures proposed for inclusion in DSM-5.
Data were collected as part of the multisite DSM-5 Field Trials in large academic settings. There were seven sites focusing on adult patients and four sites focusing on child and adolescent patients.Cross-cutting symptom measures were self-completed by the patient or an informant before the test and the retest interviews, which were conducted from 4 hours to 2 weeks apart. Clinician-report measures were completed during or after the clinical diagnostic interviews. Informants included adult patients, child patients age 11 and older, parents of all child patients age 6 and older, and legal guardians for adult patients unable to self-complete the measures. Study patients were sampled in a stratified design,and sampling weights were used in data analyses. The mean scores and standard deviations were computed and pooled across adult and child sites. Reliabilities were reported as pooled intraclass correlation coefficients (ICCs) with 95% confidence intervals.
In adults, test-retest reliabilities of the cross-cutting symptom items generally were good to excellent. At the child and adolescent sites, parents were also reliablereporters of their children’s symptoms,with few exceptions. Reliabilities were not as uniformly good for child respondents, and ICCs for several items fell into the questionable range in this age group. Clinicians rated psychosis with good reliability in adult patients but were less reliable in assessing clinical domains related to psychosis in children and to suicide in all age groups.
These results show promising test-retest reliability results for this group of assessments, many of which are newly developed or have not been previously tested in psychiatric populations
PubMed ID
23111499 View in PubMed
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DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses.

https://arctichealth.org/en/permalink/ahliterature119336
Source
Am J Psychiatry. 2013 Jan 1;170(1):59-70
Publication Type
Article
Date
Jan-1-2013
Author
Darrel A Regier
William E Narrow
Diana E Clarke
Helena C Kraemer
S Janet Kuramoto
Emily A Kuhl
David J Kupfer
Author Affiliation
American Psychiatric Association, Division of Research and American Psychiatric Institute for Research and Education, Arlington, Va, USA. dregier@psych.org
Source
Am J Psychiatry. 2013 Jan 1;170(1):59-70
Date
Jan-1-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Anxiety Disorders - classification - diagnosis - psychology
Canada
Child
Comorbidity
Cross-Cultural Comparison
Depressive Disorder, Major - classification - diagnosis - psychology
Diagnosis, Differential
Diagnostic and Statistical Manual of Mental Disorders
Humans
Mental Disorders - classification - diagnosis - psychology
Multicenter Studies as Topic - statistics & numerical data
Patient Care Planning
Prognosis
Psychotic Disorders - classification - diagnosis - psychology
Randomized Controlled Trials as Topic - methods - statistics & numerical data
Reproducibility of Results
Statistics as Topic
Suicidal ideation
Suicide - prevention & control - psychology
United States
Abstract
The DSM-5 Field Trials were designed to obtain precise (standard error,0.1) estimates of the intraclass kappa asa measure of the degree to which two clinicians could independently agree on the presence or absence of selected DSM-5 diagnoses when the same patient was interviewed on separate occasions, in clinical settings, and evaluated with usual clinical interview methods.
Eleven academic centers in the United States and Canada were selected,and each was assigned several target diagnoses frequently treated in that setting.Consecutive patients visiting a site during the study were screened and stratified on the basis of DSM-IV diagnoses or symptomatic presentations. Patients were randomly assigned to two clinicians for a diagnostic interview; clinicians were blind to any previous diagnosis. All data were entered directly via an Internet-based software system to a secure central server. Detailed research design and statistical methods are presented in an accompanying article.
There were a total of 15 adult and eight child/adolescent diagnoses for which adequate sample sizes were obtained to report adequately precise estimates of the intraclass kappa. Overall, five diagnoses were in the very good range(kappa=0.60–0.79), nine in the good range(kappa=0.40–0.59), six in the questionable range (kappa = 0.20–0.39), and three in the unacceptable range (kappa values,0.20). Eight diagnoses had insufficient sample sizes to generate precise kappa estimates at any site.
Most diagnoses adequately tested had good to very good reliability with these representative clinical populations assessed with usual clinical interview methods. Some diagnoses that were revised to encompass a broader spectrum of symptom expression or had a more dimensional approach tested in the good to very good range.
PubMed ID
23111466 View in PubMed
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[Erik Essen-Möller and the roots of multiaxial classification in psychiatry].

https://arctichealth.org/en/permalink/ahliterature134760
Source
Fortschr Neurol Psychiatr. 2011 May;79(5):277-82
Publication Type
Article
Date
May-2011
Author
M. Jäger
K. Frasch
T. Becker
Author Affiliation
Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Bezirkskrankenhaus Günzburg. markus.jaeger@bkh-guenzburg.de
Source
Fortschr Neurol Psychiatr. 2011 May;79(5):277-82
Date
May-2011
Language
German
Publication Type
Article
Keywords
Diagnostic and Statistical Manual of Mental Disorders
History, 20th Century
Humans
Mental Disorders - classification - diagnosis - psychology
Neuropsychological Tests
Psychiatric Status Rating Scales - history
Psychiatry - history
Sweden
Syndrome
Abstract
Against the background of the preparation of ICD-11 and DSM-V, the historical roots of a multiaxial diagnostic assessment in psychiatry are reviewed. The principles of such an approach are traced back to the Swedish psychiatrist Erik Essen-Möller who had proposed a distinction between aetiological and descriptive aspects in the classification of mental disorders. Furthermore, he suggested to break down the descriptive classification into the cross-sectional psychopathological picture and the clinical course. Nowadays, a multiaxial assessment is used in diagnostic systems such as DSM-IV. However, these current concepts differ considerably from Essen-Möller's suggestions. A return to the original approach of multiaxial diagnostic assessment comprising the axes "syndromes", "course types" and "aetiology" would be in line with current neurobiological findings and may provide a bridge between the traditional categorical diagnostic approach and dimensional models.
PubMed ID
21544760 View in PubMed
Less detail

Field trial of a diagnostic axis for defense mechanisms for DSM-IV.

https://arctichealth.org/en/permalink/ahliterature46346
Source
J Personal Disord. 1998;12(1):56-68
Publication Type
Article
Date
1998
Author
J C Perry
P. Hoglend
K. Shear
G E Vaillant
M. Horowitz
M E Kardos
H. Bille
D. Kagan
Author Affiliation
Cambridge Hospital, MA, USA.
Source
J Personal Disord. 1998;12(1):56-68
Date
1998
Language
English
Publication Type
Article
Keywords
Adult
Aged
Chi-Square Distribution
Defense Mechanisms
Depression - psychology
Diagnosis, Differential
Evaluation Studies
Feasibility Studies
Female
Humans
Male
Manuals - standards
Mental Disorders - classification - diagnosis - psychology
Middle Aged
Norway
Observer Variation
Personality Disorders - psychology
Psychiatry - methods - standards
Reproducibility of Results
Research Support, Non-U.S. Gov't
Terminology
United States
Abstract
Following critiques that the DSM multiaxial system lacks psychodynamic information useful for treatment, an axis for defense mechanisms was developed for DSM-IV, including up to 7 individual defenses from a glossary of 27, and 3 predominant defense levels from a list of 7. We tested the feasibility, reliability, and discriminability of the proposed axis. Clinician and psychiatric resident volunteers were trained at two U.S. and one Norwegian sites. After conducting initial interviews on 107 patients, they rated the DSM-III-R and defense axes, as did a second blind rater. Median kappa reliabilities were .42 (individual defenses), and .47 (defense levels). A summary measure, Overall Defensive Functioning (ODF), had similar reliability to current GAF (IR .68 vs. .62), similar 1-month stability (.75 vs. .78), but greater 6-month stability (.51 vs. .17). Independent of Axis III, ODF had small to moderate associations with other Axes and symptoms. Our findings indicate that the defense axis is a feasible, acceptably reliable, and nonredundant addition to DSM-IV, which may prove useful for planning and conducting treatment.
PubMed ID
9573520 View in PubMed
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ICD-10 classification in Danish child and adolescent psychiatry--have diagnoses changed after the introduction of ICD-10?

https://arctichealth.org/en/permalink/ahliterature78415
Source
Nord J Psychiatry. 2007;61(1):71-8
Publication Type
Article
Date
2007
Author
Møller Lene Ruge
Sørensen Merete Juul
Thomsen Per Hove
Author Affiliation
Psychiatric Hospital for Children and Adolescents, Aarhus University Hospital, Harald Selmersvej 66, Risskov, 8240, Denmark.
Source
Nord J Psychiatry. 2007;61(1):71-8
Date
2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adolescent Psychiatry - methods
Child
Child, Preschool
Denmark
Diagnosis, Differential
Female
Humans
International Classification of Diseases
Male
Mental Disorders - classification - diagnosis - psychology
Registries
Severity of Illness Index
Sex Factors
Abstract
The aim was to test this in a nationwide register study of diagnoses used in child and adolescents psychiatry in Denmark. A larger number of different diagnoses were expected to be applied after the introduction of the 10th version of the International Classification of Diseases (ICD-10). Reflecting the time trend, we particularly expected an increase in the number of neuropsychiatric diagnoses. From the Danish Psychiatric Central Register data were drawn on clinical discharge diagnoses. All patients aged 0-15 years examined at psychiatric hospitals from 1995-2002 were included; 22,469 children and adolescents with a first contact were registered. The most frequent discharge diagnoses were pervasive development disorders (PDD; 11.9%), adjustment disorders (10.6%), conduct disorder (9.5%), emotional and anxiety disorders (7.6%), hyperkinetic disorders (7.3%), and specific developmental disorders (7.3%). We found a significant increase in the number of neuropsychiatric and affective diagnoses and a significant decrease in the number of adjustment, conduct and anxiety diagnoses during the study period. Of the 22,469 diagnoses, 45% were only partly specified according to ICD-10. Thirty-four per cent had diagnoses unspecified on the four-character level (Fxx.9) and 11% had Z-diagnoses. A larger number of different diagnoses and an increase in the use of neuropsychiatric diagnoses were seen after the introduction of ICD-10. Many diagnoses were only partly specified; consequently, a more detailed specification of the ICD-10 is still required.
PubMed ID
17365792 View in PubMed
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Is a diagnosis-based classification system appropriate for funding psychiatric care in Alberta?

https://arctichealth.org/en/permalink/ahliterature213960
Source
Can J Psychiatry. 1995 Nov;40(9):507-13
Publication Type
Article
Date
Nov-1995
Author
C M Wellock
Author Affiliation
Alberta Hospital Edmonton.
Source
Can J Psychiatry. 1995 Nov;40(9):507-13
Date
Nov-1995
Language
English
Publication Type
Article
Keywords
Alberta
Cost-Benefit Analysis
Diagnosis-Related Groups - economics
Humans
Length of Stay - economics
Mental Disorders - classification - diagnosis - psychology - therapy
Patient Discharge - economics
Reimbursement Mechanisms - economics
Abstract
This study evaluated the appropriateness of the Refined Group Number (RGN) classification system for funding psychiatric discharges in Alberta.
Multiple regression was used to calculate the amount of variation explained (R2) in length of stay by RGNs for psychiatric discharges. The distribution of short-stay cases (less than 5 days) was also reviewed.
The R2 value was higher than those from American studies (0.284 versus less than 0.10) for psychiatric discharges. The length of stay distribution by RGN indicated that the mean was not representative of typical cases. Short-stay cases made up the majority of cases from rural hospitals and had a negative impact on the average length of stay.
The RGN methodology performed better than diagnosis-based classification systems in the United States. However, there were significant weaknesses in the classification system which suggest that a funding system using the RGN grouper would result in inequitable funding for psychiatric discharges.
PubMed ID
8574985 View in PubMed
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The joint structure of DSM-IV Axis I and Axis II disorders.

https://arctichealth.org/en/permalink/ahliterature101854
Source
J Abnorm Psychol. 2011 Feb;120(1):198-209
Publication Type
Article
Date
Feb-2011
Author
Espen Røysamb
Kenneth S Kendler
Kristian Tambs
Ragnhild E Orstavik
Michael C Neale
Steven H Aggen
Svenn Torgersen
Ted Reichborn-Kjennerud
Author Affiliation
Norwegian Institute of Public Health and University of Oslo, Norway. espen.roysamb@psykologi.uio.no
Source
J Abnorm Psychol. 2011 Feb;120(1):198-209
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Adult
Diagnostic and Statistical Manual of Mental Disorders
Diseases in Twins - classification - diagnosis - psychology
Factor Analysis, Statistical
Female
Humans
Male
Mental Disorders - classification - diagnosis - psychology
Models, Psychological
Norway
Personality Assessment
Psychometrics
Questionnaires
Twins - psychology
Abstract
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.
PubMed ID
21319931 View in PubMed
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Routine evaluation of mental health: reliable information or worthless "guesstimates'?

https://arctichealth.org/en/permalink/ahliterature212749
Source
Acta Psychiatr Scand. 1996 Feb;93(2):125-8
Publication Type
Article
Date
Feb-1996
Author
H. Loevdahl
S. Friis
Author Affiliation
Department of Clinical Psychiatric Research, Ullevaal University Hospital, Oslo, Norway.
Source
Acta Psychiatr Scand. 1996 Feb;93(2):125-8
Date
Feb-1996
Language
English
Publication Type
Article
Keywords
Diagnosis, Differential
Humans
Mental Disorders - classification - diagnosis - psychology
Norway
Observer Variation
Patient care team
Personality Inventory - statistics & numerical data
Psychometrics
Reproducibility of Results
Abstract
Routine evaluation of mental health care systems necessitates a quick assessment of progress and outcome. This study was designed to determine the value of the GAF-scale in such applications. We allowed 104 raters from six therapeutic centres to rate five clinical case-vignettes. Interrater reliability was almost equal for raters within different professional categories. The highest and the lowest scores for each of the case-vignettes differed by between 39 and 45 points. The raters' biases ranged from -23 to +30 points, and random deviations were between 1 and 20 points. Systematic differences between centres were up to 6 points. Our main finding is that the reliability of GAF scores in routine settings proved unsatisfactory with entrained raters.
PubMed ID
8686482 View in PubMed
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10 records – page 1 of 1.