Tags

Type your tag names separated by a space and hit enter

On the threshold of disorder: a study of the impact of the DSM-IV clinical significance criterion on diagnosing depressive and anxiety disorders in clinical practice.
J Clin Psychiatry. 2004 Oct; 65(10):1400-5.JC

Abstract

BACKGROUND

Two recent reanalyses of epidemiologic studies found that adding a clinical significance criterion reduced disorder prevalence. Patients presenting for clinical care are usually distressed or impaired by their symptoms; thus, the DSM-IV clinical significance criterion might have little impact on diagnosis in clinical practice. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examine the impact of the DSM-IV clinical significance criterion on diagnostic frequencies of depressive and anxiety disorders in psychiatric outpatients.

METHOD

1500 psychiatric outpatients were evaluated with the Structured Clinical Interview for DSM-IV. We determined the percentage of patients who met symptom criteria but did not meet the DSM-IV clinical significance criterion for major depressive disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), social phobia, specific phobia, panic disorder, and obsessive-compulsive disorder.

RESULTS

No patient who met the symptom criteria for current major depressive disorder or PTSD failed to meet the clinical significance criterion. Less than 2% of patients meeting the symptom criteria for current GAD did not meet the clinical significance criterion. There was variability among the remaining anxiety disorders in the percentage of symptomatic patients who met the clinical significance criterion.

CONCLUSION

In psychiatric patients, the clinical significance criterion had little impact on diagnosing major depressive disorder, GAD, and PTSD, disorders that are defined, in part, by disruptions of daily regulatory domains such as sleep, appetite, energy, and concentration. In contrast, the clinical significance criterion had a greater impact in determining whether phobic fears, obsessive thoughts, and panic attacks were sufficiently distressing or impairing to qualify for disorder status.

Authors+Show Affiliations

Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI, USA. mzimmerman@lifespan.orgNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15491245

Citation

Zimmerman, Mark, et al. "On the Threshold of Disorder: a Study of the Impact of the DSM-IV Clinical Significance Criterion On Diagnosing Depressive and Anxiety Disorders in Clinical Practice." The Journal of Clinical Psychiatry, vol. 65, no. 10, 2004, pp. 1400-5.
Zimmerman M, Chelminski I, Young D. On the threshold of disorder: a study of the impact of the DSM-IV clinical significance criterion on diagnosing depressive and anxiety disorders in clinical practice. J Clin Psychiatry. 2004;65(10):1400-5.
Zimmerman, M., Chelminski, I., & Young, D. (2004). On the threshold of disorder: a study of the impact of the DSM-IV clinical significance criterion on diagnosing depressive and anxiety disorders in clinical practice. The Journal of Clinical Psychiatry, 65(10), 1400-5.
Zimmerman M, Chelminski I, Young D. On the Threshold of Disorder: a Study of the Impact of the DSM-IV Clinical Significance Criterion On Diagnosing Depressive and Anxiety Disorders in Clinical Practice. J Clin Psychiatry. 2004;65(10):1400-5. PubMed PMID: 15491245.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - On the threshold of disorder: a study of the impact of the DSM-IV clinical significance criterion on diagnosing depressive and anxiety disorders in clinical practice. AU - Zimmerman,Mark, AU - Chelminski,Iwona, AU - Young,Diane, PY - 2004/10/20/pubmed PY - 2004/12/16/medline PY - 2004/10/20/entrez SP - 1400 EP - 5 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 65 IS - 10 N2 - BACKGROUND: Two recent reanalyses of epidemiologic studies found that adding a clinical significance criterion reduced disorder prevalence. Patients presenting for clinical care are usually distressed or impaired by their symptoms; thus, the DSM-IV clinical significance criterion might have little impact on diagnosis in clinical practice. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examine the impact of the DSM-IV clinical significance criterion on diagnostic frequencies of depressive and anxiety disorders in psychiatric outpatients. METHOD: 1500 psychiatric outpatients were evaluated with the Structured Clinical Interview for DSM-IV. We determined the percentage of patients who met symptom criteria but did not meet the DSM-IV clinical significance criterion for major depressive disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), social phobia, specific phobia, panic disorder, and obsessive-compulsive disorder. RESULTS: No patient who met the symptom criteria for current major depressive disorder or PTSD failed to meet the clinical significance criterion. Less than 2% of patients meeting the symptom criteria for current GAD did not meet the clinical significance criterion. There was variability among the remaining anxiety disorders in the percentage of symptomatic patients who met the clinical significance criterion. CONCLUSION: In psychiatric patients, the clinical significance criterion had little impact on diagnosing major depressive disorder, GAD, and PTSD, disorders that are defined, in part, by disruptions of daily regulatory domains such as sleep, appetite, energy, and concentration. In contrast, the clinical significance criterion had a greater impact in determining whether phobic fears, obsessive thoughts, and panic attacks were sufficiently distressing or impairing to qualify for disorder status. SN - 0160-6689 UR - https://www.unboundmedicine.com/medline/citation/15491245/On_the_threshold_of_disorder:_a_study_of_the_impact_of_the_DSM_IV_clinical_significance_criterion_on_diagnosing_depressive_and_anxiety_disorders_in_clinical_practice_ L2 - http://www.psychiatrist.com/jcp/article/pages/2004/v65n10/v65n1016.aspx DB - PRIME DP - Unbound Medicine ER -