Despite extensive research and a vast literature, the diagnosis of schizophrenia remains primarily a clinical decision based upon the presence of some agreed-upon symptom complex. Laboratory studies and special testing procedures have not yet demonstrated their utility in establishing diagnosis in this syndrome. While it is easy to cite studies of diagnostic difficulty (Beck, 1962), it is also apparent that when clinicians state they are ‘certain of the diagnosis' or agree to utilize pre-established diagnostic stereotypes, the diagnostic agreement frequently achieves an 80 per cent reliability (Beck, 1962; Hordern et al., 1968). Clinicians the world over tend to identify gross symptoms in similar ways. However, they may ascribe varying significance to similar symptom complexes and may even use similar symptom constellations to arrive at different diagnoses (Saenger, 1968; Sandifer et al., 1968). There seems to be general agreement on the major symptoms found in schizophrenia (Cooper, 1967; Beck et al., 1962; Hordem et al., 1968); however, diagnostic agreement on subtypes, and on admixtures of paranoid symptoms and depression is much more difficult to achieve (Cooper, 1967; Morgan et al., 1968; Lorr and Klett, 1968; Hordem et al., 1968). The present study attempts to formalize the apparent commonality of clinical features which together establish a diagnosis of schizophrenia through the development of a valid and reliable checklist of symptoms.
To determine the demographics, DSM-III-R disorders diagnosed, indications used in recommending psychoanalysis, previous treatment histories, use of medication, and length of treatment in patients in psychoanalysis in the U.S., Canada, and Australia, a mail survey of practice was sent to every other active member of the American Psychoanalytic Association and every member of the Australian Psychoanalytical Society. This supplemented an earlier survey sent to all Ontario psychoanalysts. The response rates were 40.1 % (n = 342) for the U.S., 67.2% (n = 117) for Canada, and 73.9% (n = 51) for Australia. Respondents supplied data on 1,718 patients. The employment rate for patients increases as analysis progresses (p < .0001). The mean number of concurrent categories of disorders (Axis I, Axis II, and Disorders First Evident in Childhood) per patient at the start of treatment is 5.01 (SD = 3.66; median = 4; mode = 3). There are no statistically significant differences across countries. Mood, anxiety, sexual dysfunction, and personality disorders are most common. American Psychiatric Association / American Psychoanalytic Association peer review criteria for indicating psychoanalysis are followed for 86.5% of patients. Over 80% of patients in all three countries had undergone previous treatments prior to analysis. In the U.S., 18.2% of analysands are on concurrent psychoactive medication; in Australia, 9.6%. The mean length of analyses conducted in the U.S. is 5.7 years, in Australia 6.6, and in Canada 4.8. Psychoanalytic patients in all three countries have similar rates of DSM-III-R psychopathology, and many indications of chronicity.
A study was conducted to validate our previous work on the DSM-III-R disorders diagnosed in patients in psychoanalysis in the U.S., Canada, and Australia and to determine which specific mood, anxiety, and personality disorders were the most common in these patients. The earlier study consisted of three surveys of psychoanalytic practice that together obtained data on 1,718 patients, through extensive mail surveys to analysts in the three countries. In the validation study, 206 patients were diagnosed using a different technique. Analysts similar in important respects to those who participated in the original surveys rated patients diagnostically before and after DSM-III-R training. After training, no significant changes appeared in the rates for any of the specific mood disorders. For the thirty disorders examined, training effects decreased the identification of the generalized anxiety disorder, and increased the identification of three personality disorders: avoidant, dependent, and personality disorder not otherwise specified. Thus, analysts slightly underdiagnosed the number of personality disorders, and some "anxious" patients appear to have qualified for personality disorders. Some limitations of the DSM-III-R notion of narcissistic personality are discussed, as are the importance and stability of the self-defeating (masochistic) personality disorder. The most common Axis I disorder in psychoanalytic patients was dysthymia, followed by major depression, recurrent. This study reinforces the findings of the original three surveys. Minor corrections were developed to adjust the original three surveys.
This questionnaire study was designed to confirm and further explore an earlier finding of a gender difference in post‐termination patient‐analyst contact, as well as to assess whether practices regarding post‐termination contact have changed in the five‐year interval since the first study. The hypothesis that women analysts are more likely to have post‐termination contact with their analysands than men analysts was confirmed by the present study. Analysts who report thinking frequently about their most significant analyst are contacted by a much larger proportion of prior patients than those who rarely think about their analyst. Further, women analysts are more likely to feel they benefited from the analysis they consider their most significant analysis, and to feel positively about that analyst. In 1994, analysts were much more accepting of and more likely to propose post‐termination contact than in 1989. What the analyst reports he/she says to the patient is associated with the likelihood of such contact.
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