A survey of the uses and attitudes of 146 mental health professionals, primarily psychiatrists and psychologists, in 42 countries (not including the United States) toward the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and its revision (DSM-III-R; American Psychiatric Association, 1980,1987) is reported. The results revealed wide-spread endorsement of the multiaxial system, theoretical neutrality, descriptive symptom criteria forming discrete categories, and the placement of personality disorders on a separate axis. We report that the DSM-III and DSM-III-R are more widely used around the world than the International Classification of Diseases for teaching, research, and clinical practice. Opinions about various dimensions of the DSM's usefulness and shortcomings are presented.

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Reviewing the recent literature on the overlapping spectrum of neurotic depressive and dysthymic conditions--unofficially referred to as "minor," "atypical" or "characterologic" depressives--the authors conclude that significant symptomatologic admixtures with anxiety disorders do not represent the prototypical features of these disorders as defined in DSM-III-R. It is long-standing anhedonia on an intermittent or chronic basis which appears to characterize the trait illness of dysthymia. The emerging data on dysthymia suggest that it begins early in life, is often complicated by major depressions, and pursues a chronic--often pernicious--course. The development of hypomanic switches during the prospective course of some of these patients further suggests some kinship to bipolar disorder. Although traditionally conceived as being largely "psychogenic," familial data and selected biologic indices--especially in the area of sleep--and thymoleptic responsiveness impart some credibility to the role of biologic factors in the origin of these disorders. Given the high prevalence of dysthymic conditions in clinical practice, new research strategies on their causes are needed as a precondition for more rational treatment approaches.

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Dzflerential diagnosis of patients whose course of illness includes substantial psychotic and mood syndromes is among the most challenging in psychiatry. The relative temporal preponderance of one or the other of these syndromes over course of illness forms the basis for distinctions among DSM-III-R diagnoses of schizoaflective disorder (SA), bipolar disorder (BPD), and schizophrenia (SZ); and such temporal assesmnents may be especially diflcult to make reliably. Elsewhere we report relatively low reliability of SA and a tendency for it be "con.ed" with SZ and BPD. I n this paper, we identi3 clinical variables that increase diagnostic diflerentiation. Data are fiom a Diagnostic Interview for Genetic Studies (DIGS) reliability study in which patients with independently assessed DSM-III-R lifetime diagnoses of SA-bipolar subtype,(SA-BP), BPD, and SZ were also clinically assessed and diagnosed by the DIGS on two occasions by t w o diflerent interviewers blind to entry diagnoses. The relative strength of DIGS-based DSM-III-R diagnoses and individual DIGS clinical variables in predicting entry diagnoses is shown in a series of logistic regression analyses. Models incorporating DIGS variables are more predictive of entry diagnoses than models using DIGS diagnoses alone. Based o n DIGS information, the SA-BP group is more clearly diflerentiated fiom the BPD group than fiom the SZ group. Dzflerent proJiles of DIGS variables distinguish the groups. Findings are discussed in terms of their implications for nosologic research. Depression 3:309-315 (1 99511 996). 0 1996 Wiley-Liss, Inc. *