Reliability and procedural validity of UM-CIDI DSM-III-R phobic disorders

Wittchen, Hans‐Ulrich; Zhao, Shanyang; Abelson, Jamie M.; Kessler, R. C.

doi:10.1017/s0033291700035893

Cited by 145 publications

(99 citation statements)

References 21 publications

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“…All subjects underwent a structured interview (SCID) (Wittchen et al 1996) by an experienced psychiatrist. Subjects were found to be free of any history of mental disorder or somatic disease by means of physical examination, electrocardiogram, electroencephalogram and routine laboratory testing.…”

Section: Methodsmentioning

confidence: 99%

Vigabatrin Decreases Cholecystokinin-Tetrapeptide (CCK-4) Induced Panic in Healthy Volunteers

Zwanzger

Baghai

Schuele

et al. 2001

Neuropsychopharmacology

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Vigabatrin increases gamma aminobutyric acid (GABA) levels by irreversible inhibition of the GABA-catabolizing enzyme GABA-transaminase (GABA-T). Preclinical studies suggest anxiolytic effects in vigabatrin treated rats. Anxiolytic effects in patients with panic disorder (PD) could therefore be expected. To evaluate putative anxiolytic properties of vigabatrin in humans, CCK-4-induced panic symptoms were studied in healthy volunteers before and after vigabatrin treatment. After placebo-controlled administration of 50 g CCK-4, ten healthy volunteers received vigabatrin for seven days with a daily dosage of 2 g. The treatment period was followed by a second CCK-4 challenge. Panic and anxiety were assessed using the Acute Panic Inventory (API) score and a DSM-IV derived panicsymptom-scale (PSS). ACTH and cortisol plasma levels were determined during the CCK-4 challenge. All subjects reported a marked reduction of CCK-4-induced panic symptoms and anxiety after seven days of vigabatrin treatment both in the API-and PSS-scores. MoreoverThe new antiepileptic drug vigabatrin is a selective irreversible inhibitor of GABA-transaminase (GABA-T), the main degradative enzyme of GABA (Harden 1994). Vigabatrin increases CSF GABA levels by 2 to 3-fold when administered in anticonvulsant doses (Ben-Menachem 1989). Preclinical studies suggest that vigabatrin has anxiolytic properties in addition to its anticonvulsant effects. Sayin et al. (1992) compared the anxiolytic effects of diazepam and vigabatrin in rats and found a significant decrease of anxiety with both substances using the elevated plus maze test. Sherif and colleagues investigated the effects of GABA-transaminase inhibition on exploratory behaviour in socially isolated rats using both the elevated plus maze and the open field NO . 5 test (Sherif et al. 1994;Sherif and Oreland 1995). Despite these promising results in animal models it is still unclear whether vigabatrin exerts anxiolytic properties also in humans.CCK-4 has potent anxiogenic properties both in patients with panic disorder and in healthy volunteers (Bradwejn et al. 1990;Bradwejn et al. 1991a;Bradwejn et al. 1991b). Recent data suggest that CCK-4-induced panic is attenuated by antipanic treatment. A decrease of the anxiogenic effects of CCK-4 has been shown after treatment with benzodiazepines in healthy volunteers (de Montigny 1989). Moreover, antidepressants that are commonly used as antipanic treatment, e.g. imipramine (Bradwejn and Koszycki 1994a), fluvoxamine (van Megen etal. 1997) and citalopram (Shlik et al. 1997) reduced CCK-4-induced panic in patients with panic disorder.CCK-4-induced panic appears to be a suitable model to assess anxiolytic properties of psychopharmacological drugs in humans. To evaluate the putative anxiolytic properties of the selective GABA transaminase inhibitor vigabatrin, we therefore studied the effects of treatment with vigabatrin for seven days on CCK-4-induced panic symptoms in healthy male volunteers. METHODSTen male healthy volunteers (mean age ϭ 30.7 years, S...

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Section: Methodsmentioning

confidence: 99%

Vigabatrin Decreases Cholecystokinin-Tetrapeptide (CCK-4) Induced Panic in Healthy Volunteers

Zwanzger

Baghai

Schuele

et al. 2001

Neuropsychopharmacology

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“…Diagnoses were established using CIDI version 2.1, according to DSM-IV criteria (WHO, 1998). The CIDI is a structured interview with acceptable reliability and validity (Wittchen, 1994 ;Wittchen et al 1996). It was administered by specially trained research staff.…”

Section: Study Samplementioning

confidence: 99%

Course trajectories of unipolar depressive disorders identified by latent class growth analysis

et al. 2011

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Background. Current classification of unipolar depression reflects the idea that prognosis is essential. However, do DSM categories of major depressive disorder (MDD), dysthymic disorder (Dysth) and double depression (DD=MDD+Dysth) indeed adequately represent clinically relevant course trajectories of unipolar depression ? Our aim was to test DSM categories (MDD, Dysth and DD) in comparison with empirically derived prognostic categories, using a prospectively followed cohort of depressed patients.Method. A large sample (n=804) of out-patients with unipolar depression were derived from a prospective cohort study, the Netherlands Study of Depression and Anxiety (NESDA). Using latent class growth analysis (LCGA), empirically derived 2-year course trajectories were constructed. These were compared with DSM diagnoses and a wider set of putative predictors for class membership.Results. Five course trajectories were identified, ranging from mild severity and rapid remission to high severity and chronic course trajectory. Contrary to expectations, more than 50 % of Dysth and DD were allocated to classes with favorable course trajectories, suggesting that current DSM categories do not adequately represent course trajectories. The class with the most favorable course trajectory differed on several characteristics from other classes (younger age, more females, less childhood adversity, less somatic illnesses, lower neuroticism, higher extraversion). Older age, earlier age of onset and lower extraversion predicted poorest course trajectory.Conclusions. MDD, Dysth and DD did not adequately match empirically derived course trajectories for unipolar depression. For the future classification of unipolar depression, it may be wise to retain the larger, heterogeneous category of unipolar depression, adopting cross-cutting dimensions of severity and duration to further characterize patients.

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“…Based on these results, refinements were made in the CIDI to improve validity in assessing DSM-III-R disorders . Generally good concordance with blinded clinical diagnoses was found in this revised version of CIDI in the general population of the US Wittchen, 1994;Wittchen et al, 1995;Wittchen et al, 1996). However, the results of CIDI clinical reappraisal studies varied across other settings.…”

Section: B Responding To the Challenges: Validity Of Diagnosesmentioning

confidence: 69%

Psychiatric epidemiology: Challenges and opportunities

Kessler

2007

International Review of Psychiatry

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This paper discusses challenges and prospects for increasing the clinical relevance of psychiatric epidemiological research. The discussion begins with a review of the structural determinants of the fact that current psychiatric epidemiological research has less clinical relevance that epidemiological research in other areas of medicine. The discussion then turns to ways in which the focus of psychiatric epidemiological research might be changed to increase its clinical relevance. A review is then presented of recent innovations in community psychiatric epidemiological research that were designed to increase clinical relevance. An argument is then made that the full clinical value of psychiatric epidemiology will only be realized when community epidemiology becomes better integrated with clinical epidemiology and the latter takes on a more prominent role than it currently has in psychiatric research. Existing initiatives to realize an integration of community psychiatric epidemiology with clinical epidemiology are then reviewed. Finally, an agenda is proposed for an expansion of clinical psychiatric epidemiology to include a focus on both naturalistic and quasiexperimental studies of illness course and treatment response in diverse clinical samples. KeywordsMental illness; Psychiatric epidemiology; epidemiology; clinical epidemiology; World Mental Health (WMH) Survey Initiative I was asked to prepare a paper on the challenges of using epidemiology to inform clinical practice in psychiatry because of my involvement in recently published exchanges about the clinical value (or lack thereof) of the WHO World Mental Health (WMH) Survey Initiative (Jorm, 2006;Kessler, 2006; Kessler et al., in press-b;Weich and Araya, 2004). The WMH Survey Initiative (henceforth WMH) is a project of the Assessment, Classification, and Evaluation (ACE) Group at the WHO that involves the implementation, coordination, and centralized analysis of data from a series of psychiatric epidemiological surveys in more than two dozen countries around the world. (www.hcp.med.harvard.edu/wmh.) I am one of the WMH co-directors.Psychiatric epidemiologists have done quite a bit over the past two decades to increase the clinical relevance of their research. The vast majority of this work has been carried out in general population samples. The potential for clinical relevance is much greater, though, for epidemiological research carried out in clinical samples. In this paper I review recent developments in community psychiatric epidemiology related to clinical relevance. I also sketch out a research agenda for clinical psychiatric epidemiology aimed at increasing clinical relevance. Before turning to these topics, though, it is important to define some basic terms and to discuss the overarching practical challenges faced by psychiatric epidemiologists as they attempt to increase the clinical relevance of their research.

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Reliability and procedural validity of UM-CIDI DSM-III-R phobic disorders

Cited by 145 publications

References 21 publications

Vigabatrin Decreases Cholecystokinin-Tetrapeptide (CCK-4) Induced Panic in Healthy Volunteers

Vigabatrin Decreases Cholecystokinin-Tetrapeptide (CCK-4) Induced Panic in Healthy Volunteers

Course trajectories of unipolar depressive disorders identified by latent class growth analysis

Psychiatric epidemiology: Challenges and opportunities

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