November 2014

Vol. 26. No. 4


Terrorism: Behavior defies psychiatric diagnosis

Terrorism has become mundane. Since the terrorist attacks of September 11, 2001, the world has become a much more dangerous place. I recall, in the middle to late 1990s, reading that Osama bin Laden was America’s worst nightmare, but no one paid much attention until it was too late. A similar phenomenon has just happened with the group calling itself ISIS. We have known about the group for some time, but the country—and media—only recently has paid attention to their diabolical actions, brought squarely into view with beheadings of a few unfortunate Westerners. The cruelty attributed to this group of thugs—beheadings, mass executions, ethnic and religious persecution and cleansing—can only be characterized as medieval. It is as though terrorism has become so common that it has faded into the background: something that we reluctantly accept as part of our modern world.



Mixed, melancholic, and anxious features in depression: A cross-sectional study of sociodemographic and clinical correlates

Leonardo Zaninotto, MD | Daniel Souery, MD, PhD | Raffaella Calati, PsyD, PhD | Paolo Scudellari, MD | Luigi Janiri, MD, PhD | Stuart Montgomery, MD, PhD | Siegfried Kasper, MD, PhD | Joseph Zohar, MD, PhD | Julien Mendlewicz, MD, PhD | Alessandro Serretti, MD, PhD

BACKGROUND: Major depression (MD) is currently viewed as a heterogeneous condition, characterized by different psychopathological dimensions.

METHODS: Our sample was composed of 1,289 nonpsychotic bipolar/ unipolar depressed patients. Participants were divided into mixed (MXD), melancholic (MEL), and anxious (ANX) depressed, according to a hierarchical functional model. Sociodemographic and clinical variables were compared across depressive subtypes by χ2 test and analysis of variance. The Young Mania Rating Scale (YMRS) and 2 subscales (melancholic [MEL-S] and psychic-somatic anxiety [PSOM-ANX]) from the Hamilton Depression Rating Scale also served as continuous outcome measures.

RESULTS: MXD patients more frequently had bipolar I disorder (BD I), younger age of onset, and a higher familial load for mood disorders. MEL and ANX patients were more frequently diagnosed with major depressive disorder and reported a higher suicide risk. YMRS scores in depression were associated with BD I diagnosis (P < .0001) and manic polarity of the last episode (P < .0001), while a depressive polarity of the last episode (P < .0001) was associated with higher MEL-S score. No specific predictor was associated with PSOM-ANX score.

CONCLUSIONS: Overall, our findings suggest that mixed depressive features are associated with significant hallmarks of bipolarity, and melancholic features may be influenced by previous depressive polarity. The symptom domain of anxiety appears to have no specific predictor.


Asthma in patients with attention-deficit/ hyperactivity disorder: A nationwide population-based study

Chia-Jui Tsai, MD | Po-Han Chou, MD | Chin Cheng, MD, MPhil | Ching-Heng Lin, PhD | Tsuo-Hung Lan, MD, PhD | Chih-Chien Lin, MD

BACKGROUND: Asthma symptoms can interrupt daily activities, disturb sleep, and increase the risk of a child having an attention deficit or irritability, which also are symptoms of attention-deficit/hyperactivity disorder (ADHD). Previous studies have shown conflicting results regarding the association between ADHD and asthma. This study investigates the possible correlation between asthma and ADHD.

METHODS: We retrieved data on 221,068 pediatric patients from Taiwan’s National Health Insurance Research Database in 2005, and calculated the prevalence and risk factors of allergic diseases among ADHD patients.

RESULTS: The prevalence of asthma in the ADHD group, compared with the control group, was 4.3 fold higher in the age 12 to 17 subgroup (95% CI, 1.71 to 10.6), 1.5-fold higher in males (95% CI, 1.05 to 2.03), and 1.6-fold higher for children living in urban areas (95% CI, 1.12 to 2.28). Multivariate logistic regression models showed the odds ratio of asthma for children with ADHD was 1.43 (95% CI, 1.05 to 1.95) as compared with children without ADHD.

CONCLUSIONS: Pediatric ADHD was associated positively with asthma, but the underlying mechanisms require further clarification.


A brief, clinically useful, clinician-rated dimensional rating system for psychiatric diagnoses: Reliability and validity in psychiatric outpatients

Mark Zimmerman, MD | Theresa A. Morgan, PhD | Kristy Dalrymple, PhD | Diane Young, PhD | Iwona Chelminski, PhD

BACKGROUND: In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we describe the development of a dimensional rating system for Axis I disorders.

METHODS: We evaluated 1,600 psychiatric outpatients with a semistructured diagnostic interview for Axis I disorders and completed a self-report measure of psychosocial morbidity. A Standardized Clinical Outcome Rating (SCOR), a 7-point dimensional rating, was made for 17 Axis I disorders and 1 symptom construct.

RESULTS: The dimensional ratings were highly reliable. After controlling for the number of Axis I disorders, each of the partial correlations between the dimensional rating and the measures of psychosocial morbidity was significant (mean partial r = 0.21). However, when the dimensional score was controlled, none of the partial correlations between the sum of the number of Axis I disorders and measures of psychosocial morbidity were significant (mean partial r = 0.03).

CONCLUSIONS: The SCORs are brief standardized outcome ratings that clinicians can incorporate into routine clinical practice without incurring undue burden. These ratings could make it more feasible to conduct effectiveness studies in clinical practice and to extend measurementbased care recommendations to include clinical ratings as well as selfreport assessments.


Further evidence for the reliability and validity of the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ)

Lee Baer, PhD | Susan Ball, PhD | JonDavid Sparks, PhD | Joel Raskin, MD | Sanjay Dubé, MD | Margaret Ferguson, PharmD | Maurizio Fava, MD

BACKGROUND: The Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ) was developed to assess clinically relevant cognitive and physical symptoms associated with depression that are not adequately assessed by traditional measures. Although the CPFQ has been shown previously to be a reliable and valid measure, the purpose of the present study was to provide additional evidence using larger samples from 4 independent clinical trials that were designed to test the efficacy and safety of different antidepressants.

METHODS: The psychometric analyses were based on data from 4 independent clinical trials that were designed to test the safety and efficacy of different antidepressants. Reliability of the items and of the overall questionnaire was evaluated with principal components analysis, whereas validity was assessed by associations of the questionnaire scores with convergent and divergent external criteria.

RESULTS: Overall, the results have replicated previous findings that the CPFQ has good internal reliability. Validation also is strengthened by the demonstration of predictive differences among known groups as well as a sensitivity to change with antidepressant treatment.

CONCLUSIONS: Results support the use of the CPFQ as a valuable instrument for the detection of clinically relevant symptoms that are not captured by typical measures of depression used for the assessment of treatment outcomes.