The content validity of Premenstrual Dysphoric Disorder in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) has been questioned in the literature. We tested whether mood-related symptoms reported by 26 women seeking treatment for premenstrual disorders were among the proposed criteria. These women were asked to list their premenstrual symptoms and rate the severities of listed symptoms daily for two menstrual cycles before treatment. They completed semistructured interviews to differentiate symptoms of Premenstrual Dysphoric Disorder from those of other psychiatric disorders in women who had other disorders. All participants reported functional interference due to the symptoms. 19 symptoms of or similar to those of Premenstrual Dysphoric Disorder were among the 22 most frequent premenstrual symptoms experienced. Premenstrual depressed mood was less frequent than premenstrual irritability or anger when other psychiatric disorders such as major depression were taken into account. Results suggest that the DSM-IV-TR criteria have generally good content validity but may need revision to represent treatment-seekers experiences more accurately.

Exposure to potential environmental triggers is common, and recommended trigger avoidance measures are infrequently adopted. While specific exposures may vary with demographic and socioeconomic variables, all children are at risk. New methods for educating parents to reduce such exposures should be tested.

Investigators examined whether premenstrual dysphoric disorder (PMDD) poses a risk for major depressive disorder (MDD). In an initial study, women rated premenstrual symptoms and functional impairment daily for two menstrual cycles. A semistructured diagnostic interview was given to obtain psychiatric histories and differentiate PMDD from premenstrual exacerbations of other disorders. Participants in this pilot study were eight women with PMDD and a random subgroup without PMDD (n = 9) initially. Another semistructured interview was given to diagnose psychiatric disorders occurring during a two-year follow-up interval. In all, seven of the eight women with PMDD developed MDD within two years, including all those who had never had MDD before. The odds that a woman with PMDD developed MDD were 14 times the odds that a woman without PMDD developed MDD ( p <.05). Premenstrual dysphoric disorder may be a prodrome of or causal risk factor for MDD. Preliminary evidence for the diagnostic validity of PMDD is provided.

Depressive personality disorder (DPD) characteristics may reflect both state dependent concomitants and traits independent of current depression. In all, 30 clinically, 30 formerly, and 30 never depressed participants were given the Diagnostic Interview for Depressive Personality (J. G. Gunderson, K. A. Phillips, J. Triebwasser, & R. M. A. Hirschfeld, 1994). Negative reactivity, remorsefulness, a limited capacity for fun, gloominess, pessimism, difficulty being critical or angry, unassertiveness, self-denial, and seriousness differentiated depressed and nondepressed participants, indicating that they are primarily concomitants of depression. Self-criticalness differentiated formerly from never depressed participants after subclinical symptoms were controlled, suggesting that it is a trait independent of current depression. Low self-esteem, feeling burdened, and counterdependency manifested both state and trait components. If DPD is placed on Axis II, it should be defined by traits at least partly independent of depression.

Objective. To highlight the unique challenges of evaluative research on practice behavior change in the “real world'' settings of contemporary managed‐care organizations, using the experience of the Pediatric Asthma Care PORT (Patient Outcomes Research Team). Study Setting. The Pediatric Asthma Care PORT is a five‐year initiative funded by the Agency for Healthcare Research and Quality to study strategies for asthma care improvement in three managed‐care plans in Chicago, Seattle, and Boston. At its core is a randomized trial of two care improvement strategies compared with usual care: (1) a targeted physician education program using practice based Peer Leaders (PL) as change agents, (2) adding to the PL intervention a “Planned Asthma Care Intervention'' incorporating joint “asthma check‐ups'' by nurse‐physician teams. During the trial, each of the participating organizations viewed asthma care improvement as an immediate priority and had their own corporate improvement programs underway. Data Collection. Investigators at each health plan described the organizational and implementation challenges in conducting the PAC PORT randomized trial. These experiences were reviewed for common themes and “lessons'' that might be useful to investigators planning interventional research in similar care‐delivery settings. Conclusions. Randomized trials in “real world'' settings represent the most robust design available to test care improvement strategies. In complex, rapidly changing managed‐care organizations, blinding is not feasible, corporate initiatives may complicate implementation, and the assumption that a “usual care'' arm will be static is highly likely to be mistaken. Investigators must be prepared to use innovative strategies to maintain the integrity of the study design, including: continuous improvement within the intervention arms, comanagement by researchers and health plan managers of condition‐related quality improvement initiatives, procedures for avoiding respondent burden in health plan enrollees, and anticipation and minimization of risks from experimental arm contamination and major organizational change. With attention to these delivery system issues, as well as the usual design features of randomized trials, we believe managed‐care organizations can serve as important laboratories to test care improvement strategies.