Psychometric Theory Is an Obstacle to the Progress of Clinical Research

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Background: Psychiatric disorders are frequent in dermatology patients, and many studies pointed out complex, mutual relationships between psyche and skin. Our aim was to provide a systematic psychosocial evaluation of a large and heterogeneous population of patients with skin diseases, including assessments of quality of life, psychiatric status according to the DSM-IV and psychological conditions with psychosomatic relevance according to established criteria (Diagnostic Criteria for Psychosomatic Research, DCPR). Methods: We studied 545 dermatological inpatients aged 18–65 years, free from dementia and cognitive impairment. They completed the Skindex-29 and the 12-item General Health Questionnaire (GHQ-12) and were administered the SCID-I and the Structured Interview for Psychological Conditions of Psychosomatic Relevance by a trained mental health professional blinded to questionnaire scores. Results: Overall, 38% of patients received a DSM-IV diagnosis. The most common diagnoses were mood (20%) and anxiety disorders (16%); 48% of patients also received a DCPR diagnosis. The most common were demoralisation, irritable mood, type A behaviour and various forms of abnormal illness behaviour. Adjusting for gender, age, and education, the presence of DSM-IV or DCPR diagnoses was significantly associated with high scores on the GHQ-12 and on the Functioning and Emotions scales of the Skindex-29. Also, DCPR diagnoses were significantly associated with high scores on the Symptoms scale of the Skindex-29. Conclusions: These findings highlight the high frequency of psychosocial problems in patients with skin disease and suggest that the joint use of DSM-IV and DCPR criteria may help identify those patients in whom psychiatric issues are worthy of increased clinical attention.

Section: Discussionsupporting

confidence: 81%

Psychosomatic Assessment of Skin Diseases in Clinical Practice

Picardi

Pasquini

Abeni

et al. 2005

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“…Despite the complex methodological problems involved in the assessment of anger and the recent criticism of the classical psychometric theory [44,45,46] also underlying some of the scales used here, this study demonstrates that symptoms related to lowered impulse control like anger attacks are more prevalent in male than in female depressed inpatients. Moreover, our results point out the need for the development of gender-specific diagnostic criteria in depression, which could be valuable for specific treatment approaches.…”

Section: Discussionmentioning

confidence: 63%

Anger Attacks in Depression – Evidence for a Male Depressive Syndrome

Winkler

Pjrek

Kasper³

2005

155

Background: It has been proposed that aggression and especially anger attacks play an important role in the symptomatology of depression. Furthermore, it has been hypothesized that these symptoms are more prevalent in males than in females. Methods: We conducted a study in 217 depressed patients (104 females, 113 males) without psychiatric comorbidity using questionnaires. Study subjects had previously been treated as inpatients and were contacted after discharge from hospital by mail or phone. Overall response rate was 69.6%. Patients were asked to retrospectively rate their state during their last depression. Results: Males obtained higher scores on irritability (p = 0.010) and showed a tendency to overreact (p = 0.018) during their last depressive episode. They had suffered significantly more often from anger attacks than female patients (4.3 ± 7.52 versus 1.2 ± 2.97 anger attacks per month; p = 0.001). Further multivariate analyses displayed that men had significantly lower impulse control and more frequently showed symptomatic substance intake and hyperactive behavior during their depression, whereas women suffered more often from hypersomnia and heaviness in limbs (p < 0.0001). Conclusion: Our findings are indicative of gender differences in symptoms related to lowered impulse control in depressed patients. Further study is required to replicate and extend our results and to assess the significance of aggression as a gender-specific diagnostic criterion for depression.

“…Our results suggest that manic/hypomanic symptoms and syndromes may be common in the community, do not necessarily entail clinical features and may lead to overdiagnosis of bipolar disorders in epidemiological studies [23, 24, 25, 26]. Subclinical manic/hypomanic symptoms may also be present in allegedly unipolar individuals and may have treatment implications.…”

Section: Discussionmentioning

confidence: 79%

Assessing the Community Prevalence of Bipolar Spectrum Symptoms by the Mood Disorder Questionnaire

Mangelli

Benazzi²,

Fava³

2005

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Background: The goal of this study was to assess the frequency and spectrum of symptoms related to bipolar disorders in a community sample by means of a self-rating questionnaire. Method: The Mood Disorder Questionnaire, a self-rating scale which evaluates DSM-IV manic/hypomanic symptoms, was administered to a community sample of 1,034 individuals recruited through advertisements. Symptom interrelationships were studied by factor analysis. Results: 275 individuals (26.6%) reported moderate or severe impairment due to the symptoms. Manic/hypomanic symptoms were present in a high proportion of individuals. Factor analysis found a two-factor structure of bipolar spectrum symptoms (an elevated mood overactivity factor, and an irritable behavior factor). Conclusion: The findings of this study highlight the need of complementing clinical investigations on the bipolar spectrum with community studies. Subclinical manic-hypomanic symptoms may be present also in allegedly unipolar patients and may have implications on the course of illness.