The concept of a ‘case’ in psychiatric population surveys

Abstract

SYNOPSISA series of in-patients, a series of out-patients and a series of women from a general population sample, all aged under 65, and all living in the same area of south-east London, were examined using the ninth edition of the Present State Examination (PSE). An ‘index of definition’ (ID), based on number, type and severity of PSE symptoms, was constructed in order to define a threshold point above which sufficient information was available to allow classification into one of the functional psychoses or neuroses. The index specified 8 levels of definition of disorder; the threshold point for a ‘case’ lying between levels 4 and 5. The identification of ‘cases’ by this means in the general population series was highly concordant with global clinical judgement.When the 3 series were compared, the in-patient series contained the most definite cases, the out-patient series was intermediate, and the general population series was characterized mainly by below-threshold conditions.Disorders above the threshold point were classified using the CATEGO program. The clinical severity of the depressive disorders and anxiety states identified in this way in the 3 series was compared on the basis of symptom and syndrome profiles and PSE scores. As expected, the inpatients had the most severe, and the general population ‘cases’ the least severe disorders.It is suggested that the PSE-ID-CATEGO techniques can be used to help standardize certain aspects of case-finding and case-description in both referred and non-referred populations and thereby make the results of surveys more comparable.

Unequal access and unmet need: neurotic disorders and the use of primary care services

“…They argued that this ' first filter ' of making contact with the primary care physician was very permeable, with most people with diagnosable disorders in the community seeking help in this way. They placed weight on findings of Hagnell (1966), Brown & Harris (1978), Weissman & Myers (1978) and Wing et al (1978). However, these studies tended to focus on depression of at least moderate severity, which was more likely to have resulted in a consultation.…”

The need for psychiatric treatment in the general population: the Camberwell Needs for Care survey

“…Although each has its advantages and disadvantages, the most widely used instruments in this type of survey have been the Present State Examination (PSE) system (Wing et al 1974(Wing et al , 1978, and the Diagnostic Interview Schedule (DIS - Robins et al 1985). Between them, they have been used in around 30 community surveys worldwide (Bebbington, 1994).…”

The Place of Site of Lesion in the Aetiology of Post-Stroke Depression

“…Most investigators have adopted the method used by Robinson's group, namely a structured psychiat ric interview schedule which enabled a DSM-III or DSM-III-R diagnosis to be made, and categorised depression as either major depression (DSM-III) or minor depression. Cases of the latter were those who satisfied the DSM-111 criteria for dysthymia, but without the 2-year duration requirement [4], The OCSP used the Present State Exami nation (PSE) [19] and the PSE-ID-CATEGO system [20] to derive a diagnosis of depression. They found that the scores for PSD using the Beck Depressive Inventory and the PSE 1 month after stroke were continuously distribut ed [21], Thus, it is quite likely that the major and minor depression categories used by Robinson's group are two ends of a unidimensional spectrum of depression.…”