Origins of DSM-I: a study in appearance and reality
Article Abstract:
Like other physicians, psychiatrists in 19th century America thought that health represented a balance between nature, society and the individual. Early attempts at disease classification (nosology) were broad, and mental disorders were identified by external signs and symptoms. For instance, imbecility was categorized as a birth defect. Around 1800, developments in quantitative research led to a statistical inquiry into mental illness focusing on demographics and admission and discharge rates. Interest in psychiatric nosology was not rekindled until Kraepelin differentiated diseases according to their outcome, and identified symptoms that were specific for schizophrenia and manic-depressive psychosis. In 1918, the first standardized psychiatric nosology was printed. It divided mental disorders into 22 groups: one covered all undiagnosed psychoses, another covered all nonpsychotic disorders, and the remaining groups had different biologic or physical bases such as: senile or traumatic psychoses. World War II attracted young doctors trained in psychoanalytic concepts who joined to form the American Psychological Association (APA). In 1952, the APA published its first edition of the Diagnostic and Statistical Manual (DSM-I), which classified mental disorders under two general headings: brain dysfunctions and psychiatric adjustment disorders with secondary brain function disturbance. American psychiatry remained shaped by European psychoanalytic theory, which emphasized the use of defense mechanisms aimed at keeping repressed traumatic and unacceptable impulses (such as aggression and desire) from becoming conscious. By the 1960s, a shift toward a more biologic approach would lead to renewed debate and new diagnostic categories. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Psychiatry
Subject: Psychology and mental health
ISSN: 0002-953X
Year: 1991
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Relationships between requests for psychiatric consultations and psychiatric diagnoses in long-term-care facilities
Article Abstract:
Psychiatric disorders in nursing homes often go undiagnosed according to research studies, and the prevalence of psychiatric disorders in this setting may be high. Often, it seems, requests for psychiatric consultations are presented by staff as requests to evaluate maladaptive behaviors rather than to evaluate the patient for psychiatric illness. Whether this has an effect on diagnosis and treatment is unknown. The relationships between reasons for referral for psychiatric consultation and diagnoses made by the consulting team were investigated in nursing homes over a two-year period. Diagnostic assessment was made on 197 nursing home patients, and reasons for referral were recorded along with final diagnoses. There were seven broad reasons for referral: behavioral problems, mood-related problems, psychoses, physical signs, impaired activities of daily living, consultation, and other. Most common among the reasons for referral were behavioral problems, which were cited in 96 percent of the cases. Mood-related problems were cited in 35 percent of the cases, psychotic features in 16 percent, physical signs in 12 percent, and consultation was the reason for referral in 19 percent of cases. But correlations between reason for referral and diagnosis were modest, at best. The most important conclusions drawn from the data are that there is a broad range of psychiatric problems seen in nursing homes and that there is a need for professional psychiatric evaluation so that appropriate treatment interventions can be offered. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Psychiatry
Subject: Psychology and mental health
ISSN: 0002-953X
Year: 1991
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Psychiatric status of patients with primary fibromyalgia, patients with rheumatoid arthritis, and subjects without pain: a blind comparison of DSM-III diagnoses
Article Abstract:
Primary fibromyalgia syndrome is characterized by symptoms of general aches and pains, tenderness, stiffness, and fatigue, but the condition remains obscure as a clinical entity. Because of this, some have proposed that there is a significant psychological or psychosomatic component to the illness. When compared with patients with rheumatoid arthritis, differences emerge between groups by physical symptoms, but no particular psychological problems or differences in minor problems have been identified for these two groups. The present study compared the frequency of psychiatric diagnoses in 35 patients with primary fibromyalgia syndrome, 33 with rheumatoid arthritis, and in 31 patients without pain. Psychiatric diagnoses were assessed for each patient using a standard psychiatric diagnostic interview. There were no lifetime differences found among groups regarding history of psychiatric illness. However, patients with both primary fibromyalgia syndrome and a psychiatric history reported more physical symptoms than those in the other two groups. Patients with primary fibromyalgia and no psychiatric history resembled patients with rheumatoid arthritis and patients without pain in this regard. The data therefore do not support the model that explains primary fibromyalgia in terms of psychopathology; the psychiatric diagnostic interview did not discriminate these patients from the others. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Psychiatry
Subject: Psychology and mental health
ISSN: 0002-953X
Year: 1991
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- Abstracts: Discussion of "Substance use reduction in the context of outpatient psychiatric treatment." (commentary on an article published in this issue)
- Abstracts: Response to treatment with antidepressants of patients with severe or moderate nonpsychotic depression and of patients with psychotic depression
- Abstracts: Substance abuse disorders: a psychiatric priority. Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders
- Abstracts: Prevalence and correlates of postpartum depression in first-time mothers
- Abstracts: Patterns of neuropsychological impairment after severe blunt head injury. Neuropsychological performance in patients with mild multiple sclerosis