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Background: Despite an abundance of questionnaire data, the prevalence of clinically significant and medically unexplained pain syndromes in the general population has rarely been examined with a rigid personal-interview methodology. Objective To examine the prevalence of pain syndromes and DSM-IV pain disorder in the general population and the association with other mental disorders, as well as effects on disability and health-care utilization. Methods: Analyses were based on a community sample of 4.181 participants 18–65 years old; diagnostic variables were assessed with a standardized diagnostic interview (M-CIDI). Results: The 12-month prevalence for DSM-IV pain disorder in the general population was 8.1%; more than 53% showed concurrent anxiety and mood disorders. Subjects with pain disorder revealed significantly poorer quality of life, greater disability, and higher health-care utilization rates compared to cases with pain below the diagnostic threshold. The majority had more than one type of pain, with excessive headache being the most frequent type. Conclusions: Even when stringent diagnostic criteria are used, pain disorder ranks among the most prevalent conditions in the community. The joint effects of high prevalence in all age groups, substantial disability, and increased health services utilization result in a substantial total burden, exceeding that of depression and anxiety.

<p>The general aim of the studies presented in this thesis is to investigate the possibility of using clinical data to measure outcomes in psychiatric outpatient services. The specific aims are to investigate whether routine clinical assessments and ratings are reliable and have adequate validity, and then to use these data to calculate treatment outcomes and explore factors that affect these outcomes.</p><p>The main result shows that ratings of global mental health made by clinicians in routine clinical work can be used to evaluate treatment outcomes in outpatient settings. The clinicians responsible for diagnosing and assessing patients used the GAF scale with satisfactory reliability (ICC1,1 = 0.81) and fair interrater reliability (overall kappa = 0.53) when categorizing main diagnostic groups of the DSM-IV axis I. The GAF scale can thus be used to assess global mental health and to monitor outcomes in clinical settings. However, a GAF culture bias was observed. This bias can probably be corrected with feedback and training.</p><p>Psychiatric treatment in outpatient settings had a generally positive effect on patients’ global mental heath (ES = 0.65). The overall result when clinical significance methodology was used showed that 28.1% of the patients had recovered and a further 6.6% showed reliable improvement. Patients being treated with psychotherapeutically influenced methods showed a considerably better effect (ES = 1.00). There is a dose of sessions effect that is particularly marked for short treatment episodes. Thirteen sessions are required for 50% of the patients to show reliable improvement. The strongest influence on treatment outcome was whether the termination of a patient’s treatment was planned or unplanned.</p><p>In conclusion: Clinical databases can be used to study the outcome of psychiatric services provided they a) include a large number of subjects representing an intention-to-treat perspective; b) the instruments used are clinically relevant and reliable; c) the raters contributing to the data base are motivated to decrease attrition; d) the database includes extensive data to allow for control of confounding factors; and e) data are collected at critical occasions in treatment, such as at the start of treatment and at discharge from treatment, making it possible to focus on effects. Psychiatric outpatient treatment has a positive effect, but considerable improvements may be possible with more stringent use of psychotherapeutic methods, sufficient doses of sessions, and planned terminations. However, the progress of treatment is also affected by such factors as pre-treatment severity and diagnoses.</p>

The general aim of the studies presented in this thesis is to investigate the possibility of using clinical data to measure outcomes in psychiatric outpatient services. The specific aims are to investigate whether routine clinical assessments and ratings are reliable and have adequate validity, and then to use these data to calculate treatment outcomes and explore factors that affect these outcomes. The main result shows that ratings of global mental health made by clinicians in routine clinical work can be used to evaluate treatment outcomes in outpatient settings. The clinicians responsible for diagnosing and assessing patients used the GAF scale with satisfactory reliability (ICC1,1 = 0.81) and fair interrater reliability (overall kappa = 0.53) when categorizing main diagnostic groups of the DSM-IV axis I. The GAF scale can thus be used to assess global mental health and to monitor outcomes in clinical settings. However, a GAF culture bias was observed. This bias can probably be corrected with feedback and training. Psychiatric treatment in outpatient settings had a generally positive effect on patients’ global mental heath (ES = 0.65). The overall result when clinical significance methodology was used showed that 28.1% of the patients had recovered and a further 6.6% showed reliable improvement. Patients being treated with psychotherapeutically influenced methods showed a considerably better effect (ES = 1.00). There is a dose of sessions effect that is particularly marked for short treatment episodes. Thirteen sessions are required for 50% of the patients to show reliable improvement. The strongest influence on treatment outcome was whether the termination of a patient’s treatment was planned or unplanned. In conclusion: Clinical databases can be used to study the outcome of psychiatric services provided they a) include a large number of subjects representing an intention-to-treat perspective; b) the instruments used are clinically relevant and reliable; c) the raters contributing to the data base are motivated to decrease attrition; d) the database includes extensive data to allow for control of confounding factors; and e) data are collected at critical occasions in treatment, such as at the start of treatment and at discharge from treatment, making it possible to focus on effects. Psychiatric outpatient treatment has a positive effect, but considerable improvements may be possible with more stringent use of psychotherapeutic methods, sufficient doses of sessions, and planned terminations. However, the progress of treatment is also affected by such factors as pre-treatment severity and diagnoses.

Background: The relationship of panic attacks (PA), panic disorder (PD) and agoraphobia (AG) is controversial. The aim of the current study is to prospectively examine the 10-year natural course of PA, PD and AG in the first three decades of life, their stability and their reciprocal transitions. Methods: DSM-IV syndromes were assessed via Composite International Diagnostic Interview – Munich version in a 10-year prospective-longitudinal community study of 3,021 subjects aged 14–24 years at baseline. Results: (1) Incidence patterns for PA (9.4%), PD (with and without AG: 3.4%) and AG (5.3%) revealed differences in age of onset, incidence risk and gender differentiation. (2) Temporally primary PA and PD revealed only a moderately increased risk for subsequent onset of AG, and primary AG had an even lower risk for subsequent PA and PD. (3) In strictly prospective analyses, all baseline groups (PA, PD, AG) had low remission rates (0–23%). Baseline PD with AG or AG with PA were more likely to have follow-up AG, PA and other anxiety disorders and more frequent complications (impairment, disability, help-seeking, comorbidity) as compared to PD without AG and AG without PA. Conclusions: Differences in incidence patterns, syndrome progression and outcome, and syndrome stability over time indicate that AG exists as a clinically significant phobic condition independent of PD. The majority of agoraphobic subjects in this community sample never experienced PA, calling into question the current pathogenic assumptions underlying the classification of AG as merely a consequence of panic. The findings point to the necessity of rethinking diagnostic concepts and DSM diagnostic hierarchies.

Introduction: This paper does not aim to predict the future of clinical psychology in Germany. The future of psychology depends on the complex interaction between political, sociological, economic and health-care related factors as well as on the scientific progress in the discipline itself and in neighbour disciplines. However, it is fair to say that clinical psychology continues to gain even stronger influences in health care and will face a number of new challenges over the next years of its expansion. Our paper will present some of these potential fields of development and change based on a brief description of the status quo. The focus of the article will be specific developments in Germany, although there will be an overlap with general tendencies that describe the situation of clinical psychology in the new millenium in general. Furthermore, for research as well as practice, the specific relationship between clinical psychology and psyciatry will be highlighted.

Avsikten med denna uppsats är att undersöka hur dissociativ identitetsstörning (DID)gestaltas i filmen Split. Stereotyper och missuppfattningar har representerats länge i filmom psykiatriska sjukdomar och Split har blivit kritiserad för sin gestaltning avsyndromet, dock ser verkligheten med diagnosen olika ut. Analysen utforskar filmengenom de fyra DSM-IV kriterierna för DID. Scener analyseras med hjälp av Jens Ederskaraktärsklocka och representation av personer med DID som de andra, vilket innebärpersoner med psykiatriska sjukdomar ofta blir alienerade i film, och vi tillsammans, somfokuserar på hur de humaniseras och inkluderas samt stimulerar publikens medkänsla.Dessa metoder har använts för att komma fram till att filmen förhåller sig till DSM-IVkriterierna men att självaste gestaltningen av DID-karaktären är problematisk.Komplexa symptom i syndromet diskuteras i filmen men i slutändan framställs personermed DID som en fara för sig själva och andra, vilket kan bidra till att skada derassjälvbild

Background: The relationship of panic attacks (PA), panic disorder (PD) and agoraphobia (AG) is controversial. The aim of the current study is to prospectively examine the 10-year natural course of PA, PD and AG in the first three decades of life, their stability and their reciprocal transitions. Methods: DSM-IV syndromes were assessed via Composite International Diagnostic Interview – Munich version in a 10-year prospective-longitudinal community study of 3,021 subjects aged 14–24 years at baseline. Results: (1) Incidence patterns for PA (9.4%), PD (with and without AG: 3.4%) and AG (5.3%) revealed differences in age of onset, incidence risk and gender differentiation. (2) Temporally primary PA and PD revealed only a moderately increased risk for subsequent onset of AG, and primary AG had an even lower risk for subsequent PA and PD. (3) In strictly prospective analyses, all baseline groups (PA, PD, AG) had low remission rates (0–23%). Baseline PD with AG or AG with PA were more likely to have follow-up AG, PA and other anxiety disorders and more frequent complications (impairment, disability, help-seeking, comorbidity) as compared to PD without AG and AG without PA. Conclusions: Differences in incidence patterns, syndrome progression and outcome, and syndrome stability over time indicate that AG exists as a clinically significant phobic condition independent of PD. The majority of agoraphobic subjects in this community sample never experienced PA, calling into question the current pathogenic assumptions underlying the classification of AG as merely a consequence of panic. The findings point to the necessity of rethinking diagnostic concepts and DSM diagnostic hierarchies.

Les implications sociales et personnelles du jeu pathologique étant importantes, il devient nécessaire d'évaluer l'ampleur de la problématique dans la population. Pour ce faire, l'utilisation d'un instrument qui évalue les joueurs avec justesse est essentielle. Cette étude, réalisée auprès de 200 adultes, porte sur la capacité du NORC DSM-IV Screen (NODS) à évaluer correctement les joueurs. De façon plus précise, elle vise à déterminer le pourcentage de faux positifs généré par le NODS chez une population de joueurs de loterie vidéo. Un critère de comparaison a été établi à partir d'une entrevue clinique. Les résultats démontrent que le NODS surestime le nombre de personnes rapportant avoir un problème de jeu. Ce résultat va à l'opposé des études de validation du NODS et questionne la pertinence d'utiliser cet instrument pour estimer la prévalence du problème de jeu dans une population.

Asperger's syndrome (AS) is a pervasive developmental disorder that is associated with marked social dysfunction. Deficits in the perception of nonverbal cues of emotion may be related to this social impairment. Research has indicated that children with autism are limited in their emotion perception abilities, but studies that have addressed this issue with individuals with AS or high-functioning autism (HFA) have yielded inconsistent findings. These inconsistencies may be related to methodological differences across studies including diagnostic criteria and failure to consider the intensity of the emotion cues. It was hypothesized that children with AS and HFA would both have deficits in emotion perception compared to typically-developing children. However, children with HFA were expected to have an even greater emotion perception deficit than children with AS and this difference was hypothesized to be most pronounced for low intensity cues of emotion. It is important to clarify whether individuals with AS and HFA differ in emotion perception because most studies of this skill combine them into one group or use poorly defined diagnostic criteria. This study examined the ability of 30 8- to 15-year-old children with either AS or HFA to perceive emotion from high and low intensity cues. In order to address limitations with the differential validity of the DSM-IV criteria for AS, diagnoses were based on diagnostic criteria proposed by Klin et al. (in press). A researcher who was blind to diagnosis administered a test that presented low and high intensity cues of emotion in photographs of facial expression and audiotapes of tone of voice. Comparison of the emotion perception accuracy of children with AS to the normative means of this instrument for typically-developing children did not reveal any significant differences. In contrast, the children with HFA were significantly less accurate in their perception of facial expressions and tone of voice than the normative sample and the participants with AS. Contrary to expectations, IQ was significantly related to emotion perception accuracy. After controlling for IQ, the difference in perception of facial expressions between children with AS and HFA was not significant. On the other hand, cue intensity moderated the relation between diagnosis and emotion perception accuracy for tone of voice even after IQ was taken into account. Children with AS perceived high and low intensity tone of voice cues with similar accuracy, but children with HFA had significantly poorer performance on the low intensity tone of voice cues. Although emotion perception accuracy was related to better adjustment, it was not correlated with the most sensitive measure of current social functioning. This suggests that even when children with AS or HFA perceive cues correctly, they may not know how or be able to properly integrate them for adaptive responses in social interaction. The findings have important implications for understanding inconsistencies in past research and identifying future directions.