On the Threshold of Disorder: A Study of the Impact of the DSM-IV Clinical Significance Criterion on Diagnosing Depressive and Anxiety Disorders in Clinical Practice.

摘要: Background: Two recent reanalyses of epidemiologic studies found that adding a clinical significance criterion reduced disorder prevalence. Patients presenting for care are usually distressed or impaired by their symptoms; thus, the DSM-IV might have little impact on diagnosis in practice. In present report from Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examine diagnostic frequencies depressive anxiety disorders psychiatric outpatients. Method: 1500 outpatients were evaluated with Structured Clinical Interview DSM-IV. We determined percentage patients who met symptom criteria but did not meet major disorder, posttraumatic stress (PTSD), generalized (GAD), social phobia, specific panic obsessive-compulsive disorder. Results: No patient current PTSD failed criterion. Less than 2% meeting GAD There was variability among remaining symptomatic Conclusion: patients, had diagnosing GAD, PTSD, defined, part, disruptions daily regulatory domains such as sleep, appetite, energy, concentration. contrast, greater determining whether phobic fears, obsessive thoughts, attacks sufficiently distressing impairing qualify status.