Diagnosing personality disorders according to structured expert interviews is time-consuming and costly. For epidemiological studies, self-report instruments have several advantages. The DSM-IV and ICD-10 personality questionnaire (DIP-Q) is a selfreport questionnaire constructed to identify personality disorder according to DSM-IV and ICD-10.

The DIP-Q is validated vs a structured expert interview in a clinical sample of 138 individuals. In addition, prevalence rates yielded by DIP-Q among 136 healthy volunteers are assessed and compared to expected prevalence.

For DSM-IV the agreement for any personality disorder as measured by Cohen's Kappa was 0.61 and 0.56 for ICD-10. Overall sensitivity for any personality disorder was for DSM-IV 0.84 and for ICD-10 0.85. However, specificity was lower: 0.77 and 0.70, respectively. When dimensional scores between self-report and interview for each personality disorder were compared, the intraclass correlation for the DSMIV entities was 0.37–0.87 and for the ICD-10 entities 0.33–0.73. Among healthy volunteers the base rate of personality disorders was found to be 14%.

DIP-Q can be used as a screening instrument for personality disorders according to DSM-IV and ICD-10. Self-report questionnaires such as DIP-Q will probably play an increasingly important role in future epidemiological studies.

To evaluate the impact of Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV)-defined premenstrual dysphoric disorder (PMDD) lifetime co-morbidity among 92 bipolar patients.

Ninety-two women with a lifetime diagnosis of DSM-IV-defined Bipolar Disorder (BD) either type I or type II were consecutively enrolled to determine co-morbidity rates with PMDD and associated clinical features. Measures included the Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID-I) and the Clinical Global Impression (CGI) rating scale.

In our sample, 25 (27.2%) patients reported a lifetime history of PMDD according to DSM-IV criteria (PMDD+). PMDD+ reported higher rates of Cyclothymia and BP-II than PMDD− (respectively 72% vs. 36% and 88% vs. 60%). On the contrary, the carbohydrate-craving feature was more represented among PMDD− than PMDD+ (25% vs. 4%). PMDD was also significantly associated with post-partum depression (36% vs. 15%), Obsessive-Compulsive (24% vs. 7.5%) and Body Dysmorphic Disorders (24% vs. 6%). Finally, PMDD+ reported higher total number of Axis I co-morbid disorders than PMDD−.

In our cohort of BD women, PMDD is a frequent co-morbid condition, in particular among patients with BD-II or Cyclothymia. Multiple co-morbidities also represent a clinical variable associated with PMDD. Further perspective studies are necessary to better define the relationships between PMDD and BD.

This is the first cross-national study of intermittent explosive disorder (IED).

A total of 17 face-to-face cross-sectional household surveys of adults were conducted in 16 countries (n = 88 063) as part of the World Mental Health Surveys initiative. The World Health Organization Composite International Diagnostic Interview (CIDI 3.0) assessed DSM-IV IED, using a conservative definition.

Lifetime prevalence of IED ranged across countries from 0.1 to 2.7% with a weighted average of 0.8%; 0.4 and 0.3% met criteria for 12-month and 30-day prevalence, respectively. Sociodemographic correlates of lifetime risk of IED were being male, young, unemployed, divorced or separated, and having less education. The median age of onset of IED was 17 years with an interquartile range across countries of 13–23 years. The vast majority (81.7%) of those with lifetime IED met criteria for at least one other lifetime disorder; co-morbidity was highest with alcohol abuse and depression. Of those with 12-month IED, 39% reported severe impairment in at least one domain, most commonly social or relationship functioning. Prior traumatic experiences involving physical (non-combat) or sexual violence were associated with increased risk of IED onset.

Conservatively defined, IED is a low prevalence disorder but this belies the true societal costs of IED in terms of the effects of explosive anger attacks on families and relationships. IED is more common among males, the young, the socially disadvantaged and among those with prior exposure to violence, especially in childhood.

Knowledge on fundamental aspects of the influence of ‘stress’ on animal and human organisms is accumulating. In clinical situations, however, psychiatrists still do not use apropriate instruments to recognize and handle the impact of daily life stress. DSM-IV is insufficient in this respect.

A different approach is sketched for clinicians to be able to integrate knowledge from research more effectively.

Application of a ‘broad’ biological view may reveal the significance of interpretation, emotion, impulse and reaction as stages of a ‘mental tract’, which is involved in processing the input of stressful situations.

This may lead to a more rational ‘targeting’ of pharmacological and psychotherapeutic strategies in clinical practice.

A re-orientation of clinical psychiatry from mere classification towards a ‘broad’ biological approach may pave the way for a more rational and purposeful application of research findings to therapy.

There has been considerable debate about the diagnostic rules for bipolar II disorder, particularly the 4-day duration criteria for hypomanic episodes. This study examined whether highs lasting minutes or hours differed from longer highs in terms of clinical features and symptom severity. It also examined whether duration of highs predicted bipolar disorder being diagnosed.

A total of 518 subjects with significant episodes of depression and ‘highs’ completed a web-based self-report questionnaire. Those who reported their longest highs lasting minutes or hours were compared with those who reported longer durations of highs on a range of clinical variables and measures of symptom severity.

Subjects whose highs lasted minutes or hours reported clinical features and severity of symptoms similar to those whose highs lasted 3–7 days. However, the odds of being diagnosed with bipolar disorder for those with highs lasting 3–7 days were almost three times higher than for those whose highs lasted minutes or hours.

The 4-day DSM-IV minimum-duration criteria for hypomania may lead to failure to diagnose subjects with brief highs who have true bipolar disorder and thus should be reconsidered.

This paper will bring you on a polemical journey to understand the issues related in conceptualizing bereavement-related depression.

A critical narrative review was carried out to evaluate arguments and controversies surrounding DSM-IV classifications of bereavement exclusion for the diagnosis of major depressive disorder (MDD).

Available studies that are associated with bereavement exclusion criteria, the open trials and treatments with the implications of such conceptualizations and the current removal of the bereavement exclusion from MDD in DSM-5 were addressed.

The review highlights the never-ending polemical journey of conceptualizing any mental disorders, bereavement-related depression included.

Although DSM-IV attention deficit hyperactivity disorder (ADHD) is known to be associated with numerous adverse outcomes, uncertainties exist about how much these associations are mediated temporally by secondary co-morbid disorders.

The US National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a national survey of adolescents aged 13–17 years (n = 6483 adolescent–parent pairs), assessed DSM-IV disorders with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Statistical decomposition was used to compare direct effects of ADHD with indirect effects of ADHD through temporally secondary mental disorders (anxiety, mood, disruptive behavior, substance disorders) in predicting poor educational performance (suspension, repeating a grade, below-average grades), suicidality (ideation, plans, attempts) and parent perceptions of adolescent functioning (physical and mental health, interference with role functioning and distress due to emotional problems).

ADHD had significant gross associations with all outcomes. Direct effects of ADHD explained most (51.9–67.6%) of these associations with repeating a grade in school, perceived physical and mental health (only girls), interference with role functioning and distress, and significant components (34.5–44.6%) of the associations with school suspension and perceived mental health (only boys). Indirect effects of ADHD on educational outcomes were predominantly through disruptive behavior disorders (26.9–52.5%) whereas indirect effects on suicidality were predominantly through mood disorders (42.8–59.1%). Indirect effects on most other outcomes were through both mood (19.8–31.2%) and disruptive behavior (20.1–24.5%) disorders, with anxiety and substance disorders less consistently important. Most associations were comparable for girls and boys.

Interventions aimed at reducing the adverse effects of ADHD might profitably target prevention or treatment of temporally secondary co-morbid disorders.

Axis IV is for reporting ‘psychosocial and environmental problems that may affect the diagnosis, treatment and prognosis of mental disorders’. No studies have examined the prognostic value of Axis IV in DSM-IV.

We analyzed data from 2497 participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) with major depressive episode (MDE). We hypothesized that psychosocial stressors predict a poor prognosis of MDE. Secondarily, we hypothesized that psychosocial stressors predict a poor prognosis of anxiety and substance use disorders. Stressors were defined according to DSM-IV's taxonomy, and empirically using latent class analysis (LCA).

Primary support group problems, occupational problems and childhood adversity increased the risks of depressive episodes and suicidal ideation by 20–30%. Associations of the empirically derived classes of stressors with depression were larger in magnitude. Economic stressors conferred a 1.5-fold increase in risk for a depressive episode [95% confidence interval (CI) 1.2–1.9]; financial and interpersonal instability conferred a 1.3-fold increased risk of recurrent depression (95% CI 1.1–1.6). These two classes of stressors also predicted the recurrence of anxiety and substance use disorders. Stressors were not related to suicidal ideation independent from depression severity.

Psychosocial and environmental problems are associated with the prognosis of MDE and other Axis I disorders. Although DSM-IV's taxonomy of stressors stands to be improved, these results provide empirical support for the prognostic value of Axis IV. Future work is needed to determine the reliability of Axis IV assessments in clinical practice, and the usefulness of this information to improving the clinical course of mental disorders.