Examining \u3cem\u3eDSM\u3c/em\u3e Criteria for Trichotillomania in A Dimensional Framework: Implications for \u3cem\u3eDSM-5\u3c/em\u3e And Diagnostic Practice

Background: Diagnosis of Trichotillomania (TTM) requires meeting several criteria that aim to embody the core pathology of the disorder. These criteria are traditionally interpreted monothetically, in that they are all equally necessary for diagnosis. Alternatively, a dimensional conceptualization of psychopathology allows for examination of the relatedness of each criterion to the TTM latent continuum. Objectives: First, to examine the ability of recently removed criteria (B and C) to identify the latent dimensions of TTM psychopathology, such that they discriminate between individuals with low and high degrees of hair pulling severity. Second, to determine the impact of removing criteria B and C on the information content of remaining diagnostic criteria. Third, to determine the psychometric properties of remaining TTM diagnostic criteria that remain largely unchanged in DSM-5; that is, whether they measure distinct or overlapping levels of TTM psychopathology. Fourth, to determine whether information content derived from diagnostic criteria aid in the prediction of disease trajectory (i.e., can relapse propensity be predicted from criteria endorsement patterns). Method: Statistics derived from Item Response Theory were used to examine diagnostic criteria endorsement in 91 adults with TTM who underwent psychotherapy. Results: The removal of two criteria in DSM-5 and psychometric validity of remaining criteria was supported. Additionally, individual trait parameters were used to predict treatment progress, uncovering predictive power where none previously existed. Conclusions: Diagnostic criteria for TTM should be examined in dimensional models, which allow for nuanced and sensitive measurement of core symptomology in treatment contexts

The association between preoperative spinal cord rotation and postoperative C5 nerve palsy

BACKGROUND: C5 nerve palsy is a known complication of cervical spine surgery. The development and etiology of this complication are not completely understood. The purpose of the present study was to determine whether rotation of the cervical spinal cord predicts the development of a C5 palsy. METHODS: We performed a retrospective review of prospectively collected spine registry data as well as magnetic resonance images. We reviewed the records for 176 patients with degenerative disorders of the cervical spine who underwent anterior cervical decompression or corpectomy within the C4 to C6 levels. Our measurements included area for the spinal cord, space available for the cord, and rotation of the cord with respect to the vertebral body. RESULTS: There was a 6.8% prevalence of postoperative C5 nerve palsy as defined by deltoid motor strength of /= 11 degrees ) and palsy (point-biserial correlation = 0.94; p \u3c 0.001). A diagnostic criterion of 6 degrees of rotation could identify patients who had a C5 palsy (sensitivity = 1.00 [95% confidence interval, 0.70 to 1.00], specificity = 0.97 [95% confidence interval, 0.93 to 0.99], positive predictive value = 0.71 [95% confidence interval, 0.44 to 0.89], negative predictive value = 1.00 [95% confidence interval, 0.97 to 1.00]). CONCLUSIONS: Our evidence suggests that spinal cord rotation is a strong and significant predictor of C5 palsy postoperatively. Patients can be classified into three types, with Type 1 representing mild rotation (0 degrees to 5 degrees ), Type 2 representing moderate rotation (6 degrees to 10 degrees ), and Type 3 representing severe rotation (\u3e/= 11 degrees ). The rate of C5 palsy was zero of 159 in the Type-1 group, eight of thirteen in the Type-2 group, and four of four in the Type-3 group. This information may be valuable for surgeons and patients considering anterior surgery in the C4 to C6 levels

Imaging assessment of lumbar pedicle screw placement: sensitivity and specificity of plain radiographs and computer axial tomography

STUDY DESIGN: This is a diagnostic study in which cadavers were evaluated by imaging and dissection after pedicle screw placement. OBJECTIVE: This study was designed to evaluate the accuracy of plain radiographs and/or CT in determining pedicle instrumentation. SUMMARY OF BACKGROUND DATA: One biomechanical advantage provided by pedicle screws fixation is improved fusion rates. The accuracy of pedicle screw placement has relied on radiograph and CT. Our goal is to evaluate the accuracy of these methods. METHODS: Cadaveric lumbar spines were exposed by a posterior approach. Titanium pedicle screws were inserted. Radiographs and CTs were obtained. The spines were then dissected to examine screw location. A blinded examiner reviewed the imaging. Screws were considered misaligned if they were extrapedicular or had evidence of cortical perforation. RESULTS: The sensitivity of radiographs, CT, and combined is 93.9%, 94%, and 98.7%, respectively. The specificity of radiograph, CT, and combined is 12.5%, 36.7%, and 40.7%, respectively. The positive predictive value for radiograph, CT, and combined is 83.2%, 88.1%, and 90.4%, respectively. The negative predictive value for radiograph, CT, and combined is 30.8%, 55.9%, and 84.6%, respectively. The accuracy of radiograph, CT, and combined is equal to 79.4%, 84.4%, and 90%, respectively. CONCLUSION: Patients who present with significant complaints of pain or neurologic deficits, optimal determination of pedicle screw positions is with the combination of radiographs and CT. Furthermore, routine evaluation of patients\u27 status post pedicle screw fixation can be reliable obtained with radiographs. The biomechanical advantage of pedicle screw fixation has improved fusion rates and diminished the number of levels required for stability. Despite the widespread clinical use of pedicle screw fixation, there is relatively little literature concerning accuracy. This study was designed to evaluate the accuracy of plain radiographs and/or CT in determining the proper position of pedicle screws

How Do Scores on the Functional Status Examination (FSE) Correspond to Scores on the Glasgow Outcome Scale-Extended (GOSE)?

This study was designed to determine how raw scores correspond between two alternative measures of functional recovery from traumatic brain injury (TBI), the Functional Status Examination (FSE) and the Glasgow Outcome Scale-Extended (GOSE). Using data from 357 persons with moderate-severe TBI who participated in a large clinical trial, we performed item response theory analysis to characterize the relationship between functional ability measured by the FSE and GOSE at 6 months post-injury. Results revealed that raw scores for the FSE and GOSE can be linked, and a table is provided to translate scores from one instrument to the other. For example, a FSE score of 7 (on its 0-21 scale, where higher scores reflect more impairment) is equivalent to a GOSE score of 6 (where GOSE is scaled on an 8-point scale, with higher scores reflecting less impairment). These results allow clinicians or researchers who have a score for a person on one instrument to cross-reference it to a score on the other instrument. Importantly, this enables researchers to combine data sets where some persons only completed the GOSE and some only the FSE. In addition, an investigator could save participant time by eliminating one instrument from a battery of tests, yet still retain a score on that instrument for each participant. More broadly, the findings help anchor scores from these two instruments to the broader continuum of injury-related functional limitations

A dimensional comparison of a self-report and a structured interview measure of conduct disorder

Eligibility for a diagnosis of antisocial personality disorder (ASPD) requires evidence of antecedent conduct disorder (CD). Accurately identifying CD may be influenced by various factors, including assessment methodology. The present study used a two-parameter latent variable model to examine the relative performance of a self-report measure and a structured clinical interview in retrospectively detecting the CD spectrum among adult male offenders (N = 1,159). Self-report and clinical interview tended to converge regarding the rank order of severity indicated by CD symptom criteria. In addition, at relatively low levels of CD severity, self-report provided more information about the CD spectrum than did clinical interview. At relatively higher levels of CD severity, however, clinical interview provided more information about the CD spectrum than did self-report. Latent variable models offer a potential means of combining multiple assessment methods in a way that maximizes information gleaned by capitalizing on the contextual strengths of each approach