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To evaluate the efficacy of rapidly effective treatments it is necessary to use measures that are designed to assess symptom severity over short intervals. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we modified our previously published anxiety scale and examined the reliability and validity of a daily version of the Clinically Useful Anxiety Outcome Scale (CUXOS-D, D indicates daily version). Two thousand four hundred and ninety-one patients presenting for treatment to a partial hospital program completed the CUXOS-D as part of their initial paperwork and on a daily basis thereafter. Test-retest reliability was examined in 50 patients who completed the CUXOS-D twice on the same day. A subset of 73 patients was interviewed by a trained rater who administered the Hamilton Anxiety Rating Scale (HAMA) at baseline and on the day of discharge. The CUXOS-D had high internal consistency and test-retest reliability and was more highly correlated with another measure of anxiety symptoms than depressive symptoms. CUXOS-D scores progressively declined during the course of treatment, and scores on each successive day were significantly lower than the preceding day. The change in CUXOS-D scores was significantly correlated with a change in HAMA scores (r = 0.61, p < .001). A large effect size was found for both measures (CUXOS-D: d = 1.22; HAMA: d = 0.93). In a large sample of partial hospital patients mostly diagnosed with mood and anxiety disorders, we demonstrated some aspects of the reliability and validity of the CUXOS-D. •There has been recent optimism in developing rapidly effective treatments for mood and anxiety disorders.•There have been increasing calls to measure outcome in clinical practice.•To address the problem of diagnostic heterogeneity we previously recommended that depression and anxiety be measured in all patients and be considered psychiatric vital signs•We demonstrated some aspects of the reliability and validity of a daily version of a scale assessing anxiety symptoms

Vöhringer et al. identified a triad of items on the Mood Disorder Questionnaire (MDQ) that best discriminated between borderline personality disorder (BPD) and bipolar disorder (BD) in a tertiary mood clinic setting [23]. The present study aimed to replicate and extend these findings by examining the performance of the triad across a range of cut-off scores and comparing the operating characteristics of the triad to the full MDQ. Patients presenting for treatment were assessed with the Structured Clinical Interview for DSM-IV (SCID) and the BPD module of the Structured Interview for DSM-IV Personality (SIDP-IV). The present report is based on 476 depressed patients who had a principal diagnosis of major depressive disorder or BD and who completed the MDQ. Fifty-seven patients were diagnosed with BD and fifty-four patients were diagnosed with BPD. Both the triad and full MDQ significantly predicted BD diagnosis (p < .001), but the triad had optimal operating characteristics, particularly at a cut-off of two. Within a sample of depressed patients, the MDQ triad is a better screener for BD than the full MDQ, particularly if a positive triad screen is indicated by the presence of any two items. The triad is particularly good for differentiating between BD and BPD, whereas the full MDQ does a poorer job of differential diagnosis. Future studies should administer the triad as a stand-alone scale. •Within a sample of depressed patients, the MDQ triad is a better screener for BD than the full MDQ.•A positive triad screen is best indicated by the presence of two triad items.•The full MDQ does a poor job of distinguishing between BD and BPD.

The COVID-19 pandemic provided a unique opportunity for quantifying the impact of Five Factor Model personality domains (i.e. neuroticism, extraversion, openness, agreeableness, and conscientiousness) and COVID-related lifestyle changes on psychological distress. To examine these relationships, we designed and preregistered the present study (https://osf.io/qfw9h). We assessed a large, heterogeneous sample including undergraduates, graduate students, faculty, and staff of a large, public, Midwestern university (n = 1055) to ascertain whether personality domains uniquely predicted distress in response to COVID-19 shelter-in-place orders. This was a three-panel study in which the same potential participant pools were invited to participate at each survey announcement. Data collection occurred between early March through late May 2020, from within days of local shelter-in-place order onset to within days of reaching 100,000 COVID-related deaths in the USA. Domain and distress scores were determined from self-reported ratings on the Big Five Inventory and the 21-Item Depression Anxiety and Stress Scales, respectively. Participants also reported personal experiences with six COVID-specific lifestyle impacts: insufficient outdoor or indoor living space, job insecurity, income insecurity, or taking care of or homeschooling school-aged children during working hours. Zero-order correlations revealed that all personality domains except openness had statistically significant correlations with distress, and all correlations were negative except for that of neuroticism. When entered simultaneously, neuroticism was the predominant risk factor of distress that held across all preregistered and exploratory analyses. Our expectation that extraversion would be negatively associated with distress was not supported broadly, while agreeableness was a unique potential risk factor (though this effect was mostly limited to exploratory analyses). The results especially highlight the link between employment and income uncertainty with psychological distress, while also identifying insufficient indoor and outdoor space as potential risk factors. We hope these findings inform future public health action and further emphasize the utility of personality trait models in general.

Bipolar disorder and borderline personality disorder (BPD) are each significant public health problems. It has been frequently noted that distinguishing BPD from bipolar disorder is challenging. Consequently, reviews and commentaries have focused on differential diagnosis and identifying clinical features to distinguish the two disorders. While there is a burgeoning literature comparing patients with BPD and bipolar disorder, much less research has characterized patients with both disorders. In the current report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compare psychiatric outpatients with both BPD and bipolar disorder to patients with BPD without bipolar disorder and patients with bipolar disorder without BPD. Psychiatric outpatients presenting for treatment were evaluated with semi-structured interviews. The focus of the current study is the 517 patients with both BPD and bipolar disorder (n = 59), BPD without bipolar disorder (n = 330), and bipolar disorder without BPD (n = 128). Compared to patients with bipolar disorder, the patients with bipolar disorder and BPD had more comorbid disorders, psychopathology in their first-degree relatives, childhood trauma, suicidality, hospitalizations, time unemployed, and likelihood of receiving disability payments. The added presence of bipolar disorder in patients with BPD was associated with more posttraumatic stress disorder in the patients as well as their family, more bipolar disorder and substance use disorders in their relatives, more childhood trauma, unemployment, disability, suicide attempts, and hospitalizations. Patients with both bipolar disorder and BPD have more severe psychosocial morbidity than patients with only one of these disorders.

Background: Antidepressants are amongst the most frequently prescribed medications. More than a decade ago, our clinical research group applied a prototypic set of inclusion/exclusion criteria used in an antidepressant efficacy trial (AET) to patients presenting for treatment in our outpatient practice and found that most patients would not qualify for the trial. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we apply the psychiatric inclusion/exclusion criteria used in 158 placebo-controlled studies to a large sample of depressed patients who presented for outpatient treatment to determine the range and extent of the representativeness of samples treated in AETs and whether this has changed over time. Method: We applied the inclusion and exclusion criteria used in 158 AETs to 1,271 patients presenting to an outpatient practice who received a principal diagnosis of major depressive disorder. The patients underwent a thorough diagnostic evaluation. Results: Across all 158 studies, the percentage of patients that would have been excluded ranged from 44.4 to 99.8% (mean = 86.1%). The percentage of patients that would have been excluded was significantly higher in the studies published in 2010 through 2014 compared to the studies published from 1995 to 2009 (91.4 vs. 83.8%, t(156) = 3.74, p < 0.001). Conclusions: Only a minority of depressed patients seen in clinical practice are likely to be eligible for most AETs. The generalizability of AETs has decreased over time. It is unclear how generalizable the results of AETs are to patients treated in real-world clinical practice.

In DSM-5, all symptoms of depression are considered equal representations of severity. In ICD-10, the type of symptom is considered in classifying severity. It is important to better understand if the defining symptoms of depression are differentially associated with overall severity so that severity categorization in diagnostic systems is most valid. In the present study from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project we examined the association between the individual diagnostic criteria for major depressive disorder (MDD) and global ratings of depression severity. We thus examined whether there is support for the ICD-10 approach in which some symptoms are better indicators of severity than are other symptoms. Patients were evaluated with a semi-structured interview and the presence of each symptom of MDD was recorded. Patients were also rated on the Clinical Global Index of severity (CGI-S). All 9 DSM-5 criteria were significantly correlated with the CGI with suicidality having the highest correlation. A regression analysis found that all 9 criteria were significant predictors of the CGI. At the symptom level, 15 of the 17 symptoms were significantly correlated with the CGI (all except increased appetite and increased weight). There were differences between the symptoms of depression in their association with severity with suicidal ideation, depressed mood, and anhedonia having the highest correlations with severity whereas some symptoms were not significantly associated with severity distinctions. Future descriptions of the severity of depression should not consider all criteria as equal representations of severity. •All 9 DSM-5 criteria were significantly correlated with global ratings of depression severity.•However, all correlations were below 0.20 except for the suicidal ideation criterion.•Future descriptions of the severity of depression should include suicidality as a component of the definition.

Among mental health providers, there is growing dissatisfaction with the DSM, and preliminary research suggests clinicians prefer the dimensional HiTOP model over the DSM’s categorical approach. Whether this preference generalizes to clients, however, remains unknown. In the present study, 457 age-stratified adults with a history of psychiatric treatment completed both survey and experimental arms. The survey arm explored the prevalence and perceived value of psychodiagnostic assessment and diagnostic feedback in clinical care. In an experimental arm, participants were randomly assigned to receive DSM, HiTOP, or no diagnostic feedback after reading a vignette depicting either internalizing or psychotic symptoms. Survey data revealed high diagnostic comorbidity and considerable heterogeneity in diagnostic histories. Participants reported strong attachment to prior diagnoses and identified explicit diagnostic feedback as the most helpful among commonly used assessment strategies including self-report and semi-structured or structured interviewing. Diagnostic feedback—regardless of classification system—was consistently rated as more useful than receiving no feedback across most outcome measures. Although HiTOP did not significantly outperform the DSM, it was received comparably. Clients may be less concerned with specific diagnostic language and more focused on whether the feedback feels validating and informative. These findings suggest HiTOP was not perceived as confusing or alienating, indicating that the model can be integrated into clinical care without diminishing perceived utility. These findings support the viability of HiTOP as a clinically acceptable alternative to the DSM and provide evidence for its broader implementation in practice.

Objective.Almost all depression measures have been developed without discussing how to best conceptualize and assess the severity of depression. It is therefore not surprising that measures differ in both how items are rated and item content. The question that we address in the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project is whether a measure of depression severity should include symptoms that are frequent in depressed patients but are defining features of other disorders (eg, anxiety, irritability)Methods.Patients were evaluated with a semi-structured interview and severity ratings were made of each symptom of major depressive disorder (MDD) as well as anxiety, irritability, and somatization. Patients were also rated on the Clinical Global Index of severity (CGI).Results.Three of the 5 nondepressive symptoms (psychic anxiety, somatic anxiety, and subjective anger) were significantly correlated with the CGI. The correlation between the sum of all 5 nondepressive symptoms and the CGI was significantly lower than the correlation between the sum of the depressive symptom severity ratings (0.12 vs 0.52, z = 11.0, p < .001). The partial correlation between the CGI and the nondepressive symptom severity ratings (after controlling for the total depressive symptom ratings) was nonsignificant.Discussion.After accounting for the severity of depressive symptoms, the severity of the nondepressive symptoms was not associated with global ratings of depressive severity. These findings raise questions regarding the appropriateness of including ratings of anxiety, irritability, and somatization on a measure that purportedly assesses the severity of depression.

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirically based, hierarchical model of the structure of psychopathology that was created in response to the limitations of traditional, categorical psychiatric classification frameworks. The HiTOP model has become increasingly popular in clinical psychology and psychiatry since its publication in 2017. In this Review, we consider the applicability of the HiTOP model to diverse, underrepresented and epistemically excluded populations. We first review the philosophy underlying psychopathology research in general to understand the impact of scientific norms on the inclusion of diverse populations within the research canon. We then review the HiTOP approach to modelling psychopathology, and how diverse populations have been included within HiTOP-related research to date. We conclude by highlighting ways for future research to increase the applicability of the HiTOP framework to diverse populations. Seriously engaging with the HiTOP model’s suitability for diverse, underrepresented and epistemically excluded populations is imperative in order to achieve the HiTOP consortium’s goal of delineating a fully empirical classification of psychopathology, and to provide a model that can guide the field of psychopathology research and training to increase representation.The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirically based, hierarchical model of the structure of psychopathology. In this Review, Rodriguez-Seijas et al. consider the applicability of the HiTOP model to diverse, underrepresented and epistemically excluded populations.

The standard of diagnosing and categorizing mental disorders in the United States has long been the Diagnostic and Statistical Manual of Mental Disorders (DSM), but the DSM has been criticized through evidence suggesting it lacks appropriate validity, reliability, and clinical utility. The Hierarchical Taxonomy of Psychopathology (HiTOP) has been offered as a solution to these criticisms. But the recommendation to replace the DSM and its categorical diagnostic system has been met with doubt and criticism by others in the field. A common sentiment in these critiques is a lack of evidence that the HiTOP dimensions are clinically useful or that clinicians would be open to applying them to their patients. The goal of the present study was to compare clinician perceptions of the HiTOP and DSM systems for the conceptualization of clinical cases. A sample of actively practicing clinicians (n = 143) rated one of three clinical vignettes using the HiTOP and DSM systems then rated the two approaches on seven indices of clinical utility. HiTOP was favored for overall clinical utility score as well as utility for formulating effective intervention, communicating clinical information to the client, comprehensively describing client psychopathology, describing global functioning, and ease of applying the system to the individual. There was no preference between HiTOP and the DSM for communicating with other mental health providers. The DSM was not favored for any clinical utility outcome. These results suggest interest in HiTOP and dissatisfaction with the DSM among clinicians.