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Defining Psychopathology in the 21st Century This page intentionally left blank Defining Psychopathology in the 21st Century DSM-V and Beyond Editedby John E. Helzer, M.D. James J. Hudziak, M.D. American Psychopathological Association Washington, D.C. London, England Note:Theauthorshaveworkedtoensurethatallinformationinthisbookconcerning drugdosages,schedules,androutesofadministrationisaccurateasofthetimeof publicationandconsistentwithstandardssetbytheU.S.FoodandDrug Administrationandthegeneralmedicalcommunity.Asmedicalresearchand practiceadvance,however,therapeuticstandardsmaychange.Forthisreasonand becausehumanandmechanicalerrorssometimesoccur,werecommendthatreaders followtheadviceofaphysicianwhoisdirectlyinvolvedintheircareorthecareofa memberoftheirfamily.Aproduct’scurrentpackageinsertshouldbeconsultedfor fullprescribingandsafetyinformation. BookspublishedbyAmericanPsychiatricPublishing,Inc.,representtheviewsand opinionsoftheindividualauthorsanddonotnecessarilyrepresentthepoliciesand opinionsofAPPIortheAmericanPsychiatricAssociation. Copyright(cid:2)C 2002AmericanPsychiatricPublishing,Inc. ALLRIGHTSRESERVED ManufacturedintheUnitedStatesofAmericaonacid-freepaper 06 05 04 03 02 5 4 3 2 1 FirstEdition AmericanPsychiatricPublishing,Inc. 1400KStreet,N.W. Washington,DC20005 www.appi.org LibraryofCongressCataloging-in-PublicationData Definingpsychopathologyinthe21stcentury:DSM-Vandbeyond/editedby JohnE.Helzer,JamesJ.Hudziak.—1sted. p.;cm. Includesbibliographicalreferencesandindex. ISBN1-58562-063-7(alk.paper) 1.Mentalillness—Classification—Congresses. 2.Mentalillness—Longitudinal studies—Congresses. 3.Mentalillness—Diagnosis—Congresses. I.Title: Definingpsychopathologyinthetwentyfirstcentury. II.Helzer,JohnE. III.Hudziak,JamesJ. [DNLM:1.MentalDisorders—classification—Congresses. 2.Diagnostic Imaging—Congresses. 3.LongitudinalStudies—Congresses. 4.Mental Disorders—diagnosis—Congresses.WM15D3132002] RC455.2.C4D44 2002 616.89(cid:3)001(cid:3)2—dc21 2001053745 BritishLibraryCataloguinginPublicationData ACIPrecordisavailablefromtheBritishLibrary. One of the privileges of a prestigious university is the opportunity to know and be influenced by great men like Sam Guze. Hisdeathisalossfortheprofessionandapersonallossforthoseofus hetaught.WearegratefulthattheMillennialmeetingoftheAmerican PsychopathologicalAssociationprovidedustheopportunitytogiveSam theJosephZubinAward,theonlyawardourassociationconfersthatSam hadnotbeenhonoredwith.Samrichlydeservedtheaward,butitwasa pittancecomparedtoourdebttohim. JEH JJH This page intentionally left blank Contents Contributors ix Preface xiii PartI Definitional Tensions 1 FiveCriteriaforanImprovedTaxonomy ofMentalDisorders 3 RobertE.Kendell,M.D. 2 DefiningClinicallySignificantPsychopathology WithEpidemiologicData 19 DarrelA.Regier,M.D.,M.P.H.,and WilliamE.Narrow,M.D.,M.P.H. 3 WhyRequiringClinicalSignificanceDoesNotSolve Epidemiology’sandDSM’sValidityProblem: ResponsetoRegierandNarrow 31 JeromeC.Wakefield,D.S.W.,Ph.D., andRobertL.Spitzer,M.D. 4 PsychometricPerspectivesonComorbidity 41 RobertF.Krueger,Ph.D. PartII ImagingPsychopathology 5 TowardaNeuroanatomicalUnderstanding ofPsychiatricIllness:TheRoleofFunctionalImaging 57 JaneEpstein,M.D.,NancyIsenberg,M.D.,M.P.H., EmilyStern,M.D.,andDavidSilbersweig,M.D. 6 NeuroimagingStudiesofMoodDisorders 71 WayneC.Drevets,M.D. 7 GeneticNeuroimaging:HelpingtoDefine PhenotypesinAffectiveDisorders 107 KellyN.Botteron,M.D. PartIII LongitudinalStudies 8 PsychopathologyandtheLifeCourse 129 StephenL.Buka,Sc.D.,andStephenE.Gilman,Sc.D. 9 DetectingLongitudinalPatternsofAlcoholUse 143 JohnE.Helzer,M.D.,andJohnS.Searles,Ph.D. 10 EmpiricallyBasedAssessmentandTaxonomy AcrosstheLifeSpan 155 ThomasM.Achenbach,Ph.D. 11 ADHDComorbidityFindingsFromtheMTAStudy: NewDiagnosticSubtypesandTheirOptimal Treatments 169 PeterS.Jensen,M.D.,andMembersofthe MTACooperativeGroup PartIV ExploringAlternatives 12 ImplicationsofGeneticEpidemiology forClassification 195 KathleenR.Merikangas,Ph.D. 13 ImportanceofPhenotypeDefinitioninGenetic StudiesofChildPsychopathology 211 JamesJ.Hudziak,M.D. 14 DefiningGeneticallyMeaningfulClasses ofPsychopathology 231 StephenV.Faraone,Ph.D. 15 SchizotaxiaandthePreventionofSchizophrenia 249 MingT.Tsuang,M.D.,Ph.D. Index 261 Contributors ThomasM.Achenbach,Ph.D. WayneC.Drevets,M.D. ProfessorofPsychiatry AssociateProfessor andPsychology DepartmentsofPsychiatry UniversityofVermont andRadiology Burlington,Vermont UniversityofPittsburgh Pittsburgh,Pennsylvania KellyN.Botteron,M.D. Chief,MoodandAnxietyDisorders AssistantProfessor NeuroimagingSection DepartmentsofPsychiatry NationalInstituteofMentalHealth andRadiology NationalInstitutesofHealth WashingtonUniversitySchool Bethesda,Maryland ofMedicine St.Louis,Missouri JaneEpstein,M.D. AssistantProfessorofPsychiatry StephenL.Buka,Sc.D. WeillCornellMedicalCollege AssociateProfessor NewYork,NewYork DepartmentsofMaternaland ChildHealthandEpidemiology HarvardSchoolofPublicHealth Boston,Massachusetts ix

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Defining Psychopathology in the 21st Century This page intentionally left blank Defining Psychopathology in the 21st Century DSM-V and Beyond Editedby John E. Helzer, M.D. James J. Hudziak, M.D. American Psychopathological Association Washington, D.C. London, England Note:Theauthorshaveworkedtoensurethatallinformationinthisbookconcerning drugdosages,schedules,androutesofadministrationisaccurateasofthetimeof publicationandconsistentwithstandardssetbytheU.S.FoodandDrug Administrationandthegeneralmedicalcommunity.Asmedicalresearchand practiceadvance,however,therapeuticstandardsmaychange.Forthisreasonand becausehumanandmechanicalerrorssometimesoccur,werecommendthatreaders followtheadviceofaphysicianwhoisdirectlyinvolvedintheircareorthecareofa memberoftheirfamily.Aproduct’scurrentpackageinsertshouldbeconsultedfor fullprescribingandsafetyinformation. BookspublishedbyAmericanPsychiatricPublishing,Inc.,representtheviewsand opinionsoftheindividualauthorsanddonotnecessarilyrepresentthepoliciesand opinionsofAPPIortheAmericanPsychiatricAssociation. Copyright(cid:2)C 2002AmericanPsychiatricPublishing,Inc. ALLRIGHTSRESERVED ManufacturedintheUnitedStatesofAmericaonacid-freepaper 06 05 04 03 02 5 4 3 2 1 FirstEdition AmericanPsychiatricPublishing,Inc. 1400KStreet,N.W. Washington,DC20005 www.appi.org LibraryofCongressCataloging-in-PublicationData Definingpsychopathologyinthe21stcentury:DSM-Vandbeyond/editedby JohnE.Helzer,JamesJ.Hudziak.—1sted. p.;cm. Includesbibliographicalreferencesandindex. ISBN1-58562-063-7(alk.paper) 1.Mentalillness—Classification—Congresses. 2.Mentalillness—Longitudinal studies—Congresses. 3.Mentalillness—Diagnosis—Congresses. I.Title: Definingpsychopathologyinthetwentyfirstcentury. II.Helzer,JohnE. III.Hudziak,JamesJ. [DNLM:1.MentalDisorders—classification—Congresses. 2.Diagnostic Imaging—Congresses. 3.LongitudinalStudies—Congresses. 4.Mental Disorders—diagnosis—Congresses.WM15D3132002] RC455.2.C4D44 2002 616.89(cid:3)001(cid:3)2—dc21 2001053745 BritishLibraryCataloguinginPublicationData ACIPrecordisavailablefromtheBritishLibrary. One of the privileges of a prestigious university is the opportunity to know and be influenced by great men like Sam Guze. Hisdeathisalossfortheprofessionandapersonallossforthoseofus hetaught.WearegratefulthattheMillennialmeetingoftheAmerican PsychopathologicalAssociationprovidedustheopportunitytogiveSam theJosephZubinAward,theonlyawardourassociationconfersthatSam hadnotbeenhonoredwith.Samrichlydeservedtheaward,butitwasa pittancecomparedtoourdebttohim. JEH JJH This page intentionally left blank Contents Contributors ix Preface xiii PartI Definitional Tensions 1 FiveCriteriaforanImprovedTaxonomy ofMentalDisorders 3 RobertE.Kendell,M.D. 2 DefiningClinicallySignificantPsychopathology WithEpidemiologicData 19 DarrelA.Regier,M.D.,M.P.H.,and WilliamE.Narrow,M.D.,M.P.H. 3 WhyRequiringClinicalSignificanceDoesNotSolve Epidemiology’sandDSM’sValidityProblem: ResponsetoRegierandNarrow 31 JeromeC.Wakefield,D.S.W.,Ph.D., andRobertL.Spitzer,M.D. 4 PsychometricPerspectivesonComorbidity 41 RobertF.Krueger,Ph.D. PartII ImagingPsychopathology 5 TowardaNeuroanatomicalUnderstanding ofPsychiatricIllness:TheRoleofFunctionalImaging 57 JaneEpstein,M.D.,NancyIsenberg,M.D.,M.P.H., EmilyStern,M.D.,andDavidSilbersweig,M.D. 6 NeuroimagingStudiesofMoodDisorders 71 WayneC.Drevets,M.D. 7 GeneticNeuroimaging:HelpingtoDefine PhenotypesinAffectiveDisorders 107 KellyN.Botteron,M.D. PartIII LongitudinalStudies 8 PsychopathologyandtheLifeCourse 129 StephenL.Buka,Sc.D.,andStephenE.Gilman,Sc.D. 9 DetectingLongitudinalPatternsofAlcoholUse 143 JohnE.Helzer,M.D.,andJohnS.Searles,Ph.D. 10 EmpiricallyBasedAssessmentandTaxonomy AcrosstheLifeSpan 155 ThomasM.Achenbach,Ph.D. 11 ADHDComorbidityFindingsFromtheMTAStudy: NewDiagnosticSubtypesandTheirOptimal Treatments 169 PeterS.Jensen,M.D.,andMembersofthe MTACooperativeGroup PartIV ExploringAlternatives 12 ImplicationsofGeneticEpidemiology forClassification 195 KathleenR.Merikangas,Ph.D. 13 ImportanceofPhenotypeDefinitioninGenetic StudiesofChildPsychopathology 211 JamesJ.Hudziak,M.D. 14 DefiningGeneticallyMeaningfulClasses ofPsychopathology 231 StephenV.Faraone,Ph.D. 15 SchizotaxiaandthePreventionofSchizophrenia 249 MingT.Tsuang,M.D.,Ph.D. Index 261 Contributors ThomasM.Achenbach,Ph.D. WayneC.Drevets,M.D. ProfessorofPsychiatry AssociateProfessor andPsychology DepartmentsofPsychiatry UniversityofVermont andRadiology Burlington,Vermont UniversityofPittsburgh Pittsburgh,Pennsylvania KellyN.Botteron,M.D. Chief,MoodandAnxietyDisorders AssistantProfessor NeuroimagingSection DepartmentsofPsychiatry NationalInstituteofMentalHealth andRadiology NationalInstitutesofHealth WashingtonUniversitySchool Bethesda,Maryland ofMedicine St.Louis,Missouri JaneEpstein,M.D. AssistantProfessorofPsychiatry StephenL.Buka,Sc.D. WeillCornellMedicalCollege AssociateProfessor NewYork,NewYork DepartmentsofMaternaland ChildHealthandEpidemiology HarvardSchoolofPublicHealth Boston,Massachusetts ix

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