Axis I disorders

First MB, Spitzer RL, Gibbon M, et al Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Patient Edition With Psychotic Screen (SCID-I/ P W/ PSY SCREEN) New York, New York State Psychiatric Institute, Biometrics Research, 1997... 

F. The disturbance is not better accounted for by another Axis I disorder. 

Chen, Y. W. and Dilsaver, S. C. Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other Axis I disorders. Biol. Psych. 39 896-899,1996. 

Increase the homogeneity of the population (use standard diagnostic tools maximum feasible reduction of comorbidities with other Axis I disorders)... 

The most commonly used semi-structured diagnostic scale is the Structured Clinical Interview for DSM-IV Axis I Disorders (SCI I) First et al., 1997). A clinical version of the SCID (SCID-CV) is designed for use in clinical settings and covers the most commonly seen diagnoses according to DSM-IV. The research version of the SCID includes ratings for different subtypes, severity and course specifiers of mental disorders. The SCLD-CV contains six modules (A) Mood Episodes (B) Psychotic Symptoms (C) Psychotic Disorders (D) Mood Disorders (E) Substance Use Disorders fF) Anxiety and Other Disorders. 

First, MJT, Spitzer, R.L., Gibbon, M., Williams, J.B.W. Structured Clinical Interview for DSM-IY Axis I Disorders. American Psychiatric Press, Washington. DC, 1997. 

Klous MG, Nuijen B, van Den Brink W, van Ree JM Beijnen JH (2007). Pharmaceutical development of dosage forms of diamor-phine for use by heroin addicts. Pharma-ceutisch Weekblad, 142, 98-104 Kokkevi A, Stefanis N, Anastasopoulou E Kostogianni C (1998). Personality disorders in drug abusers prevalence and their association with AXIS I disorders as predictors... 

GAD may be diagnosed along with another Axis I disorder (including another anxiety disorder) provided that the GAD symptoms are present at least sometimes without symptoms of the other disorder and that the anxiety is not focused on the symptoms of the other disorder. 

Approximately one-third of children with ADHD having an Axis I disorder as adults. 

Usually a better consult choice for the patient with multiple conditions, especially an Axis I disorder, personality disorder and substance abuse. 

Axis II characteristics reflect atypical or mild chronic Axis I disorders... 

Thus, when medications are used to treat various Axis I disorders, it is well to keep in mind that, despite the success of drug treatment, ultimate therapeutic success and relapse prevention may depend heavily on the role Axis II factors play. 

It is possible that what initially appear to be characteristic symptoms of personality disorder may reflect some form of mild, chronic, or atypical Axis I disorder. Let s consider several examples. For years clinicians described certain patients as suffering from masochistic or depressive personalities. These people were often seen as chronically pessimistic, bitter, irritable individuals, and the implication was that the low-grade depressive traits were manifestations of personality— that is, etched into the character of the individual. Although certainly this is the case for some people, in recent years a significant number of dysthymic patients have experienced very positive results when treated with antidepressants. 

As mentioned in chapter 2, individuals particular personality style and unique psychodynamics will often dramatically influence how they respond to pharmacotherapy. Robert Michaels (1992) has commented that in general clinical practice two-thirds of patients with Axis I disorders appear to respond quite well either to medication treatment or to brief, targeted psychological interventions, such as cognitive-behavioral or interpersonal therapy. However, a significant minority of patients with clear-cut Axis I disorders don t respond well to such treatments, primarily due to serious co-morbid character pathology. In treating these people, at the very least the clinician must be alert to how personality factors influence treatment outcome often medication treatment must be accompanied by more intensive psychotherapy that addresses the personality disorder. 

Axis II Traits Medication-Responsive Axis I Disorder Psychotropic Medication Options... 

Beyond these commonalties are a considerable variety of symptomatic presentations. The particular behaviors observed are colored by the patient s style (obsessional, histrionic, and so on), the nature of their current social support network, and the presence or absence of comorbid Axis I disorders (See Preston 1997). 

The critical defining feature that can help the clinician be more certain of a borderline diagnosis is the history. As noted in chapter 4, many individuals may transiently experience borderline characteristics while in the throes of a major Axis I disorder (for example, a depression), only to recompensate when the Axis I problem resolves. A more definitive diagnosis of borderline disorder emerges when there is a well-documented history of ego impairment dating back to adolescence or early adulthood—"stable instability."... 

In addition to these subtypes, it is important to keep in mind that many, if not most, borderline personalities have comorbid Axis I disorders—especially common are major depression and substance abuse. These coexisting disorders always complicate the picture and must be dealt with in any approach to treatment. In particular, longitudinal studies following the course and outcome of borderline personality disorders over the life span suggest very clearly that those patients who continue to do poorly are those who continue to abuse alcohol and other substances. Thus treatment of chemical dependency problems must be addressed. 

In addition, it exerts beneficial effects in many disorders as an adjuvant to other treatment modalities. Such effects are apparent only if it is administered to an already pharmacologically treated patient. For example, in unresponsive major depressive disorder, the co-administration of lithium to an ongoing antidepressant treatment increases the response rate by up to 50%. In most cases, the response to lithium augmentation is either considerable or not at all ( all-or-none phenomenon). Some (currently not convincing) results have also been reported in unipolar depression, bulimia nervosa, and attention deficit hyperactivity disorder (ADHD). Lithium also exerts antiaggressive effects in conduct disorder, independent of any mood disorder, and can reduce behavioral dyscontrol and self-mutilation in mentally retarded patients. One of the most striking effects of lithium is its antisuicidal effect in patients who suffer from bipolar and unipolar depressive disorder irrespective of comorbid axis I disorder. ... 

Lithium has shown its capacity as an augmenter in various axis I disorders. However, its use in BN has not been properly examined, probably due to its relative narrow therapeutic window and particularly because its serum levels can shift markedly with rapid volume changes, as often happens in BN. ... 

There is a growing body of evidence to support the efficacy of low-dose SCAs in decreasing impulsivity, aggression, self-injury, affective instability, and psychosis in BPD. ° If response is suboptimal within 4-6 weeks, the dose can be increased to the range used for Axis I disorders. Over the past few years, olanzapine (5-20 mg/day) has been the most thoroughly studied SCA for treating BPD. Olanzapine has benefited patients in all measured domains,... 

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