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Use of a Psychophysiological Script-driven Imagery Experiment to Study Trauma-related Dissociation in Borderline Personality Disorder

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Validity of the DSM-5 Mixed Features Specifier Interview.

Mark Zimmerman¹, Daniel Mackin¹

¹Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island, USA.

Bipolar Disorders

|April 29, 2024

Summary

The DSM-5 Mixed Features Specifier Interview (DMSI) reliably assesses mixed features in depressed patients. This tool aids in diagnosing and measuring the severity of these symptoms.

Keywords:

bipolar disorder depression mixed features, DSM‐5 mixed features specifier

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Area of Science:

Psychiatry
Clinical Psychology
Psychometrics

Background:

The DSM-5 includes a "mixed features" specifier for depressive episodes, indicating the presence of manic/hypomanic symptoms.
Accurate assessment of this specifier is crucial for diagnosis and treatment.
Existing assessment tools may lack reliability or validity for this specific specifier.

Purpose of the Study:

To evaluate the reliability and validity of a new semi-structured interview, the DSM-5 Mixed Features Specifier Interview (DMSI).
To establish the DMSI as a tool for both diagnosing the mixed features specifier and measuring its severity.

Main Methods:

A semi-structured interview, the DMSI, was administered to 459 psychiatric patients experiencing a depressive episode.
Inter-rater reliability and psychometric properties of the DMSI were assessed.
Patients were also rated on depression, anxiety, irritability, psychosocial functioning, suicidality, and family history of bipolar disorder.

Main Results:

The DMSI demonstrated excellent inter-rater reliability.
The prevalence of mixed features was higher in the week prior to assessment (9.4%) compared to the majority of the episode (3.9%).
DMSI scores correlated more strongly with manic symptoms than with depression or anxiety; mixed features were more common in bipolar depression than MDD, and associated with increased suicide attempts and comorbidities in MDD.

Conclusions:

The DMSI is a reliable and valid instrument for assessing the DSM-5 mixed features specifier in depressed individuals.
The DMSI can be used to determine the presence and severity of mixed features, aiding clinical practice.