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Both internal and global consistencies are equivalent to or better than previously found concerning: SUDDS for DSM-III-R and DSM-IV [11,13]; different versions of SCID for DSM-IV [16,20,23-25] different versions of MINI for DSM-III-R and DSM-IV [17,22]; and the Composite International Diagnostic Interview (CIDI) for ICD-10 and DSM-III-R [26].
The present manuscript addressed the applicability of the PID-5 for group comparisons across the Emirati and the Portuguese clinical and community populations. To draw valid inferences regarding the mean score differences across both countries, an MI study was previously conducted, which is a prerequisite for cross-cultural comparisons [35, 36].
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For DSM-IV a number of preliminary steps were undertaken, including invited reviews of the literature, data reanalysis, and, finally, a large multi-site field trial conducted with over 100 raters of nearly 1,000 cases in various (20+) sites around the world. Goals for DSM-IV included balancing sensitivity and specificity across the IQ range and age, convergence (if possible) with the ICD-10 diagnostic approach, and potentially including new disorders in the DSM-IV definition [7].
Seventy-five probable cases of animal hoarding were found from administrative proceedings filed in the city of Porto Alegre by the City Office for Animal Rights (SEDA, in the Portuguese acronym). The researchers visited 61 homes between August 2015 and May 2016. The team was allowed in by 48 people, 38 of whom accepted to take part in the study. The addresses to the other 14 homes were either not found by the team or the people had already moved.
Out of the 38 people who agreed to participate, three did not meet the criteria required to be diagnosed with Animal Hoarding Disorder because their animals were in good health and nutrition conditions and the environment was suitable. Regarding this criterion, a report on each home visited and provided by SEDA veterinarians was used. One participant was excluded because of a speech impediment that prevented data from being collected. Another one was also excluded for being a schizophrenic.
The rhythmicity subdomain consists of 6 items investigating alterations in mood, energy and physical well-being according to the weather, the season, and the phase of menstrual cycle. The vegetative functions subdomains are: sleep (12 items), weight and appetite (4 items), sexual functions (5 items), physical symptoms (5 items, including headaches, dry mouth, constipation and stomach or bowel problems and sensitivity to heat, cold or pain). For the present study we excluded from the analyses two items of the sleep subdomain that explore alterations over the course of the menstrual cycle and apply only to females. The instrument can be downloaded from the web site www.spectrum-project.org. Suicidality is assessed using 6 items of the MOODS-SR that explore whether the subject had ever experienced periods of 3 to 5 days or more when he or she: thought that life is not worth living (N=102); wished he/she would not wake up in the morning, or that he/she would die in an accident or from something like a heart attack or a stroke (N=103); wanted to die or hurt him/herself (N=104); wanted to die and had a specific plan to hurt or kill him/herself (N=105); actually committed a suicide attempt (N=106); committed a suicide attempt that required medical attention (N=107). For the purpose of the present study, suicidality was rated counting the positive answers to these questions.
Several limitations of the study are important to note. First of all, as already mentioned, this was a cross-sectional study in which the use of a lifetime assessment does not allow establishing whether the alterations in rhythmicity and vegetative function preceded or co-occurred with suicidal ideation or attempts. No data, in fact, was collected in the study that could provide information as to whether a temporal association exists between these two variables. Second, rhythmicity and vegetative functions symptoms were assessed by means of a self-report and this may be less reliable than objective observations. Matousek et al. [73] reported poor agreement between the subjective and objective assessment of disturbed night sleep and alertness in the daytime in a sample of patients with mild depression, suggesting a significant influence of anxiety and depression on these reports. Similarly, the presence of suicidal ideation or attempts was not assessed through the rating of the clinician, so that a self-report of suicidality may be considered less accurate. In any case, literature data comparing self-reports and clinical assessment of suicidal symptoms indicate that self-rating of suicidality contains considerable predictive value and should be the primary data source [38]. A further limitation relates to the measure of suicidal ideation used in study. This measure was a composite score of a range of behaviors including wishes of death, suicidal ideation and planning. Particularly, wishes of deaths might represent different phenomena from suicidal thoughts and plans and, although the continuum view of suicidality has received support by recent studies [74], this may represent an important methodological limitation. Third, the sample size was small, although with a similar number of men and women. Fourth, because the MOODS-SR is a lifetime assessment we could not determine whether an ongoing drug treatment might have influenced the alterations in weight and/or appetite reported. Fifth, the lack of information on the characteristics of the index trauma (e.g. severity, degree of exposure, length of exposure) and of PTSD in terms of chronicity of the illness, may affect the results of the present study as they could not be generalizable to all categories of patients diagnosed with PTSD.
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