Effects of diagnosis on treatment recommendations in chronic insomnia - A report from the APA/NIMH DSM-IV field trial

Daniel J. Buysse, Charles F. Reynolds, David J. Kupfer, Michael J. Thorpy, Edward Bixler, Anthony Kales, Rocco Manfredi, Alex Vgontzas, Edward Stepanski, Thomas Roth, Peter Hauri, Deborah Stapf

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

The objective of this study was to determine whether sleep specialists and nonspecialists recommend different treatments for different insomnia diagnoses according to two different diagnostic classifications. Two hundred sixteen patients with chronic insomnia at five sites were each interviewed by two clinicians: one sleep specialist and one nonsleep specialist. All interviewers indicated diagnoses using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV); sleep specialists also indicated diagnoses according to the International Classification for Sleep Disorders (ICSD). Interviewers then indicated how strongly they would recommend each item in a standard list of treatment and diagnostic interventions for each patient. We examined differences in treatment recommendations among the six most common DSM-IV diagnoses assigned by sleep specialists at different sites (n = 192), among the six most common ICSD diagnoses assigned by sleep specialists at different sites (n = 153), and among the six most common DSM-IV diagnoses assigned by nonspecialists at different sites (n = 186). In each analysis, specific treatment and polysomnography recommendations differed significantly for different diagnoses, using either DSM-IV or ICSD criteria. Conversely, different diagnoses were associated with different rank orderings of specific treatment and diagnostic recommendations. Sleep specialist and nonspecialist interviewers each distinguished treatment recommendations among different diagnoses, but in general, nonspecialists more strongly recommended medications and relaxation treatments. Significant site-related differences in treatment recommendations also emerged. Differences in treatment recommendations support the distinction between different DSM-IV and ICSD diagnoses, although they do not provide formal validation. Site-related differences suggest a lack of consensus in how these disorders are conceptualized and treated.

Original languageEnglish (US)
Pages (from-to)542-552
Number of pages11
JournalSleep
Volume20
Issue number7
StatePublished - 1997

Fingerprint

National Institute of Mental Health (U.S.)
Sleep Initiation and Maintenance Disorders
Diagnostic and Statistical Manual of Mental Disorders
Sleep
Therapeutics
Interviews
Polysomnography
Consensus

Keywords

  • Diagnosis
  • DSM-IV
  • Insomnia
  • International classification of sleep disorders
  • Treatment

ASJC Scopus subject areas

  • Physiology

Cite this

Buysse, D. J., Reynolds, C. F., Kupfer, D. J., Thorpy, M. J., Bixler, E., Kales, A., ... Stapf, D. (1997). Effects of diagnosis on treatment recommendations in chronic insomnia - A report from the APA/NIMH DSM-IV field trial. Sleep, 20(7), 542-552.

Effects of diagnosis on treatment recommendations in chronic insomnia - A report from the APA/NIMH DSM-IV field trial. / Buysse, Daniel J.; Reynolds, Charles F.; Kupfer, David J.; Thorpy, Michael J.; Bixler, Edward; Kales, Anthony; Manfredi, Rocco; Vgontzas, Alex; Stepanski, Edward; Roth, Thomas; Hauri, Peter; Stapf, Deborah.

In: Sleep, Vol. 20, No. 7, 1997, p. 542-552.

Research output: Contribution to journalArticle

Buysse, DJ, Reynolds, CF, Kupfer, DJ, Thorpy, MJ, Bixler, E, Kales, A, Manfredi, R, Vgontzas, A, Stepanski, E, Roth, T, Hauri, P & Stapf, D 1997, 'Effects of diagnosis on treatment recommendations in chronic insomnia - A report from the APA/NIMH DSM-IV field trial', Sleep, vol. 20, no. 7, pp. 542-552.
Buysse, Daniel J. ; Reynolds, Charles F. ; Kupfer, David J. ; Thorpy, Michael J. ; Bixler, Edward ; Kales, Anthony ; Manfredi, Rocco ; Vgontzas, Alex ; Stepanski, Edward ; Roth, Thomas ; Hauri, Peter ; Stapf, Deborah. / Effects of diagnosis on treatment recommendations in chronic insomnia - A report from the APA/NIMH DSM-IV field trial. In: Sleep. 1997 ; Vol. 20, No. 7. pp. 542-552.
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