Mohammed T. Abou-Saleh

PSYCHIATRIC DIAGNOSIS AND OLD AGE 121of psychopathology, would likely show greater utility andreliability than the current Axis V measure. While this approachwas discussed for DSM-IV, it was not adopted as it was viewed asuntested. Future consideration of how best to rate a patient’sfunctional abilities will be an important issue for DSM-V.In a similar vein, development of a cognitive rating scale withinthe overall diagnostic classification would have substantial clinicaland heuristic value. Here, too, one confronts substantial controversy.Does the clinician attempt to rate absolute capability orto assess change (i.e. decline)? While a measure reflectingintellectual integrity or decline would assist when considering awide variety of disorders (including dementia, mood disturbancesand psychoses), how should one account for variations in literacy,education, cultural background or country of origin? At present,no single scale has proved suitable for all circumstances. Beforeinclusion in any formal diagnostic system, such a measure wouldrequire substantial testing to ensure both its validity and itsreliability.CONCLUSIONGeriatric psychiatry is only now achieving in the USA theattention and status that it has held for many years in othercountries. Historically, clinicians and researchers who haveworked in this area have had little impact on the nosologiesrecorded in the diagnostic manuals of the American PsychiatricAssociation. This situation is changing dramatically. However,specific suggestions for revision bear only as much weight as thestrength of the research base upon which they are built. The rapidgrowth in North America of research dealing with psychopathologyof the elderly is a heartening development, one portendingfuture changes in DSM-V that we may not have yet anticipated.REFERENCES1. Kleinman AM. Depression, somatization and the ‘‘new cross-culturalpsychiatry’’. Soc Sci Med 1977; 11: 3–10.2. Reynolds EH. Structure and function in neurology and psychiatry. BrJ Psychiat 1990; 157: 481–90.3. Caine ED, Porsteinsson A, Lyness JM, First M. Reconsidering theDSM-IV diagnoses of Alzheimer’s disease: behavioral andpsychological symptoms in patients with dementia. Int Psychogeriat(in press).4. Caine ED. Diagnostic classification of neuropsychiatric signs andsymptoms in patients with dementia. Int Psychogeriat 1996; 8(suppl 3): 273–9.5. Crook T, Bartus RT, Ferris SH et al. Age-associated memoryimpairment. Dev Neuropsychol 1986; 2: 261–76.6. Caine ED. Should aging-associated cognitive decline be included inDSM-IV? J Neuropsychiat Clin Neurosci 1993; 5: 1–5.7. Lyness JM, Caine ED, King DA et al. Psychiatric disorders in olderprimary care patients. J Gen Intern Med 1999; 14: 249–54.8. Atkinson RM. Aging and alcohol use disorders. Psychogeriatrics1990; 2: 55–72.9. Agronin ME, Maletta G. Personality disorders in late life:understanding and overcoming the gap in research. Am J GeriatrPsychiat 2000; 8: 4–18.10. Lyness JM, Duberstein PR, King DA et al. Medical illness burden,trait neuroticism, and depression in older primary care patients. Am JPsychiat 1998; 155: 969–71.11. Duberstein PR, So¨rensen S, Lyness JM, King DA et al. Personality isassociated with perceived health and functional status in olderprimary care patients. Psychol Aging (in press).12. Duberstein PR, Conwell Y. Personality disorders and completedsuicide: a methodological and conceptual review. Clin Psychol SciPrac 1997; 4: 359–76.