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van Langen MJM, van Hulst BM, Durston S. Hidden in plain sight: how individual ADHD stakeholders have conflicting ideas about ADHD but do not address their own ambivalence. Eur Child Adolesc Psychiatry 2024; 33:1921-1933. [PMID: 37688613 PMCID: PMC11211115 DOI: 10.1007/s00787-023-02290-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Abstract
Psychiatric classifications refer to clusters of behavioral symptoms. We know much about how psychiatric classifications are intended to be used in theory. Yet the scientific study of the practice of classification to date is limited. We aimed to explore how individuals navigate and make sense of the complexity surrounding an ADHD classification. We used thematic analysis to analyse stakeholder perspectives from seven focus groups: adults classified with ADHD, adolescents classified with ADHD, parents of children classified with ADHD, clinicians, researchers, teachers, and policy makers. We found seven themes in how stakeholders navigate the classification ADHD. Yet, what stood out was an overarching discursive pattern: individual stakeholders expressed highly ambivalent ideas about ADHD but did not address their own ambivalence. We suggest that promoting a social kinds perspective on ADHD may help us navigate the complexity and ambivalence associated with ADHD more competently.
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Affiliation(s)
- Myrte J M van Langen
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, HP A01.126 (B01.106), Utrecht, The Netherlands.
| | - Branko M van Hulst
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, HP A01.126 (B01.106), Utrecht, The Netherlands
- LUMC Curium - Child and Adolescent Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sarah Durston
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, HP A01.126 (B01.106), Utrecht, The Netherlands
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O’Brien J, Gregg L, Wittkowski A. "Finding my voice again" - women's experiences of psychological therapy in perinatal secondary care settings: a qualitative study. Front Psychiatry 2024; 15:1240855. [PMID: 38863602 PMCID: PMC11165924 DOI: 10.3389/fpsyt.2024.1240855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 05/06/2024] [Indexed: 06/13/2024] Open
Abstract
Introduction Although women often experience mental health comorbidities in the perinatal period, the evidence-base for psychological therapy across diagnostic boundaries in the perinatal period remains limited. As there is a need to understand experiences of therapy, irrespective of diagnosis, to inform intervention provision, the aims of this study were to explore women's experiences of psychological therapy for perinatal mental health difficulties and to identify the mechanisms that women attributed to the most significant therapeutic change for themselves and/or the mother-infant relationship. Method Semi-structured interviews were conducted with 16 women who received therapy within specialist perinatal community mental health settings in the Northwest of England, the UK. Interview data were analysed using reflexive thematic analysis. Results One overarching theme entitled participant life stories were at the heart of therapy was identified alongside three other main themes: 1.) We're in this together - therapeutic bond and establishing a coherent sense of self, 2.) Surfing the urge to 'fix' feelings - Sitting with emotions improved regulation and 3.) Seeing myself in a new light - Shifting self-blame to self-compassion enhanced self-efficacy. Theme 1 consisted of three subthemes. Participants described the quality of the therapeutic relationship as the fundamental foundation to (re)connecting with their needs, values and boundaries, which improved their sense of agency, self-esteem, therapeutic engagement and self-understanding. Shifting emotional avoidance to emotional engagement improved their self-regulation. Considering alternative factors that could have contributed to their experiences helped them to defuse self-blame and enhance self-compassion. Finally, changes in their mental health led to positive relational changes in their relationship with their infant and improved communication with partners. Discussion Sensitivity, engagement and responsivity experienced in the therapist-woman relationship was reported to be mirrored in the mother-infant relationship. Developing a coherent sense of self and self-regulation skills both appeared to heighten women's self-compassion and empathy for their infants, which also seemed to improve their ability to tolerate uncertainty and mixed emotions within themselves and their infants. The mechanisms of change in the perinatal period are important to consider at a stakeholder, therapist and service management level to parsimoniously and best meet the needs of women and the mother-infant relationship.
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Affiliation(s)
- Jayne O’Brien
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Perinatal Mental Health and Parenting Research Unit, Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom
| | - Lynsey Gregg
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Anja Wittkowski
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Perinatal Mental Health and Parenting Research Unit, Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom
- Manchester Health Alliance Science Centre, The University of Manchester, Manchester, United Kingdom
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Fulton-Hamilton E, Morgan G. Examining Attitudes Towards Mental Health Diagnoses: A Q-Methodology Study. J Ment Health 2024; 33:57-65. [PMID: 37129104 DOI: 10.1080/09638237.2023.2182430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/07/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Debates exist regarding the validity and utility of functional psychiatric diagnoses. How mental health diagnoses are understood has real impacts for service users and service delivery. AIMS To investigate different attitudes about the utility of psychiatric diagnoses. METHODS Forty-one stakeholders sorted 57 statements related to the usefulness of psychiatric diagnoses. Using q-methodology, four viewpoints were identified and interpreted. RESULTS Viewpoint 1 (Pathologising human experience) regarded diagnoses as pseudo-scientific constructs that lacked validity and obscured the relationships between lived experience and distress. Viewpoint 2 (Illnesses like any other) held that labels reflected real disorders and diagnosis offered important benefits for service users and services. Viewpoint 3 (Stigmatised conditions) similarly regarded diagnoses as reflecting real disorders, but diagnostic criteria were viewed as biased and the impacts of applying labels seen as causing problems for service users. Conversely, Viewpoint 4 (Useful short-hands) viewed diagnostic processes as imperfect but necessary for supporting communication and structuring service delivery. CONCLUSIONS While not all viewpoints are in keeping with empirical evidence, we hope results will enable professionals and service users to take meta-positions in relation to their own and others' attitudes, and to reflect on the impacts of privileging certain viewpoints over others.
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Affiliation(s)
- Emily Fulton-Hamilton
- School of Psychology, George Davies Centre, University of Leicester, Leicester, England
| | - Gareth Morgan
- School of Psychology, George Davies Centre, University of Leicester, Leicester, England
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Hynes-Ryan C, Carolan A, Feeney L, Strawbridge J, Purcell A, Gilsenan G, O'Donoghue D, Keating D. Pharmacist-led medicines optimisation service in an inpatient mental health setting. Ir J Psychol Med 2023:1-8. [PMID: 38031710 DOI: 10.1017/ipm.2023.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Medicines optimisation ensures that people get the best possible outcomes from their medicines. As those with severe mental illness (SMI) are frequently prescribed psychotropic medicines with potentially significant side-effects, poor adherence to treatment and physical morbidity are common. This results in suboptimal symptom control, physical health problems and negative health outcomes. The specialist mental health pharmacist (SMHP) is best placed to provide leadership for medicines optimisation in the inpatient mental health setting. By adopting a patient-centred approach to providing information, improving adherence, screening, initiating and maintaining medicines, and supporting self-advocacy, the SMHP can ensure the patients' experience of taking medicines is optimised. As there is currently limited understanding of what a baseline clinical pharmacy service in a mental health setting looks like, we aim to outline a framework for pharmacist-led medicines optimisation for those with SMI. This framework is suitable to be scaled and adapted to other settings.
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Affiliation(s)
- Caroline Hynes-Ryan
- Pharmacy Department, Saint John of God Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland - University of Medicine and Health Sciences, Dublin, Ireland
| | - Aoife Carolan
- Pharmacy Department, Saint John of God Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland - University of Medicine and Health Sciences, Dublin, Ireland
| | - Larkin Feeney
- Mental Health Services, HSE Community Healthcare East CHO 6, Dublin, Ireland
- Saint John of God Community Mental Health Services, Dublin, Ireland
| | - Judith Strawbridge
- School of Pharmacy and Biomolecular Sciences (PBS), Royal College of Surgeons in Ireland - University of Medicine and Health Sciences, Dublin, Ireland
| | - Audrey Purcell
- Pharmacy Department, Saint John of God Hospital, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences (PBS), Royal College of Surgeons in Ireland - University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Dolores Keating
- Pharmacy Department, Saint John of God Hospital, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences (PBS), Royal College of Surgeons in Ireland - University of Medicine and Health Sciences, Dublin, Ireland
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Sabados D, Potash JS. Art for Humanizing Mental Illness When Teaching Diagnosis. JOURNAL OF HUMANISTIC PSYCHOLOGY 2023. [DOI: 10.1177/00221678231161386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Teaching a class that covers psychiatric diagnoses is essential for graduate students in mental health professions both for the purpose of providing informed therapeutic services for their clients who may have been diagnosed with a mental illness, and, increasingly, for the provision of diagnosis as a licensed clinician in the United States. Art therapy educators designed an experiential learning approach rooted in two frameworks that humanize mental illness (Two Continua Model of Mental Health and Mental Illness, Power Threat Meaning) combined with reflective art viewing and making. A cumulative art assignment based on one-canvas painting fosters students’ critical perspectives through four observed patterns: appreciating impact of layering; understanding mental illness through art materials and processes; empathizing through reflecting on one’s own experiences; and recognizing the wholeness of those living with mental illness. The incorporation of response art in the psychopathology class has had the intended dual impact of instilling a humanizing approach to mental illness and fostering self-reflection.
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Affiliation(s)
- Diana Sabados
- The George Washington University, Alexandria, VA, USA
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Examining Relations Between Parent and Child Psychopathology in Children with ADHD: Do Parent Cognitions Matter? JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2023. [DOI: 10.1007/s10862-023-10023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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7
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Mou M, Albagmi FM. Engendering a monoculture of the mind: implications for mental health policy development in Saudi Arabia. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2022. [DOI: 10.1080/19349637.2022.2137076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mandy Mou
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Faisal Mashel Albagmi
- Department of Physical Therapy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Maes MHJ, Stoyanov D. False dogmas in mood disorders research: Towards a nomothetic network approach. World J Psychiatry 2022; 12:651-667. [PMID: 35663296 PMCID: PMC9150032 DOI: 10.5498/wjp.v12.i5.651] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/07/2021] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
The current understanding of major depressive disorder (MDD) and bipolar disorder (BD) is plagued by a cacophony of controversies as evidenced by competing schools to understand MDD/BD. The DSM/ICD taxonomies have cemented their status as the gold standard for diagnosing MDD/BD. The aim of this review is to discuss the false dogmas that reign in current MDD/BD research with respect to the new, data-driven, machine learning method to model psychiatric illness, namely nomothetic network psychiatry (NNP). This review discusses many false dogmas including: MDD/BD are mind-brain disorders that are best conceptualized using a bio-psycho-social model or mind-brain interactions; mood disorders due to medical disease are attributable to psychosocial stress or chemical imbalances; DSM/ICD are the gold standards to make the MDD/BD diagnosis; severity of illness should be measured using rating scales; clinical remission should be defined using threshold values on rating scale scores; existing diagnostic BD boundaries are too restrictive; and mood disorder spectra are the rule. In contrast, our NNP models show that MDD/BD are not mind-brain or psycho-social but systemic medical disorders; the DSM/ICD taxonomies are counterproductive; a shared core, namely the reoccurrence of illness (ROI), underpins the intertwined recurrence of depressive and manic episodes and suicidal behaviors; mood disorders should be ROI-defined; ROI mediates the effects of nitro-oxidative stress pathways and early lifetime trauma on the phenome of mood disorders; severity of illness and treatment response should be delineated using the NNP-derived causome, pathway, ROI and integrated phenome scores; and MDD and BD are the same illness.
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Affiliation(s)
- Michael HJ Maes
- Department of Psychiatry, Chulalongkorn University, Bangkok 10330, Thailand
| | - Drozdstoy Stoyanov
- Department of Psychiatry, Medical University Plovdiv, Plovdiv 4000, Bulgaria
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9
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Macías J, Schosser KK, Bond FW, Blanca MJ, Valero-Aguayo L. Enhancing students' well-being with a unified approach based on contextual behavioural science: A randomised experimental school-based intervention. Appl Psychol Health Well Being 2022; 14:1022-1036. [PMID: 35505620 DOI: 10.1111/aphw.12365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
Abstract
A new generation of interventions has begun to move towards principles of acceptance that deal with the context and function of psychological events. The aim of this paper is to analyse the effectiveness of a brief contextual behavioural intervention to improve the psychological well-being of secondary school students. This intervention represents a unified model with key processes based on contextual behavioural science, including Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP). We conducted an intervention with 94 students (age range 17-19 years), randomly assigned to an experimental group (n = 50) or control group (n = 44). Participants took a pretest and post-test of distress, life satisfaction, psychological flexibility and mindfulness. The intervention consisted of three sessions of 1 h each. The results showed significant differences between the groups in distress and significant differences for the interaction (group × pre-post) in all the other variables. The intervention had greater benefits for girls than for boys. These results may provide a breakthrough, thus leading to a process of evidence-based therapies, which would be responsible for inducing psychological improvements in brief periods, in a population with an increasing risk of distress.
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Affiliation(s)
- Juanjo Macías
- Faculty of Health Sciences, Catholic University of San Antonio of Murcia, Murcia, Spain
| | - Károly K Schosser
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, University of London, London, UK
| | - Frank W Bond
- Institute of Management Studies, London University, Goldsmiths, London, UK
| | - María J Blanca
- Department of Psychobiology & Methodology of Behavioral Sciences of the Faculty of Psychology, University of Málaga, Málaga, Spain
| | - Luis Valero-Aguayo
- Department of Personality, Assessment and Psychological Treatment of the Faculty of Psychology, University of Málaga, Málaga, Spain
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Noorain S, Paola Scaparra M, Kotiadis K. Mind the gap: a review of optimisation in mental healthcare service delivery. Health Syst (Basingstoke) 2022; 12:133-166. [DOI: 10.1080/20476965.2022.2035260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Chao YS, Wu CJ, Lai YC, Hsu HT, Cheng YP, Wu HC, Huang SY, Chen WC. Why Mental Illness Diagnoses Are Wrong: A Pilot Study on the Perspectives of the Public. Front Psychiatry 2022; 13:860487. [PMID: 35573385 PMCID: PMC9098926 DOI: 10.3389/fpsyt.2022.860487] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mental illness diagnostic criteria are made based on assumptions. This pilot study aims to assess the public's perspectives on mental illness diagnoses and these assumptions. METHODS An anonymous survey with 30 questions was made available online in 2021. Participants were recruited via social media, and no personal information was collected. Ten questions focused on participants' perceptions regarding mental illness diagnoses, and 20 questions related to the assumptions of mental illness diagnoses. The participants' perspectives on these assumptions held by professionals were assessed. RESULTS Among 14 survey participants, 4 correctly answered the relationships of 6 symptom pairs (28.57%). Two participants could not correctly conduct the calculations involved in mood disorder diagnoses (14.29%). Eleven (78.57%) correctly indicated that 2 or more sets of criteria were available for single diagnoses of mental illnesses. Only 1 (7.14%) correctly answered that the associations between symptoms and diagnoses were supported by including symptoms in the diagnostic criteria of the diagnoses. Nine (64.29%) correctly answered that the diagnosis variances were not fully explained by their symptoms. The confidence of participants in the major depressive disorder diagnosis and the willingness to take medications for this diagnosis were the same (mean = 5.50, standard deviation [SD] = 2.31). However, the confidence of participants in the symptom-based diagnosis of non-solid brain tumor was significantly lower (mean = 1.62, SD = 2.33, p < 0.001). CONCLUSION Our study found that mental illness diagnoses are wrong from the perspectives of the public because our participants did not agree with all the assumptions professionals make about mental illness diagnoses. Only a minority of our participants obtained correct answers to the calculations involved in mental illness diagnoses. In the literature, neither patients nor the public have been engaged in formulating the diagnostic criteria of mental illnesses.
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Affiliation(s)
| | - Chao-Jung Wu
- Département d'Informatique, Université du Québec à Montréal, Montréal, QC, Canada
| | - Yi-Chun Lai
- National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | | | | | - Hsing-Chien Wu
- National Taiwan University Hospital, New Taipei City, Taiwan
| | - Shih-Yu Huang
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chih Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Cahill CR, Llavero GR, Escudero DM, Fernández PG, Rodríguez FS, García MIC, González KM. Iatrogenia en personas diagnosticadas de trastorno límite de la personalidad. CLÍNICA CONTEMPORÁNEA 2021. [DOI: 10.5093/cc2021a21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Hoff P, Maatz A, Vetter JS. Diagnosis as dialogue: historical and current perspectives
. DIALOGUES IN CLINICAL NEUROSCIENCE 2021; 22:27-35. [PMID: 32699503 PMCID: PMC7365291 DOI: 10.31887/dcns.2020.22.1/phoff] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ever since psychiatry emerged as a clinical discipline and field of scientific
inquiry in the late 18th century, debates about diagnosis have been at its
very heart. Considered by many a requirement for clinical communication as well as for
systematic study, others have critiqued psychiatric diagnosis for being modeled on a
medical conception of disease that is ill-suited to the specific nature of mental
disorders. Based on a review of seminal positions in the conceptual history of
psychiatry and an examination of their epistemological underpinnings, we propose to
consider diagnosis as dialogue. Such understanding, we argue, can serve
as a meta-framework that provides a conceptual and practical umbrella to encourage
open-minded conversation across the diverse conceptual and experiential frameworks that
are characteristic of psychiatry. In this perspective psychopathology will also
reinforce the interpersonal realm as a necessary element of any clinical encounter, be
it diagnostic in purpose or otherwise. Current challenges to traditional diagnostic
systems like Research Domain Criteria (RDoC) and Hierarchical Taxonomy of
Psychopathology (HiTOP) are discussed in light of these
considerations.
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Affiliation(s)
- Paul Hoff
- University Hospital of Psychiatry Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, P.O. Box 363, 8032 Zurich, Switzerland
| | - Anke Maatz
- University Hospital of Psychiatry Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, P.O. Box 363, 8032 Zurich, Switzerland
| | - Johannes Simon Vetter
- University Hospital of Psychiatry Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, P.O. Box 363, 8032 Zurich, Switzerland
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Wright AJ. Psychological and neuropsychological underpinnings of attention-deficit/hyperactivity disorder assessment. Clin Child Psychol Psychiatry 2021; 26:783-794. [PMID: 33624519 DOI: 10.1177/1359104521996765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The identification and diagnosis of attention-deficit/hyperactivity disorder (ADHD) is extremely important in order to help change the trajectory of an individual's life outcomes. A review of the current state of evidence-based assessment of ADHD is dominated by the DSM-5's conceptualization of behaviorally-oriented diagnostic criteria. This assumption that the DSM-5's method for identifying ADHD is the gold standard underlies the research base that evaluates the incremental validity of measures and methods for diagnosing it. That is, when evaluating whether a measure is useful in the identification of ADHD, the 'right answer' is based on the DSM-5's behaviorally-oriented definition. An alternative model for considering the fact that ADHD is a neurodevelopmental disorder, with its roots in executive dysfunction, is proposed. Using neuropsychological and cognitive tests to identify executive functioning problems can be combined with rating scales and interviews to diagnose ADHD in a way that does not ascribe entirely to a behavioral definition of the disorder.
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Williams BD, Thomas G, Joiner A. Barriers to and Facilitators of Evidence-Based Practice in Psychiatry Core Trainees in Northwest England. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:315-321. [PMID: 33409939 DOI: 10.1007/s40596-020-01372-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Barriers and facilitators of evidence-based practice (EBP) in psychiatrists in training have only been researched with reference to prescribing decisions. We sought to quantitatively describe general EBP barriers and facilitators perceived by psychiatry core trainees (CTs) in England. METHODS A cross-sectional survey of CTs from a single English region in their 1st to 3rd year of specialist training (CT1-3) uses the EBP inventory, a 26-item questionnaire subdivided into the domains of attitudes, social norms, perceived behavioral control (PBC), decision-making preferences, and intention and behavior. This was analyzed using a multiple indicators multiple causes model. RESULTS The response rate was 42.9% (72/168 CTs). In all, domain's responses overall tended to be positive toward EBP. The most commonly reported barriers were rarely discussing research literature, feeling incapable of staying up to date, aversion to statistics, a preference for intuition or experience, and a perception that EBP disregards the individual differences between patients. Attitudes, norms, and behavior all loaded onto their intended factors. The decision-making factor was not present and PBC subdivided into 2 factors: clinical and knowledge self-efficacy. Regression coefficients for predicting behavior from the other factors were attitudes - 0.16 (p = 0.34), norms 0.34 (p = 0.24), clinical PBC - 0.28 (p = 0.10), and knowledge PBC 0.613 (p = 0.01). Additionally, question 5 (EBP respects individual patients) and question 13 (discusses research literature with colleagues) independently predicted behavior (β = 0.388; p = 0.05 and β = 0.433; p = 0.01). CONCLUSIONS EBP intention and behavior were associated with perceiving EBP as relevant to individual patients, discussion about research with colleagues, and knowledge self-efficacy.
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Affiliation(s)
| | - Gareth Thomas
- Lancashire and South Cumbria NHS Foundation Trust, Preston, Lancashire, UK
| | - Adam Joiner
- Lancashire and South Cumbria NHS Foundation Trust, Preston, Lancashire, UK
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O'Connor C, Brassil M, O'Sullivan S, Seery C, Nearchou F. How does diagnostic labelling affect social responses to people with mental illness? A systematic review of experimental studies using vignette-based designs. J Ment Health 2021; 31:115-130. [PMID: 34008456 DOI: 10.1080/09638237.2021.1922653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND An outstanding question in the stigma literature is the extent to which negative responses are provoked by diagnostic labels, rather than observable symptoms of mental illness. Experimental studies frequently use vignettes to identify the unique effects of diagnostic labels on social responses to people with mental illness, independent of their behaviour or socio-demographic characteristics. AIMS The current article identifies, evaluates, and synthesises the body of experimental vignette studies of labelling effects. METHODS A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were subjected to quality evaluation and narrative synthesis. RESULTS Of 1511 articles screened, 22 met inclusion criteria. Most studies focused on the diagnostic categories of attention deficit hyperactivity disorder, schizophrenia spectrum disorders, and autism spectrum disorder. The literature reported diverse effects, with diagnostic disclosure either exacerbating, mitigating, or not affecting stigma. The quality of studies was generally acceptable but the review identified an over-reliance on convenience sampling and unvalidated measures. CONCLUSIONS Results highlight the complexity of labelling effects, which diverge across diagnostic categories and social contexts. The review emphasises the need for expansion of diagnostic labels and contexts studied, standardisation of validated attitude scales, incorporation of behavioural outcomes, and diversification of samples.
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Affiliation(s)
| | - Maryanne Brassil
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Sadhbh O'Sullivan
- School of Medicine, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Christina Seery
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Finiki Nearchou
- School of Psychology, University College Dublin, Dublin, Ireland
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Measuring diagnostic heterogeneity using text-mining of the lived experiences of patients. BMC Psychiatry 2021; 21:60. [PMID: 33509154 PMCID: PMC7842026 DOI: 10.1186/s12888-021-03044-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 01/06/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The diagnostic system is fundamental to any health discipline, including mental health, as it defines mental illness and helps inform possible treatment and prognosis. Thus, the procedure to estimate the reliability of such a system is of utmost importance. The current ways of measuring the reliability of the diagnostic system have limitations. In this study, we propose an alternative approach for verifying and measuring the reliability of the existing system. METHODS We perform Jaccard's similarity index analysis between first person accounts of patients with the same disorder (in this case Major Depressive Disorder) and between those who received a diagnosis of a different disorder (in this case Bulimia Nervosa) to demonstrate that narratives, when suitably processed, are a rich source of data for this purpose. We then analyse 228 narratives of lived experiences from patients with mental disorders, using Python code script, to demonstrate that patients with the same diagnosis have very different illness experiences. RESULTS The results demonstrate that narratives are a statistically viable data resource which can distinguish between patients who receive different diagnostic labels. However, the similarity coefficients between 99.98% of narrative pairs, including for those with similar diagnoses, are low (< 0.3), indicating diagnostic Heterogeneity. CONCLUSIONS The current study proposes an alternative approach to measuring diagnostic Heterogeneity of the categorical taxonomic systems (e.g. the Diagnostic and Statistical Manual, DSM). In doing so, we demonstrate the high Heterogeneity and limited reliability of the existing system using patients' written narratives of their illness experiences as the only data source. Potential applications of these outputs are discussed in the context of healthcare management and mental health research.
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Embodied Ethical Decision-Making: A Clinical Case Study of Respect for Culturally Based Meaning Making in Mental Healthcare. AMERICAN JOURNAL OF DANCE THERAPY 2021. [DOI: 10.1007/s10465-020-09338-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractHow does embodied ethical decision-making influence treatment in a clinical setting when cultural differences conflict? Ethical decision-making is usually a disembodied and rationalized procedure based on ethical codes (American Counseling Association, 2014; American Dance Therapy Association, 2015; American Mental Health Counseling Association, 2015) and a collective understanding of right and wrong. However, these codes and collective styles of meaning making were shaped mostly by White theorists and clinicians. These mono-cultural lenses lead to ineffective mental health treatment for persons of color. Hervey’s (2007) EEDM steps encourage therapists to return to their bodies when navigating ethical dilemmas as it is an impetus for bridging cultural differences in healthcare. Hervey’s (2007) nonverbal approach to Welfel’s (2001) ethical decision steps was explored in a unique case that involved the ethical decision-making process of an African-American dance/movement therapy intern, while providing treatment in a westernized hospital setting to a spiritual Mexican–American patient diagnosed with PTSD and generalized anxiety disorder. This patient had formed a relationship with a spirit attached to his body that he could see, feel, and talk to, but refused to share this experience with his White identifying psychiatric nurse due to different cultural beliefs. Information gathered throughout the clinical case study by way of chronological loose and semi-structured journaling, uncovered an ethical dilemma of respect for culturally based meanings in treatment and how we identify pathology in hospital settings. The application of the EEDM steps in this article is focused on race/ethnicity and spiritual associations during mental health treatment at an outpatient hospital setting. Readers are encouraged to explore ways in which this article can influence them to apply EEDM in other forms of cultural considerations (i.e. age) and mental health facilities. The discussion section of this thesis includes a proposed model for progressing towards active multicultural diversity in mental healthcare settings by way of the three M’s from the relational-cultural theory: movement towards mutuality, mutual empathy, and mutual empowerment (Hartling & Miller, 2004).
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Dawson A. Getting child psychotherapy right for every child: developing a clinical formulation tool for effective and accountable multi-agency work. JOURNAL OF CHILD PSYCHOTHERAPY 2020. [DOI: 10.1080/0075417x.2020.1836502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Andrew Dawson
- Specialist Children’s Services, NHS Greater Glasgow and Clyde, Glasgow, Scotland
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The Use of Evidence-Based Assessment for Anxiety Disorders in an Australian Sample. J Anxiety Disord 2020; 75:102279. [PMID: 32777601 DOI: 10.1016/j.janxdis.2020.102279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 06/19/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
Anxiety disorders are common and cause considerable functional impairment. Fortunately, evidence-based treatments are available, however, treatment effectiveness is often reliant on the provision of an accurate diagnosis. Accurate diagnosis requires a multi-method evidence-based assessment (EBA). Assessment techniques available to clinicians include a clinical interview, semi-structured diagnostic interview, self-report/clinician-administered rating scales and direct observation. Research demonstrates that only a small number of therapists utilize EBA, and to date this has not been investigated in an Australian sample. One hundred and two registered Australian psychologists (Mage = 40.98; SD = 12.67; 83.6% female) participated in an online study investigating assessment practices. Participants were asked to indicate EBA frequency of use and the obstacles they face to using EBA. The majority of participants (69% working with adult patients and 51% working with pediatric patients) reported partial use of EBA. Few psychologists (21% working with adult patients and 11% working with child patients) indicated complete use of EBA. Thirty-six percent of participants indicated negative beliefs about the usefulness or helpfulness of EBA. Multiple obstacles to the use of EBA were reported including concerns with the time required to complete assessment (27%), and a lack of access to assessment tools (10%). Implications for training and clinical practice are discussed.
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McPherson S. A NICE game of Minecraft: philosophical flaws underpinning UK depression guideline nosology. MEDICAL HUMANITIES 2020; 46:162-165. [PMID: 31263062 PMCID: PMC7476285 DOI: 10.1136/medhum-2019-011658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 06/09/2023]
Abstract
Categorising mental disorders for purposes of diagnosis, research and practice has historically been justified on philosophical terms as a pragmatic activity; categories which have been subject to wide-ranging philosophical critique have been defended on the grounds that they serve as heuristic devices providing loose representations of shared experiences, not labels for real structures. In acknowledgement of this, there has been increasing recognition that subclassifying multiple discrete forms of persistent depression moves too far away from the notion of a heuristic and that attempts to create more precise categories become less clinically useful. Hence the most recent Diagnostic and Statistical Manual of Mental Disorders (V.5) and International Classification of Diseases (V.11) both group persistent forms of depression together. However, the UK National Institute for Health and Care Excellence has delineated certain subclassifications of persistent depression in its new guideline, which grossly distorts the phenomenology of depression. This approach commits a fundamental philosophical error in conflating absence of knowledge with knowledge of absence. In this sense, the new guideline appears to be engaging in an activity akin to the digital game Minecraft, in which the craft of building structures from units of construction is largely divorced from the laws of physics. The risk of ignoring these philosophical errors and making false claims about scientific plausibility is that the guideline recommendations inevitably represent a highly distorted phenomenology of depression and will be of very little value to patients or practitioners looking for guidance on best possible treatment options.
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Affiliation(s)
- Susan McPherson
- Health and Social Care, University of Essex, Colchester CO4 3SQ, UK
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Piiksi Dahli M, Brekke M, Ruud T, Haavet OR. Prevalence and distribution of psychological diagnoses and related frequency of consultations in Norwegian urban general practice. Scand J Prim Health Care 2020; 38:124-131. [PMID: 32594819 PMCID: PMC8570762 DOI: 10.1080/02813432.2020.1783477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective: To investigate the prevalence and distribution of psychological diagnoses made by general practitioners (GPs) in urban general practice and the related frequency of consultations during 12 consecutive months in Norwegian general practice.Design: A cross-sectional study with data extracted from 16,845 electronic patient records in 35 urban GP practicesSetting: Six GP group practices in Groruddalen, Norway.Subjects: All patients aged 16-65 with a registered contact with a GP during 12 months in 2015.Main outcome measures: Frequency and distribution of psychological diagnoses made by GPs, and the number of patients' consultations.Results: GPs made a psychological diagnosis in 18.8% of the patients. The main diagnostic categories were depression symptoms or disorder, acute stress reaction, anxiety symptoms or disorder and sleep disorder, accounting for 67.1% of all psychological diagnoses given. The mean number of consultations for all patients was 4.09 (95% CI: 4.03, 4.14). The mean number of consultations for patients with a psychological diagnosis was 6.40 (95% CI: 6.22, 6.58) compared to 3.55 (95% CI 3.50, 3.51) (p<0.01) for patients without such a diagnosis. Seven percent of the diagnostic variation was due to differences among GPs.Conclusions: Psychological diagnoses are frequent in urban general practice, but they are covered using rather few diagnostic categories. Patients with psychological diagnoses had a significantly higher mean number of GP consultations regardless of age and sex.Implications: The knowledge of the burden of psychological health problems in general practice must be strengthened to define evidence-based approaches for detecting, diagnosing and treating mental disorders in the general practice population.Key PointsEighteen percent of patients aged 16-65 in our study of patients in urban general practice received one or more psychological diagnoses in 12 months.Depression was the most common diagnosis; followed by acute stress reaction, anxiety and sleep disturbance.Patients with psychological diagnoses had a significantly higher mean number of consultations compared to patients without such diagnoses regardless of age and sex.
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Affiliation(s)
- Mina Piiksi Dahli
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway;
- CONTACT Mina Piiksi Dahli Faculty of Medicine, Institute of Health and Society, University of Oslo, P.O. Box 1130, Blindern0318, Oslo, Norway
| | - Mette Brekke
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway;
- General Practice Research Unit, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway;
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway;
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole Rikard Haavet
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway;
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Auld S, Cartwright D. The Social Construction of PTSD: The Case of the 'Old Guard' Policemen After South African Democracy. Cult Med Psychiatry 2020; 44:175-192. [PMID: 31493169 DOI: 10.1007/s11013-019-09649-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Often, we assume the traumatic nature of first response work has inevitable repercussions. This can lead to assumptions about trauma being the reason for distress, resulting in fixed ideas about diagnosis and treatment, without the complex socio-political and psychodynamic implications being fully considered. This paper challenges such assumptions by exploring the presentation of PTSD in 'old guard' police officers at the cusp of the post-apartheid era in South Africa. Focusing on long serving 'white' Afrikaner policemen, an argument is advanced that, while a diagnosis of PTSD may have enabled the old guard to legitimately access care and support for distress, at another level it served to displace core conflicts related to masculinity (and other aspects of identity) triggered by adjustment difficulties inherent in the transition from apartheid to post-apartheid South Africa. A case study is used to illustrate these observations.
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Affiliation(s)
- Sharon Auld
- Department of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, 4001, KwaZulu-Natal, South Africa.
| | - Duncan Cartwright
- Department of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, 4001, KwaZulu-Natal, South Africa
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Patterson AS, Boadu NY, Clark M, Janes C, Monteiro N, Roberts JH, Shiffman J, Thomas D, Wipfli H. Investigating global mental health: Contributions from political science. Glob Public Health 2020; 15:805-817. [PMID: 32013785 DOI: 10.1080/17441692.2020.1724315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article outlines an agenda for political science engagement with global mental health. Other social sciences have tackled the topic, investigating such questions as the link between poverty and mental health disorders. Political science is noticeably absent from these explorations. This is striking because mental health disorders affect one billion people globally, governments spend only about 2% of their health budgets on these disorders, and most people lack access to treatment. With its focus on power, political science could deepen knowledge on vulnerabilities to mental illness and explain weak policy responses. By illustrating how various forms of power pertaining to governance, knowledge, and moral authority work through the concepts of issue framing, collective action, and institutions, the article shows that political science can deepen knowledge on this global health issue. Political science can analyse how incomplete knowledge leads to contentious framing, thus hobbling advocacy. It can explain why states shirk their obligations in mental health, and it can question how incentives drive mental health mobilisation. The discipline can uncover how power undergirds institutional responses to global mental health at the international, national, and community levels. Political science should collaborate with other social sciences in research networks to improve policy outcomes.
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Affiliation(s)
- Amy S Patterson
- Department of Politics, University of the South, Sewanee, TN, USA
| | - Nana Yaa Boadu
- Office of International Affairs for the Health Portfolio, Public Health Agency of Canada, Canada
| | - Mary Clark
- Department of Political Science, Tulane University, USA
| | - Craig Janes
- School of Public Health and Health Systems, University of Waterloo, Canada
| | | | - Jan Hatcher Roberts
- WHO Collaborating Center for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, University of Ottawa, Canada
| | - Jeremy Shiffman
- Bloomberg School of Public Health, School of Advanced International Studies, Johns Hopkins University, USA
| | | | - Heather Wipfli
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, USA
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Ramos JM, Broco L, Sánchez A, Doll A. La Personalidad como Vulnerabilidad Unidimensional y Bidimensional: el Papel Mediador de las Variables Cognitivas en la Gravedad Sintomatológica en una Muestra de Personas con Trastorno Grave de Personalidad. CLINICA Y SALUD 2020. [DOI: 10.5093/clysa2019a18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Repeated Police Mental Health Act Detentions in England and Wales: Trauma and Recurrent Suicidality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234786. [PMID: 31795314 PMCID: PMC6926771 DOI: 10.3390/ijerph16234786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 12/20/2022]
Abstract
Most police Mental Health Act (Section 136) detentions in England and Wales relate to suicide prevention. Despite attempts to reduce detention rates, numbers have risen almost continually. Although Section 136 has been subject to much academic and public policy scrutiny, the topic of individuals being detained on multiple occasions remains under-researched and thus poorly understood. A mixed methods study combined six in-depth interviews with people who had experienced numerous suicidal crises and police intervention, with detailed police and mental health records. A national police survey provided wider context. Consultants with lived experience of complex mental health problems jointly analysed interviews. Repeated detention is a nationally recognised issue. In South East England, it almost exclusively relates to suicide or self-harm and accounts for a third of all detentions. Females are detained with the highest frequencies. The qualitative accounts revealed complex histories of unresolved trauma that had catastrophically damaged interviewee’s relational foundations, rendering them disenfranchised from services and consigned to relying on police intervention in repeated suicidal crises. A model is proposed that offers a way to conceptualise the phenomenon of repeated detention, highlighting that long-term solutions to sustain change are imperative, as reactive-only responses can perpetuate crisis cycles.
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Egger ST, Weniger G, Müller M, Bobes J, Seifritz E, Vetter S. Assessing the severity of functional impairment of psychiatric disorders: equipercentile linking the mini-ICF-APP and CGI. Health Qual Life Outcomes 2019; 17:174. [PMID: 31744498 PMCID: PMC6862821 DOI: 10.1186/s12955-019-1235-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background The assessment of functioning and impairment due to psychiatric illness has been acknowledged to be crucial for research and practice. This led to the development of the mini-ICF-APP, which provides a reliable and time-efficient measure of functioning and impairment. Although its use is increasing, it remains unclear how it reflects severity and how change might be interpreted from a clinical perspective. Methods In a clinical sample of 3067 individuals hospitalized for mental health treatment, we used an equipercentile approach to link the mini-ICF-APP with the Clinical Global Impression scale (CGI) at admission and discharge. We linked the mini-ICF-APP sum score to the CGI-S scale and the mini-ICF-APP proportional change between admission and discharge to the CGI-I scale. Results The mini-ICF-APP and CGI scales showed a Spearman correlation of 0.50 (p < .000). CGI-S: “borderline-ill” corresponded to a mini-ICF-APP score 1–2; “mildly-ill” to 3–7; “moderately-ill” to 8–15; “markedly-ill” to 16–24; “severely-ill” to 25–37; and “extremely-ill” to a score ≥ 38. The Spearman correlation between the percentage change of mini-ICF-APP sum score and the CGI-I was 0.32 (p > .000); “no-change” in the CGI-I corresponded to an increase or decrease of 2%; “minimally-improved” to a mini-ICF-APP reduction of 3–30%; “much-improved” to a reduction of 31–63%; “very-much-improved” to a reduction of ≥64% “minimally-worse” to an increase of 3–34% “much-worse” to an increase of 35–67%; and finally “very-much-worse” with an increase of ≥68%. Conclusions Our findings improve understanding of the clinical meaning of the mini-ICF-APP sum score and percentage change in patients hospitalized for treatment.
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Affiliation(s)
- Stephan T Egger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland. .,Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain.
| | - Godehard Weniger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Mario Müller
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Julio Bobes
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Erich Seifritz
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Stefan Vetter
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
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Coyle LA, Atkinson S. Vulnerability as practice in diagnosing multiple conditions. MEDICAL HUMANITIES 2019; 45:278-287. [PMID: 29950507 PMCID: PMC6818667 DOI: 10.1136/medhum-2017-011433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 06/08/2023]
Abstract
The paper contributes to contemporary understandings of vulnerability by expanding their scope with an understanding of vulnerability as generated through institutionalised practices. The argument draws on experiential accounts of navigating the practices of diagnosis by people living with multiple conditions of ill-health and disability. Vulnerability as a concept is used widely across different domains and conveys a multitude of meanings. Contemporary biomedicine, and its associated health systems and services, understands vulnerability mostly as inherent to particular physical and mental bodily conditions that put people at risk of ill-health or emotionally fragility. This may combine with a more epidemiological understanding of vulnerability as the experience of certain population groups subject to entrenched structural inequalities. Philosophers and feminists have argued that vulnerability is a universal experience of being human while political commentators have explored its potential as a resource for resistance and action. Diagnosis within medicine and psychiatry has been the subject of extensive social analysis, critique and activism. The paper draws on first-hand experiential accounts collected through face-to-face interviews with people living with multiple conditions about their experiences of diagnosis, mostly at the primary care level. We identify five aspects to diagnostic practice that are harmful and exacerbate the experience of vulnerability: temporal sequencing; diagnostic authority; medical specialisation; strategic symptom selection; medical isolation. However, these diagnostic practices are not best understood only in terms of the power asymmetries inherent to the medical consultation, but are embedded into the very institution of diagnosis. The paper thus proposes a combined approach to vulnerability that recognises it as a universal condition of humanity but one that becomes animated or amplified for some bodies, through their own inherent incapacities or the external structures of inequality, and through the practices of medicine as situated in particular times and places.
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Affiliation(s)
| | - Sarah Atkinson
- Institute for Medical Humanities, Durham University, Durham, UK
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Bakker GM. A new conception and subsequent taxonomy of clinical psychological problems. BMC Psychol 2019; 7:46. [PMID: 31291999 PMCID: PMC6617608 DOI: 10.1186/s40359-019-0318-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/12/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A taxonomy of the objects of study, theory, assessment, and intervention is critical to the development of all clinical sciences. Clinical psychology has been conceptually and administratively dominated by the taxonomy of an adjacent discipline - psychiatry's Diagnostic and statistical manual of mental disorders (DSM). Many have called for a 'paradigm shift' away from a medical nosology of diseases toward clinical psychology's own taxonomy of clinical psychological problems (CPPs), without being able to specify what is to be listed and classified. MAIN TEXT An examination of DSM's problems for clinical psychology, especially its lack of clinical utility, and a search for the essence of CPPs in what clinical psychologists actually do, leads to the proposal that: The critical psychological-level phenomenon underlying CPPs is the occurrence of 'problem-maintaining circles' (PMCs) of causally related cognitions, emotions, behaviours, and/or stimuli. This concept provides an empirically-derived, theory-based, treatment-relevant, categorical, essentialist, parsimonious, and nonstigmatizing definition of CPPs. It distinguishes psychological problems in which PMCs have not (yet?) formed, and which may respond to 'counseling', clinical psychological problems in which active PMCs require clinical intervention, and psychopathological problems which are unlikely to be 'cured' by PMC-breaking alone. CONCLUSION A subsequent classification and coding system of PMCs is proposed, and expected benefits to research, communication, and the quality of case formulation in clinical psychology are described, reliant upon a development effort of some meaningful fraction of that which has been devoted to the DSM.
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Affiliation(s)
- Gary M Bakker
- School of Medicine, University of Tasmania, Locked Bag 1377, Launceston, Tasmania, 7250, Australia.
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Johnstone L, Boyle M. The Power Threat Meaning Framework: An Alternative Nondiagnostic Conceptual System. JOURNAL OF HUMANISTIC PSYCHOLOGY 2018. [DOI: 10.1177/0022167818793289] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lucy Johnstone
- Consultant Clinical Psychologist and Independent Trainer, Bristol, UK
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O'Connor C, Kadianaki I, Maunder K, McNicholas F. How does psychiatric diagnosis affect young people's self-concept and social identity? A systematic review and synthesis of the qualitative literature. Soc Sci Med 2018; 212:94-119. [PMID: 30029092 DOI: 10.1016/j.socscimed.2018.07.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/28/2018] [Accepted: 07/06/2018] [Indexed: 11/26/2022]
Abstract
Receiving a psychiatric diagnosis in childhood or adolescence can have numerous social, emotional and practical repercussions. Among the most important of these are the implications for a young person's self-concept and social identity. To ensure diagnoses are communicated and managed in a way that optimally benefits mental health trajectories, understanding young people's first-hand experience of living with a diagnosis is paramount. This systematic review collates, evaluates and synthesises the qualitative research that has explored how psychiatric diagnosis interacts with young people's self-concept and social identity. A search of 10 electronic databases identified 3892 citations, 38 of which met inclusion criteria. The 38 studies were generally evaluated as moderate-to-high quality research. Thematic synthesis of their findings highlighted the multifaceted ways diagnosis affects young people's self-concept and social identity. Diagnosis can sometimes threaten and devalue young people's self-concept, but can also facilitate self-understanding, self-legitimation and self-enhancement. A diagnosis can lead to social alienation, invalidation and stigmatisation, yet can also promote social identification and acceptance. Further research is needed to clarify which self and identity outcomes can be expected in a given set of circumstances, and to establish how self and identity effects interact with diagnoses' other clinical, practical, social and emotional consequences.
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Affiliation(s)
- Cliodhna O'Connor
- School of Psychology, University College Dublin, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland.
| | | | - Kristen Maunder
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Fiona McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland; Our Lady's Children's Hospital Crumlin, Dublin, Ireland; Lucena Clinic, Rathgar, Dublin, Ireland
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Abstract
Historically, psychiatry and clinical psychology focused on understanding how stressful life conditions led to psychiatric disorders. With the rise of positive psychology, the focus shifted to thriving through adversity and to concepts such as resilience. However, the number of mental disorders is still increasing. Due to a neoliberal Western decontextualizing stance in psychology, the concept of resilience is at risk of reproducing power imbalances and discrimination within our society. Resilience is analysed from a critical perspective, mostly with a Marxist point of view, including Foucauldian discursive approaches, as well as a biomedical critique of the current mental health system, to illustrate the shortcomings of Western psychologies. This article illustrates how a contextualized understanding of resilience that accounts for political, historical, and socioeconomic contexts at analytical levels besides the individual may overcome this ethnocentric and neoliberal bias.
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Chang CC, Su JA, Chang KC, Lin CY, Koschorke M, Thornicroft G. Perceived stigma of caregivers: Psychometric evaluation for Devaluation of Consumer Families Scale. Int J Clin Health Psychol 2018; 18:170-178. [PMID: 30487922 PMCID: PMC6225041 DOI: 10.1016/j.ijchp.2017.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/14/2017] [Indexed: 11/19/2022] Open
Abstract
Background/Objective: The Devaluation of Consumer Families Scale (DCFS) is commonly used to measure perceived stigma towards family members of people with mental illness. However, its factorial structure has never been confirmed using confirmatory factor analysis (CFA). This study aimed to test the psychometric properties of the DCFS Taiwan version (DCFS-TW). Method: Family caregivers (N=511) completed the DCFS-TW (97 completed the DCFS again after 2 to 4 weeks) and other instruments. CFA, test-retest reliability, internal consistency, concurrent validity, and known-group validity were analyzed. Results: The three-factor structure of the DCFS-TW performed better than the one-factor structure. Test-retest reliability (r = .66) and internal consistency were satisfactory (α = .85); concurrent validity (absolute r = .20 to .58) was acceptable; known-group validity was supported by the significantly different DCFS-TW scores in clinical characteristics (had been vs. had not been hospitalized; had been vs. had not been compulsorily admitted). Conclusions: The DCFS-TW has decent psychometric properties and is suitable for health professionals to measure perceived stigma towards family members of people with mental illness.
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Affiliation(s)
- Chih-Cheng Chang
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Health Psychology, Chang Jung Christian University, Tainan, Taiwan
| | - Jian-An Su
- Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital at Chiayi, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nursing, Chang Gung Institute of Technology, Taoyuan, Taiwan
| | - Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Mirja Koschorke
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Graham Thornicroft
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Timimi S. The diagnosis is correct, but National Institute of Health and Care Excellence guidelines are part of the problem not the solution. J Health Psychol 2018; 23:1148-1152. [PMID: 29600731 DOI: 10.1177/1359105318766139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mike Scott's study provides data demonstrating that the national Improving Access to Psychological Therapies project is not leading to improved outcomes or value for money. I present further data from both the adult and children and young people's versions of Improving Access to Psychological Therapies that lends supports to this conclusion. However, while Scott argues in favour of better compliance with National Institute of Health and Care Excellence guidelines and greater model expertise, I argue that it is this 'technical' focus that is part of the problem not the solution.
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Affiliation(s)
- Sami Timimi
- 1 Lincolnshire Partnership NHS Foundation Trust, UK.,2 Health Education England, UK.,3 University of Lincoln, UK
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Campo-Arias A, Herazo E. Innovations, Reviews and Proposals on the DSM-5: the Case of Sexual Dysfunctions, Gender Dysphoria and Paraphilic Disorders. ACTA ACUST UNITED AC 2018; 47:56-64. [PMID: 29428123 DOI: 10.1016/j.rcp.2016.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/25/2016] [Indexed: 11/18/2022]
Abstract
Human behaviours have different meanings according to the historical moment and context. In this article sexual behaviours are taken as a category in order to analyse how psychiatric nosology is structured, as manifested in texts such as the DSM-5. The development of these diagnostic manuals are tools that are far from being free of subjectivities and interference of elements of power, expressed in the way health, illness, mental health, and mental disorders, are assumed; in short, the normal and pathological. Each new diagnosis, or even its elimination, and the recomposing of the different diagnostic criteria, especially in the field of sexual behaviour, present visions of how individual and collective human life is conceived, as well as an expression of accurate attempts to control human sexualities through the medicalisation of behaviour, coupled with moral, religious, and even legal considerations. Categories such as gender dysphoria, paraphilia or paraphilic disorders are examples of how the limits intended to establish a biomedical perspective are also incomplete and imprecise. These violate individual and social construction of sexualities and the conception of mental health, showing persistent difficulties and controversies that are evident in the way psychiatric classifications are made.
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Affiliation(s)
- Adalberto Campo-Arias
- Instituto de Investigación del Comportamiento Humano (Human Behavioral Research Institute), Bogotá, Colombia; Programa de Medicina, Facultad de Ciencias de la Salud, Universidad del Magdalena, Santa Marta, Colombia.
| | - Edwin Herazo
- Instituto de Investigación del Comportamiento Humano (Human Behavioral Research Institute), Bogotá, Colombia
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Randall-James J, Coles S. Questioning diagnoses in clinical practice: a thematic analysis of clinical psychologists' accounts of working beyond diagnosis in the United Kingdom. J Ment Health 2018; 27:450-456. [PMID: 29421934 DOI: 10.1080/09638237.2018.1437599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The British Psychological Society proposes that clinical psychologists are well placed to move beyond psychiatric diagnoses and develop alternative practices. AIMS This study sought to explore what the application of these guiding principles looks like in clinical practice, the challenges faced and possible routes forward. METHODS A purpose-designed survey was completed by 305 respondents and a thematic analysis completed. RESULTS Thematic analysis was used to identify five superordinate themes relating to individuals, relational, others, structures and society, comprising of a total of 21 group themes. The presented group themes highlight an array of approaches to practicing beyond diagnosis and factors that help and hinder such action; from scaffolding change, becoming leaders, relating to the multi-disciplinary team, restructuring services and the processes of change. A key concept was "playing the diagnostic game". CONCLUSIONS "Playing the diagnostic game" enables psychologists to manage an array of tensions and anxieties: conflicts between belief and practice, relationships with colleagues, and dilemmas of position and power. It also potentially limits a concerted questioning of diagnosis and consideration of alternatives. An alternative conceptual framework for non-diagnostic practice is needed to aid the collective efforts of clinical psychologists developing their practice beyond diagnosis, some of which have been highlighted in this study. Until then, ways of mitigating the perceived threats to questioning diagnosis need further exploration, theorising and backing.
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Affiliation(s)
- James Randall-James
- a Department of Psychology and Sport Sciences , University of Hertfordshire Doctoral College , Hatfield , UK , and
| | - Steven Coles
- b Nottinghamshire Healthcare Foundation NHS Trust , Nottinghamshire , UK
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Sjöberg MN, Dahlbeck J. The inadequacy of ADHD: a philosophical contribution. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2018. [DOI: 10.1080/13632752.2017.1361709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Johan Dahlbeck
- Faculty of Education and Society, Malmö University, Malmö, Sweden
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Duncan BL, Sparks JA, Timimi S. Beyond Critique: The Partners for Change Outcome Management System as an Alternative Paradigm to Psychiatric Diagnosis. JOURNAL OF HUMANISTIC PSYCHOLOGY 2017. [DOI: 10.1177/0022167817719975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Critics claim that current psychiatric diagnostic systems lack reliability, validity, and clinical utility; are incompatible with known evidence of how change occurs in psychotherapy; are compromised by bias; and risk harmful effects for clients. This article argues that the Partners for Change Outcome Management System (PCOMS), a transparent, egalitarian process that collects and utilizes client feedback at each session, convincingly addresses these concerns. Furthermore, it suggests that PCOMS offers a viable alternative to the reimbursement and administrative functions of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases. The authors propose that PCOMS represents a radical realignment of the practitioner/client relationship via full, dialogical partnership at every level of psychotherapy practice and thus constitutes a step toward a new paradigm that reconnects psychotherapy and humanistic psychology with its core relational values.
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Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most well-established and at the same time controversial disorders to the extreme of being placed in doubt. In the first of two parts, the established position is critically reviewed, beginning with showing fallacious reasoning on which the diagnosis is based, lacking clinical proof. Similarly, a certain rhetoric and metaphysics in genetic and neurobiological research is highlighted, where, for example, a meager accumulation of data is offered as robust conclusions, and correlates and correlations as causes and bases. However, that may be, the controversy is silenced in a dialog of the deaf between “defenders” and “critics.” with no way out in sight in empirical and scientific terms. A new meta-scientific position is necessary to analyze the science of ADHD itself and its social uses. In this respect, the second part introduces Aristotle’s four causes, material, formal, efficient, final, as an instrument of enquiry. According to this analysis, ADHD is not the pretended clinical entity as presented, but a practical entity providing a variety of functions. The implications would be rather different from the usual.
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O'Connell MA, Leahy-Warren P, Khashan AS, Kenny LC, O'Neill SM. Worldwide prevalence of tocophobia in pregnant women: systematic review and meta-analysis. Acta Obstet Gynecol Scand 2017; 96:907-920. [DOI: 10.1111/aogs.13138] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/19/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Maeve A. O'Connell
- Irish Centre for Fetal and Neonatal Translational Research (INFANT Center); Department of Obstetrics & Gynecology; Cork University Maternity Hospital; Wilton Cork Ireland
| | - Patricia Leahy-Warren
- School of Nursing & Midwifery; Brookfield Health Sciences Complex; University College Cork; Cork Ireland
| | - Ali S. Khashan
- Irish Centre for Fetal and Neonatal Translational Research (INFANT Center); Department of Obstetrics & Gynecology; Cork University Maternity Hospital; Wilton Cork Ireland
- Department of Epidemiology & Public Health; Western Gateway Building; University College Cork; Cork Ireland
| | - Louise C. Kenny
- Irish Centre for Fetal and Neonatal Translational Research (INFANT Center); Department of Obstetrics & Gynecology; Cork University Maternity Hospital; Wilton Cork Ireland
| | - Sinéad M. O'Neill
- Irish Centre for Fetal and Neonatal Translational Research (INFANT Center); Department of Obstetrics & Gynecology; Cork University Maternity Hospital; Wilton Cork Ireland
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Child maltreatment, revictimization and Post-Traumatic Stress Disorder among adults in a community sample. Int J Clin Health Psychol 2017; 17:97-106. [PMID: 30487885 PMCID: PMC6220916 DOI: 10.1016/j.ijchp.2017.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/27/2017] [Indexed: 01/05/2023] Open
Abstract
Background/Objective: Childhood maltreatment (CM) has been associated with revictimization and post-traumatic stress disorder (PTSD). However, this relation is hardly examined in South European countries, and in community samples. We tested these associations in a convenience sample of 1,200 Portuguese adults in the community. Method: Data were collected using self-report questionnaires, the Post Traumatic Diagnostic Scale (PDS) and the Childhood Trauma Questionnaire–Short Form (CTQ-SF). Odds ratios, logistic and hierarchical regression were used to analyze the data. Results: Exposure to CM increased more than twofold the risk of being revictimized and threefold a PTSD diagnosis. Highly prevalent traumatic events such as accidents were associated with CM. More than 30% of adults with PTSD were exposed to emotional abuse. After adjusting for demographics, emotional abuse remained a significant predictor for revictimization and PTSD, having the largest effect on the prediction of PTSD severity (β = .24). Conclusions: Findings underline the injurious potential of emotional abuse during childhood in adults in the community. More knowledge is needed about the mechanisms linking CM with further traumatic exposure and PTSD across the lifespan to better inform preventive and therapeutic actions.
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Romero M, Aguilar JM, Del-Rey-Mejías Á, Mayoral F, Rapado M, Peciña M, Barbancho MÁ, Ruiz-Veguilla M, Lara JP. Psychiatric comorbidities in autism spectrum disorder: A comparative study between DSM-IV-TR and DSM-5 diagnosis. Int J Clin Health Psychol 2016; 16:266-275. [PMID: 30487870 PMCID: PMC6225088 DOI: 10.1016/j.ijchp.2016.03.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/29/2016] [Indexed: 12/19/2022] Open
Abstract
Background/Objective: The heterogeneous clinical presentations of individuals with Autism Spectrum Disorders (ASD) pose a significant challenge for sample characterization. Therefore the main goal of DSM-5 must be to identify subgroups of ASD, including comorbidity disorders and severity. The main goal of this study is to explore the psychiatric comorbidities and the severity of symptoms that could be relevant for the phenotype characterization in ASD and also to compare these results according to the different classification criteria between the DSM-IV-TR and the DSM-5. Method: A comparative study of severity and psychiatric comorbidities was carried out between a sample of participants that only met criteria for Pervasive Developmental Disorder (PDD) according to the DSM-IV-TR and a sample of participants that also met ASD criteria according to DSM-5 classification. The recruitment of children was via educational (N = 123). The psychiatric symptoms, comorbid disorders and severity of symptoms were assessed through The Nisonger Child Behavior Rating Form, clinical interview and The Inventory of Autism Spectrum Disorder, respectively. The psychiatric comorbidities considered were: anxiety, eating behavioural problems, self-aggressiveness, hetero–aggressiveness, self-harm, obsessive compulsive disorder and attention deficit and hyperactivity disorder. Results: Statistically significant differences between both groups were found regarding obsessive compulsive disorder, eating behavioural problems and severity. Conclusions: The results support the hypothesis that patients who meet the DSM-5 criteria have more severe symptoms, not only regarding the core autistic symptoms but also in relation with psychiatric comorbidities.
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Affiliation(s)
- Marina Romero
- King's College London, United Kingdom
- Universidad de Málaga, Andalucía TECH, IBIMA, Spain
- Corresponding author: Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom.
| | | | | | | | - Marta Rapado
- Hospital General Universitario Gregorio Marañón Madrid, Spain
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Erlandsson S, Lundin L, Punzi E. A discursive analysis concerning information on "ADHD" presented to parents by the National Institute of Mental Health (USA). Int J Qual Stud Health Well-being 2016; 11:30938. [PMID: 27052426 PMCID: PMC4823630 DOI: 10.3402/qhw.v11.30938] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2016] [Indexed: 11/14/2022] Open
Abstract
A discourse analysis was performed based on an online document under the headline: "What is Attention Deficit Hyperactivity Disorder (ADHD, ADD)?" published by the National Institute of Mental Health (NIMH), USA. Three parts of the document were analysed: (1) The introductory part, as this sets the tone of the whole text. (2) Parts of the text that were specifically addressed to parents. (3) Etiology and pathology of "ADHD" with reference to a number of different symptoms and behaviors. Inattention and hyperactivity are presented in the document as a floating spectrum of symptoms caused by "ADHD." Other factors of importance for children's development, that is, early attachment, close relationships, previous experiences, culture, and contexts are ignored. Children who are perceived as inattentive and hyperactive are portrayed as having inherent difficulties with no reference to their emotions or efforts to communicate. The child is viewed as suffering from a lifelong disorder that might not be cured but controlled by a diagnosis and subsequent medication. Parents are advised to control their child's behavior and to strive for early diagnosis in order to receive treatment provided by experts. Those who are presented as experts rely on a biomedical model, and in the document, detailed descriptions of medication to correct the undesired behaviors are provided. The value of judgment in the assessment of different symptoms and behaviors that signifies "ADHD" is absent, rather taken-for-granted beliefs were identified throughout the document. A heterogeneous set of behaviors is solely described as a disorder and hereafter it is stressed that the same behaviors are caused by the disorder. In this manner, cause and effects of "ADHD" are intertwined through circular argumentation.
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Affiliation(s)
- Soly Erlandsson
- Department of Social and Behavioral Studies, University West, Trollhättan, Sweden;
| | - Linda Lundin
- Department of Social and Behavioral Studies, University West, Trollhättan, Sweden
| | - Elisabeth Punzi
- Department of Psychology, Gothenburg University, Gothenburg, Sweden
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Abstract
Fonagy & Clark confirm in their rebuttal that they have an ideological commitment to the failed technical model of understanding and intervening in mental health problems that dominates current service provision. They fail to acknowledge the limitations and problems associated with Improving Access to Psychological Therapies (IAPT) and Children's and Young People's IAPT (CYP-IAPT) and offer an unconvincing explanation for why they did not allow some of the vast tax payers' money that they had at their dispoal to be used to implement evidence supported relational models.
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Jacobs R, Gutacker N, Mason A, Goddard M, Gravelle H, Kendrick T, Gilbody S. Determinants of hospital length of stay for people with serious mental illness in England and implications for payment systems: a regression analysis. BMC Health Serv Res 2015; 15:439. [PMID: 26424408 PMCID: PMC4590310 DOI: 10.1186/s12913-015-1107-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/23/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Serious mental illness (SMI), which encompasses a set of chronic conditions such as schizophrenia, bipolar disorder and other psychoses, accounts for 3.4 m (7 %) total bed days in the English NHS. The introduction of prospective payment to reimburse hospitals makes an understanding of the key drivers of length of stay (LOS) imperative. Existing evidence, based on mainly small scale and cross-sectional studies, is mixed. Our study is the first to use large-scale national routine data to track English hospitals' LOS for patients with a main diagnosis of SMI over time to examine the patient and local area factors influencing LOS and quantify the provider level effects to draw out the implications for payment systems. METHODS We analysed variation in LOS for all SMI admissions to English hospitals from 2006 to 2010 using Hospital Episodes Statistics (HES). We considered patients with a LOS of up to 180 days and estimated Poisson regression models with hospital fixed effects, separately for admissions with one of three main diagnoses: schizophrenia; psychotic and schizoaffective disorder; and bipolar affective disorder. We analysed the independent contribution of potential determinants of LOS including clinical and socioeconomic characteristics of the patient, access to and quality of primary care, and local area characteristics. We examined the degree of unexplained variation in provider LOS. RESULTS Most risk factors did not have a differential effect on LOS for different diagnostic sub-groups, however we did find some heterogeneity in the effects. Shorter LOS in the pooled model was associated with co-morbid substance or alcohol misuse (4 days), and personality disorder (8 days). Longer LOS was associated with older age (up to 19 days), black ethnicity (4 days), and formal detention (16 days). Gender was not a significant predictor. Patients who self-discharged had shorter LOS (20 days). No association was found between higher primary care quality and LOS. We found large differences between providers in unexplained variation in LOS. CONCLUSIONS By identifying key determinants of LOS our results contribute to a better understanding of the implications of case-mix to ensure prospective payment systems reflect accurately the resource use within sub-groups of patients with SMI.
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Affiliation(s)
- Rowena Jacobs
- Centre for Health Economics, University of York, Heslington, York, UK.
| | - Nils Gutacker
- Centre for Health Economics, University of York, Heslington, York, UK.
| | - Anne Mason
- Centre for Health Economics, University of York, Heslington, York, UK.
| | - Maria Goddard
- Centre for Health Economics, University of York, Heslington, York, UK.
| | - Hugh Gravelle
- Centre for Health Economics, University of York, Heslington, York, UK.
| | - Tony Kendrick
- Primary Care and Population Sciences, University of Southampton, Southampton, UK.
| | - Simon Gilbody
- Department of Health Sciences, University of York, Heslington, York, UK.
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Moran V, Jacobs R. Comparing the performance of English mental health providers in achieving patient outcomes. Soc Sci Med 2015. [PMID: 26218853 DOI: 10.1016/j.socscimed.2015.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evidence on provider payment systems that incorporate patient outcomes is limited for mental health care. In England, funding for mental health care services is changing to a prospective payment system with a future objective of linking some part of provider payment to outcomes. This research examines performance of mental health providers offering hospital and community services, in order to investigate if some are delivering better outcomes. Outcomes are measured using the Health of the Nation Outcome Scales (HoNOS) - a clinician-rated routine outcome measure (CROM) mandated for national use. We use data from the Mental Health Minimum Data Set (MHMDS) - a dataset on specialist mental health care with national coverage - for the years 2011/12 and 2012/13 with a final estimation sample of 305,960 observations with follow-up HoNOS scores. A hierarchical ordered probit model is used and outcomes are risk adjusted with independent variables reflecting demographic, need, severity and social indicators. A hierarchical linear model is also estimated with the follow-up total HoNOS score as the dependent variable and the baseline total HoNOS score included as a risk-adjuster. Provider performance is captured by a random effect that is quantified using Empirical Bayes methods. We find that worse outcomes are associated with severity and better outcomes with older age and social support. After adjusting outcomes for various risk factors, variations in performance are still evident across providers. This suggests that if the intention to link some element of provider payment to outcomes becomes a reality, some providers may gain financially whilst others may lose. The paper contributes to the limited literature on risk adjustment of outcomes and performance assessment of providers in mental health in the context of prospective activity-based payment systems.
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Affiliation(s)
- Valerie Moran
- Centre for Health Economics, University of York, Alcuin A Block, Heslington, York YO10 5DD, UK; Department of Economics and Related Studies, University of York, Heslington, York YO10 5DD, UK.
| | - Rowena Jacobs
- Centre for Health Economics, University of York, Alcuin A Block, Heslington, York YO10 5DD, UK
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De las Cuevas C, Peñate W. Psychometric properties of the eight-item Morisky Medication Adherence Scale (MMAS-8) in a psychiatric outpatient setting. Int J Clin Health Psychol 2014; 15:121-129. [PMID: 30487829 PMCID: PMC6224788 DOI: 10.1016/j.ijchp.2014.11.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/24/2014] [Indexed: 01/10/2023] Open
Abstract
The eight-item Morisky Medication Adherence Scale (MMAS-8) is a structured self-report measure of medication-taking behavior that has been widely used in various cultures. In Spain, no studies to date have analyzed the psychometric properties of the scale in psychiatric care. The purpose of the present instrumental study was to determine the psychometric properties of the Spanish version of the MMAS-8 in a sample of 967 consecutive psychiatric outpatients. The scale showed adequate construct validity and results pointed to a one-factor solution in which all the items contributed to the final index of adherence. The MMAS-8 exhibited significant correlation coefficients with the 10-item Drug Attitude Inventory, Form C of the Multidimensional Health Locus of Control scale, and the Hong Psychological Reactance Scale. Moreover, the MMAS-8 was able to differentiate between various mental disorder diagnosis groups. The findings of this study suggest that the Spanish version of the MMAS-8 is a reliable and valid measure of medication adherence that can be used in a psychiatric outpatient setting.
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Affiliation(s)
- Carlos De las Cuevas
- Corresponding author. Department of Internal Medicine, Dermatology and Psychiatry School of Medicine, University of La Laguna, 38071 San Cristóbal de La Laguna, Tenerife, Spain
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Rodríguez-Testal JF, Cristina Senín-Calderón, Perona-Garcelán S. From DSM-IV-TR to DSM-5: Analysis of some changes. Int J Clin Health Psychol 2014. [DOI: 10.1016/j.ijchp.2014.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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