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Bansema CH, Vermeiren RRJM, Nijland L, de Soet R, Roeleveld J, van Ewijk H, Nooteboom LA. Towards identifying the characteristics of youth with severe and enduring mental health problems in practice: a qualitative study. Eur Child Adolesc Psychiatry 2024; 33:2365-2375. [PMID: 38147108 PMCID: PMC11255042 DOI: 10.1007/s00787-023-02325-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023]
Abstract
A group of youth with severe and enduring mental health problems (SEMHP) falls between the cracks of the child-and-adolescent psychiatry (CAP) system. An insufficient understanding of these youth's mental health problems results in a failure to accurately identify and provide support to these youth. To gain a deeper understanding, the aim of this study is to explore characteristics of youth with SEMHP in clinical practice based on the experiences of youth and clinicians in CAP. This qualitative study consisted of 20 semi-structured interviews with 10 youth with lived experience and 10 specialized clinicians in CAP. Both a thematic and content analysis was conducted to identify, assess, and report themes associated with youth with SEMHP. Themes were individual characteristics such as trauma, masking, self-destructive behavior, interpersonal distrust as well as environmental and systematic characteristics including parental stressors, social isolation and societal stressors, which go beyond the existing classifications. These characteristics profoundly impact youth's daily functioning across various life domains, creating an interactive process, ultimately leading to elusive mental health problems and overwhelming feelings of hopelessness. The authors recommend proper assessment of characteristics in all life domains affected and their perpetuating effect on SEMHP during diagnostics in CAP. Engaging in a dialogue with youth themselves is crucial due to the nature of youth's characteristics, which frequently transcend traditional classifications and may not be immediately discernible. It also requires an integrated care approach, entailing collaborations between educational institutions and mental healthcare providers, and attention to potential indicators of deficits in the healthcare system and society.
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Affiliation(s)
- C H Bansema
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands.
| | - R R J M Vermeiren
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
- Youz, Parnassia Group, The Hague, The Netherlands
| | - L Nijland
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
| | - R de Soet
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
| | - J Roeleveld
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
| | - H van Ewijk
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
| | - L A Nooteboom
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
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2
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Tell Me About It: The Historical Development of the Psychiatric Interview. Harv Rev Psychiatry 2021; 29:438-443. [PMID: 34767330 DOI: 10.1097/hrp.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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3
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Grossman-Kahn R. Beyond the Rubble of Lake Street - Minds in Crisis in a City in Crisis. N Engl J Med 2021; 384:1286-1287. [PMID: 33830711 DOI: 10.1056/nejmp2034060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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4
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Newson JJ, Pastukh V, Thiagarajan TC. Poor Separation of Clinical Symptom Profiles by DSM-5 Disorder Criteria. Front Psychiatry 2021; 12:775762. [PMID: 34916976 PMCID: PMC8669440 DOI: 10.3389/fpsyt.2021.775762] [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: 09/14/2021] [Accepted: 11/05/2021] [Indexed: 12/30/2022] Open
Abstract
Assessment of mental illness typically relies on a disorder classification system that is considered to be at odds with the vast disorder comorbidity and symptom heterogeneity that exists within and across patients. Patients with the same disorder diagnosis exhibit diverse symptom profiles and comorbidities creating numerous clinical and research challenges. Here we provide a quantitative analysis of the symptom heterogeneity and disorder comorbidity across a sample of 107,349 adult individuals (aged 18-85 years) from 8 English-speaking countries. Data were acquired using the Mental Health Quotient, an anonymous, online, self-report tool that comprehensively evaluates symptom profiles across 10 common mental health disorders. Dissimilarity of symptom profiles within and between disorders was then computed. We found a continuum of symptom prevalence rather than a clear separation of normal and disordered. While 58.7% of those with 5 or more clinically significant symptoms did not map to the diagnostic criteria of any of the 10 DSM-5 disorders studied, those with symptom profiles that mapped to at least one disorder had, on average, 20 clinically significant symptoms. Within this group, the heterogeneity of symptom profiles was almost as high within a disorder label as between 2 disorder labels and not separable from randomly selected groups of individuals with at least one of any of the 10 disorders. Overall, these results quantify the scale of misalignment between clinical symptom profiles and DSM-5 disorder labels and demonstrate that DSM-5 disorder criteria do not separate individuals from random when the complete mental health symptom profile of an individual is considered. Greater emphasis on empirical, disorder agnostic approaches to symptom profiling would help overcome existing challenges with heterogeneity and comorbidity, aiding clinical and research outcomes.
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Anxious-depressive Pathology in the Structure of Adaptation Disorders (Clinics, Diagnosis, Therapy). Fam Med 2020. [DOI: 10.30841/2307-5112.5-6.2020.224988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective: evaluation of the effectiveness of the drug Giacintia (escitalopram) – coated tablets, 10 mg in the treatment of patients with anxiety and depressive symptoms in the structure of adaptation disorders.
Materials and methods. The study involved 38 patients with adaptive disorders, mixed anxiety-depressive response to ICD-10 (F 43.22). All patients received Giacintia at a dose of 10 mg per day, due to the sufficient therapeutic effect of this dosage. A comprehensive approach was used, which included methods: clinical and psychopathological; psychodiagnostic, based on the scale «Questionnaire of severity of psychopathological symptoms» (Symptom Check List-90-Revised – SCL-90-R), hospital scale of anxiety and depression (HADS) and the scale of social adaptation Sheehan (SDS); methods of mathematical statistics.
Results. Peculiarities of patients’ clinical condition and its dynamics were assessed before treatment (day 1), during therapy (day 14), and after treatment (day 90). As a result of Giacintia therapy, a significant improvement in the mental state of patients was found. When studying the regression of psychopathological symptoms, the positive dynamics of depressive disorders in this category of persons was observed by the end of the second week of therapy, and on the part of anxious – up to 21 days of therapy. Examination of patients at the end of the 90-day course of Giacintia treatment revealed a significant reduction in all previously recorded symptoms of anxiety and depression compared with baseline (p<0.05). On the SCL-90-R scale, on day 14 of therapy, patients showed a significant decrease in obsessive-compulsive symptoms, signs of paranoia (suspicion), hostility (feelings of anger), depressive symptoms, and phobic anxiety. Subsequently, there was a significant decrease in existing psychopathological symptoms and a probable decrease in all scales on day 90 of therapy with the studied antidepressant (t≥2,3477). At the time of the final assessment, the indicator on the scale of depression decreased to 0,52 points, and on the scale of anxiety – to 0,56 points, which indicates a reduction in clinically = pronounced anxiety and depressive symptoms. According to the HADS scale at the initial assessment of clinical and psychopathological manifestations of anxiety and depression, clinically expressed symptoms of anxiety were registered in 71,05 % of individuals (mean score – 15,00±2,39 points), subclinical – in 28,95 % of individuals (mean score – 8,82±0,75 points). At the same time, clinically pronounced symptoms of depression were registered in 81,58 % of individuals (mean score – 15,23±2,33 points), subclinical – in 18,42 % of individuals (mean score – 8,43±0,53 points). A significant decrease in the percentage of clinically pronounced manifestations of depressive symptoms was registered on day 14 of therapy (57,89 % of individuals, p<0,05). At the time of the final HADS assessment, clinically significant symptoms of anxiety and depression were completely reduced in the study group and were represented only by subclinical manifestations in 13,16 % of patients and 11,43 % of patients, respectively.
Conclusions. The results of the study showed high efficacy and good tolerability of the drug Giacintia in the treatment of anxiety and depressive symptoms in the structure of adaptation disorders. Giacintia has not only a balanced pronounced thymoanaleptic effect, but also provides increased professional, social and family activity and improves the quality of life of patients in general. Especially important is the good tolerability of the drug confirmed by the study, the unstable transient nature of adverse events, their insignificant severity, which is a significant advantage in the formation of patients’ commitment to treatment and achieving a deeper and more lasting therapeutic effect. Thus, the use of Giacintia can successfully overcome adaptation disorders and prevent their transformation into chronic conditions.
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Magnée T, de Beurs DP, Boxem R, de Bakker DH, Verhaak PF. Potential for substitution of mental health care towards family practices: an observational study. BMC FAMILY PRACTICE 2017; 18:10. [PMID: 28143421 PMCID: PMC5282718 DOI: 10.1186/s12875-017-0586-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/19/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Substitution is the shift of care from specialized health care to less expensive and more accessible primary health care. It seems promising for restraining rising mental health care costs. The goal of this study was to investigate a potential for substitution of patients with psychological or social problems, but without severe psychiatric disorders, from Dutch specialized mental health care to primary care, especially family practices. METHODS We extracted anonymized data from two national databases representing primary and specialized care in 2012. We calculated the number of patients with and without psychiatric disorder per 1,000 citizens in three major settings: family practices, primary care psychologists, and specialized care. Family physicians recorded psychopathology using the International Classification of Primary Care, while psychologists and specialists used the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. RESULTS Considerable numbers of patients without a diagnosed DSM-IV psychiatric disorder were treated by primary care psychologists (32.8%) or in specialized care (20.8%). Over half of the patients referred by family physicians to mental health care did not have a psychiatric disorder. CONCLUSION A recent reform of Dutch mental health care, including new referral criteria, will likely increase the number of patients with psychological or social problems that family physicians have to treat or support. Enabling and improving diagnostic assessment and treatment in family practices seems essential for substitution of mental health care.
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Affiliation(s)
- Tessa Magnée
- Netherlands Institute of Health Services Research (NIVEL), PO Box 1568, 3500 BN, Utrecht, The Netherlands.
| | - Derek P de Beurs
- Netherlands Institute of Health Services Research (NIVEL), PO Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Richard Boxem
- The Dutch Healthcare Authority, Utrecht, The Netherlands
| | - Dinny H de Bakker
- Netherlands Institute of Health Services Research (NIVEL), PO Box 1568, 3500 BN, Utrecht, The Netherlands.,Tilburg University, Scientific Centre for Transformation in Care and Welfare (TRANZO), Tilburg, The Netherlands
| | - Peter F Verhaak
- Netherlands Institute of Health Services Research (NIVEL), PO Box 1568, 3500 BN, Utrecht, The Netherlands.,Department of General Practice, Groningen University, Groningen, The Netherlands
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Abstract
SummaryThe language of psychiatry can be ambiguous and idiosyncratic, reflecting the elastic borders of mental illness and psychiatric disorder. This problem is not unique to psychiatry, but as the medical specialty moves closer towards a 'spectrum view’ of mental illness, psychiatric terminology increasingly risks misappropriation and conflation with lay concepts of normal suffering. Deciding what words mean and how psychiatric disorders are defined requires ongoing consideration of the pragmatic consequences, both intended and unintended. Refining the lexicon of psychiatry with an eye towards precision and the minimisation of stigma requires that terms be revised and updated from time to time, but often suitable word replacements remain elusive.
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Abstract
The concept of psychosis has been shaped by traditions in the concepts of mental disorders during the last 170 years. The term "psychosis" still lacks a unified definition, but denotes a clinical construct composed of several symptoms. Delusions, hallucinations, and thought disorders are the core clinical features. The search for a common denominator of psychotic symptoms points toward combinations of neuropsychological mechanisms resulting in reality distortion. To advance the elucidation of the causes and the pathophysiology of the symptoms of psychosis, a deconstruction of the term into its component symptoms is therefore warranted. Current research is dealing with the delineation from "normality", the genetic underpinnings, and the causes and pathophysiology of the symptoms of psychosis.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Jürgen Zielasek
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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Morris L, Mansell W, McEvoy P. The Take Control Course: Conceptual Rationale for the Development of a Transdiagnostic Group for Common Mental Health Problems. Front Psychol 2016; 7:99. [PMID: 26903907 PMCID: PMC4748307 DOI: 10.3389/fpsyg.2016.00099] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/18/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increasingly, research supports the utility of a transdiagnostic understanding of psychopathology. However, there is no consensus regarding the theoretical approach that best explains this. Transdiagnostic interventions can offer service delivery advantages; this is explored in the current review, focusing on group modalities and primary care settings. OBJECTIVE This review seeks to explore whether a Perceptual Control Theory (PCT) explanation of psychopathology across disorders is a valid one. Further, this review illustrates the process of developing a novel transdiagnostic intervention (Take Control Course; TCC) from a PCT theory of functioning. METHOD Narrative review. RESULTS AND CONCLUSIONS Considerable evidence supports key tenets of PCT. Further, PCT offers a novel perspective regarding the mechanisms by which a number of familiar techniques, such as exposure and awareness, are effective. However, additional research is required to directly test the relative contribution of some PCT mechanisms predicted to underlie psychopathology. Directions for future research are considered.
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Affiliation(s)
- Lydia Morris
- School of Psychological Sciences, University of Manchester Manchester, UK
| | - Warren Mansell
- School of Psychological Sciences, University of Manchester Manchester, UK
| | - Phil McEvoy
- Six Degrees Social Enterprise, CIC, The Angel Centre Salford, UK
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10
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Pierre JM. Mental illness and mental health: is the glass half empty or half full? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:651-8. [PMID: 23149280 DOI: 10.1177/070674371205701102] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
During the past century, the scope of mental health intervention in North America has gradually expanded from an initial focus on hospitalized patients with psychoses to outpatients with neurotic disorders, including the so-called worried well. The Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, is further embracing the concept of a mental illness spectrum, such that increasing attention to the softer end of the continuum can be expected in the future. This anticipated shift rekindles important questions about how mental illness is defined, how to distinguish between mental disorders and normal reactions, whether psychiatry is guilty of prevalence inflation, and when somatic therapies should be used to treat problems of living. Such debates are aptly illustrated by the example of complicated bereavement, which is best characterized as a form of adjustment disorder. Achieving an overarching definition of mental illness is challenging, owing to the many different contexts in which DSM diagnoses are used. Careful analyses of such contextual utility must inform future decisions about what ends up in DSM, as well as how mental illness is defined by public health policy and society at large. A viable vision for the future of psychiatry should include a spectrum model of mental health (as opposed to exclusively mental illness) that incorporates graded, evidence-based interventions delivered by a range of providers at each point along its continuum.
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11
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Phillips J, Frances A, Cerullo MA, Chardavoyne J, Decker HS, First MB, Ghaemi N, Greenberg G, Hinderliter AC, Kinghorn WA, LoBello SG, Martin EB, Mishara AL, Paris J, Pierre JM, Pies RW, Pincus HA, Porter D, Pouncey C, Schwartz MA, Szasz T, Wakefield JC, Waterman GS, Whooley O, Zachar P. The six most essential questions in psychiatric diagnosis: a pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis. Philos Ethics Humanit Med 2012; 7:8. [PMID: 22512887 PMCID: PMC3390269 DOI: 10.1186/1747-5341-7-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 04/18/2012] [Indexed: 05/31/2023] Open
Abstract
In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM--whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.
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Affiliation(s)
- James Phillips
- Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven,, CT, 06511, USA
| | - Allen Frances
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St., Durham, NC, 27710, USA
| | - Michael A Cerullo
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH, 45219, USA
| | - John Chardavoyne
- Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven,, CT, 06511, USA
| | - Hannah S Decker
- Department of History, University of Houston, 524 Agnes Arnold, Houston, 77204, USA
| | - Michael B First
- Department of Psychiatry, Division of Clinical Phenomenology, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Nassir Ghaemi
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Gary Greenberg
- Human Relations Counseling Service, 400 Bayonet Street Suite #202, New London, CT, 06320, USA
| | - Andrew C Hinderliter
- Department of Linguistics, University of Illinois, Urbana-Champaign 4080 Foreign Languages Building, 707 S Mathews Ave, Urbana, IL, 61801, USA
| | - Warren A Kinghorn
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St., Durham, NC, 27710, USA
- Duke Divinity School, Box 90968, Durham, NC, 27708, USA
| | - Steven G LoBello
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA
| | - Elliott B Martin
- Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven,, CT, 06511, USA
| | - Aaron L Mishara
- Department of Clinical Psychology, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL, 60654, USA
| | - Joel Paris
- Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Department of Psychiatry, McGill University, 4333 cote Ste. Catherine, Montreal, QC, H3T1E4, Canada
| | - Joseph M Pierre
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
- VA West Los Angeles Healthcare Center, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Ronald W Pies
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY, 13210, USA
| | - Harold A Pincus
- Department of Psychiatry, Division of Clinical Phenomenology, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY, 10032, USA
- Irving Institute for Clinical and Translational Research, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA
- New York Presbyterian Hospital, 1051 Riverside Drive, Unit 09, New York, NY, 10032, USA
- Rand Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Douglas Porter
- Central City Behavioral Health Center, 2221 Philip Street, New Orleans, LA, 70113, USA
| | - Claire Pouncey
- Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA
| | - Michael A Schwartz
- Department of Psychiatry, Texas A&M Health Science Center - College of Medicine, 4110 Guadalupe Street, Austin, TX 78751, USA
| | - Thomas Szasz
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY, 13210, USA
| | - Jerome C Wakefield
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
- Department of Psychiatry, NYU Langone Medical Center, 550 First Ave, New York, NY, 10016, USA
| | - G Scott Waterman
- Department of Psychiatry, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Courtyard N104, Burlington, VT, 05405, USA
| | - Owen Whooley
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St., New Brunswick, NJ, 08901, USA
| | - Peter Zachar
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA
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12
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Phillips J, Frances A, Cerullo MA, Chardavoyne J, Decker HS, First MB, Ghaemi N, Greenberg G, Hinderliter AC, Kinghorn WA, LoBello SG, Martin EB, Mishara AL, Paris J, Pierre JM, Pies RW, Pincus HA, Porter D, Pouncey C, Schwartz MA, Szasz T, Wakefield JC, Waterman GS, Whooley O, Zachar P. The six most essential questions in psychiatric diagnosis: a pluralogue part 3: issues of utility and alternative approaches in psychiatric diagnosis. Philos Ethics Humanit Med 2012; 7:9. [PMID: 22621419 PMCID: PMC3403926 DOI: 10.1186/1747-5341-7-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 05/23/2012] [Indexed: 06/01/2023] Open
Abstract
In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.
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Affiliation(s)
- James Phillips
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
| | - Allen Frances
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St, Durham, NC, 27710, USA
| | - Michael A Cerullo
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH, 45219, USA
| | - John Chardavoyne
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
| | - Hannah S Decker
- Department of History, University of Houston, 524 Agnes Arnold, Houston, 77204, USA
| | - Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Nassir Ghaemi
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Gary Greenberg
- Human Relations Counseling Service, 400 Bayonet Street Suite 202, New London, CT, 06320, USA
| | - Andrew C Hinderliter
- Department of Linguistics, University of Illinois, Urbana-Champaign, 4080 Foreign Languages Building, 707S Mathews Ave, Urbana, IL, 61801, USA
| | - Warren A Kinghorn
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St, Durham, NC, 27710, USA
- Duke Divinity School, Box 90968, Durham, NC, 27708, USA
| | - Steven G LoBello
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA
| | - Elliott B Martin
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
| | - Aaron L Mishara
- Department of Clinical Psychology, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL, 60654, USA
| | - Joel Paris
- Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Department of Psychiatry, McGill University, 4333 cote Ste. Catherine, Montreal, H3T1E4, QC, Canada
| | - Joseph M Pierre
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
- VA West Los Angeles Healthcare Center, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Ronald W Pies
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St, #343CWB, Syracuse, NY, 13210, USA
| | - Harold A Pincus
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
- Irving Institute for Clinical and Translational Research, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA
- New York Presbyterian Hospital, 1051 Riverside Drive, Unit 09, New York, NY, 10032, USA
- Rand Corporation, 1776 Main St Santa Monica, California, 90401, USA
| | - Douglas Porter
- Central City Behavioral Health Center, 2221 Philip Street, New Orleans, LA, 70113, USA
| | - Claire Pouncey
- Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA
| | - Michael A Schwartz
- Department of Psychiatry, Texas A & M College of Medicine, 4110 Guadalupe Street, Austin, Texas, 78751, USA
| | - Thomas Szasz
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St, #343CWB, Syracuse, NY, 13210, USA
| | - Jerome C Wakefield
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
- Department of Psychiatry, NYU Langone Medical Center, 550 First Ave, New York, NY, 10016, USA
| | - G Scott Waterman
- Department of Psychiatry, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Courtyard N104, Burlington, Vermont, 05405, USA
| | - Owen Whooley
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, 112 Paterson St, New Brunswick, NJ, 08901, USA
| | - Peter Zachar
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA
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Phillips J, Frances A, Cerullo MA, Chardavoyne J, Decker HS, First MB, Ghaemi N, Greenberg G, Hinderliter AC, Kinghorn WA, LoBello SG, Martin EB, Mishara AL, Paris J, Pierre JM, Pies RW, Pincus HA, Porter D, Pouncey C, Schwartz MA, Szasz T, Wakefield JC, Waterman GS, Whooley O, Zachar P. The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis. Philos Ethics Humanit Med 2012; 7:3. [PMID: 22243994 PMCID: PMC3305603 DOI: 10.1186/1747-5341-7-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 01/13/2012] [Indexed: 05/12/2023] Open
Abstract
In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.
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Affiliation(s)
- James Phillips
- Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT 06511, USA
| | - Allen Frances
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St., Durham, NC 27710, USA
| | - Michael A Cerullo
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH 45219, USA
| | - John Chardavoyne
- Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT 06511, USA
| | - Hannah S Decker
- Department of History, University of Houston, 524 Agnes Arnold, Houston, 77204, USA
| | - Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Nassir Ghaemi
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Gary Greenberg
- Human Relations Counseling Service, 400 Bayonet Street Suite #202, New London, CT 06320, USA
| | - Andrew C Hinderliter
- Department of Linguistics, University of Illinois, Urbana-Champaign 4080 Foreign Languages Building, 707 S Mathews Ave, Urbana, IL 61801, USA
| | - Warren A Kinghorn
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St., Durham, NC 27710, USA
- Duke Divinity School, Box 90968, Durham, NC 27708, USA
| | - Steven G LoBello
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL 36117, USA
| | - Elliott B Martin
- Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT 06511, USA
| | - Aaron L Mishara
- Department of Clinical Psychology, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago IL, 60654, USA
| | - Joel Paris
- Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Department of Psychiatry, McGill University, 4333 cote Ste. Catherine, Montreal H3T1E4 Quebec, Canada
| | - Joseph M Pierre
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, USA
- VA West Los Angeles Healthcare Center, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA
| | - Ronald W Pies
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY 13210, USA
| | - Harold A Pincus
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
- Irving Institute for Clinical and Translational Research, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA
- New York Presbyterian Hospital, 1051 Riverside Drive, Unit 09, New York, NY 10032, USA
- Rand Corporation, 1776 Main St Santa Monica, California 90401, USA
| | - Douglas Porter
- Central City Behavioral Health Center, 2221 Philip Street, New Orleans, LA 70113, USA
| | - Claire Pouncey
- Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320 Philadelphia, PA 19104, USA
| | - Michael A Schwartz
- Department of Psychiatry, Texas AMHSC College of Medicine, 4110 Guadalupe Street, Austin, Texas 78751, USA
| | - Thomas Szasz
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY 13210, USA
| | - Jerome C Wakefield
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA
- Department of Psychiatry, NYU Langone Medical Center, 550 First Ave, New York, NY 10016, USA
| | - G Scott Waterman
- Department of Psychiatry, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Courtyard N104, Burlington, Vermont 05405, USA
| | - Owen Whooley
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St., New Brunswick, NJ 08901, USA
| | - Peter Zachar
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL 36117, USA
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Abstract
There are well-established patterns of structural brain changes associated with aging. The change in brain volume with age and with the diseases of aging presents a particular challenge for MRI studies in the elderly. Structural MRI is important for studies in normal aging, late-life depression, dementia, Alzheimer disease and other cognitive disorders to examine how age-associated changes in neuroanatomy are associated with specific age-related changes in brain function. Functional MRI has been a major advance for the fields of cognitive and affective neuroscience by allowing investigators to test theories of the underlying neural pathways controlling cognitive and emotional processes. In this chapter, we will review the contribution of MRI studies to late-life mood and anxiety disorders: major depression, bipolar disorder and anxiety disorders in late-life.
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