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Kodra Y, Minelli G, Rocchetti A, Manno V, Carinci A, Conti S, Taruscio D. The Italian National Rare Diseases Registry: a model of comparison and integration with Hospital Discharge Data. J Public Health (Oxf) 2019; 41:46-54. [PMID: 29294017 DOI: 10.1093/pubmed/fdx176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 11/14/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Italy has been the first country at European level to implement a population-based public health registry dedicated to rare diseases. This study describes the current situation of the Italian National Rare Diseases Registry (NRDR) and compares its data with those from the National Hospital Discharge Database (HDD). METHODS Three rare diseases were analysed: Huntington disease (HD), Hereditary Haemorragic Telangiectasia (HHT) and Prader-Willi Syndrome (PWS), selected for their different characteristics. The two sources (NRDR and HDD) were linked: incidence rate ratio (IRR), sensitivity and predictive positive value (PPV) were calculated. RESULTS Incidence rates from NRDR and from HDD were compared by age groups, and IRR calculated: 1.08 for HD, 1.41 for HHT, 1.21 for PSW. For HD, sensitivity was 0.52 and PPV 0.48; for HHT sensitivity was 0.71 and PPV 0.52; for PWS the sensitivity was 0.71 and PPV 0.58. We found a strong regional variability in the results. CONCLUSIONS The integrated use of the two sources helps tracking those cases that are not captured by the Registry; further, it is a precious tool to accurately describe clinical histories of rare disease affected individuals, in terms of concomitant pathologies and medical procedures performed during hospitalization.
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Affiliation(s)
- Yllka Kodra
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Giada Minelli
- Service of Statistics, Istituto Superiore di Sanità, Rome, Italy
| | - Adele Rocchetti
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Valerio Manno
- Service of Statistics, Istituto Superiore di Sanità, Rome, Italy
| | | | - Susanna Conti
- Service of Statistics, Istituto Superiore di Sanità, Rome, Italy
| | - Domenica Taruscio
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
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Christodoulou G, Fulford B, Mezzich JE. Psychiatry for the person and its conceptual bases. Int Psychiatry 2018. [DOI: 10.1192/s174936760000535x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The 2005 General Assembly of the World Psychiatric Association (WPA) established the Institutional Program on Psychiatry for the Person (IPPP) in response both to a recognition of our profession's historical aspirations and to recent international developments in clinical care and public health. These considerations point to the relevance of a comprehensive understanding of health and the centrality of the person in the delivery and the planning of healthcare. The IPPP's goals can be summarised as the promotion of a psychiatry of the person (of the totality of the person's health, both ill and positive), by the person (with clinicians extending themselves as full human beings), for the person (assisting the fulfilment of the person's life project) and with the person (in respectful collaboration with the person who consults). Operationally, the IPPP has four components: conceptual bases, clinical diagnosis, clinical care, and public health. What follows is an initial review of the IPPP's conceptual bases and an outline of its emerging activities.
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Grassi L, Mezzich JE, Nanni MG, Riba MB, Sabato S, Caruso R. A person-centred approach in medicine to reduce the psychosocial and existential burden of chronic and life-threatening medical illness. Int Rev Psychiatry 2017; 29:377-388. [PMID: 28783462 DOI: 10.1080/09540261.2017.1294558] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The psychiatric, psychosocial, and existential/spiritual pain determined by chronic medical disorders, especially if in advanced stages, have been repeatedly underlined. The right to approach patients as persons, rather than symptoms of organs to be repaired, has also been reported, from Paul Tournier to Karl Jaspers, in opposition and contrast with the technically-enhanced evidence-based domain of sciences that have reduced the patients to 'objects' and weakened the physician's identity deprived of its ethical value of meeting, listening, and treating subjects. The paper will discuss the main psychosocial and existential burden related to chronic and advanced medical illnesses, and the diagnostic and therapeutic implications for a dignity preserving care within a person-centred approach in medicine, examined in terms of care of the person (of the person's whole health), for the person (for the fulfilment of the person's health aspirations), by the person (with physicians extending themselves as total human beings), and with the person (working respectfully with the medically ill person).
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Affiliation(s)
- Luigi Grassi
- a Department of Biomedical and Specialty Surgical Sciences, School of Medicine , Institute of Psychiatry, University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care Integrated Department of Mental Health and Addictive Behavior , University Hospital and Health Authorities , Ferrara , Italy
| | - Juan E Mezzich
- c Icahn School of Medicine at Mount Sinai, International College of Person-Centered Medicine , New York City , NY , USA
| | - Maria Giulia Nanni
- a Department of Biomedical and Specialty Surgical Sciences, School of Medicine , Institute of Psychiatry, University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care Integrated Department of Mental Health and Addictive Behavior , University Hospital and Health Authorities , Ferrara , Italy
| | - Michelle B Riba
- d Integrated Medical and Psychiatric Services Department of Psychiatry , University of Michigan Comprehensive Depression Center , Ann Arbor , MI , USA.,e PsychOncology Program, University of Michigan Comprehensive Cancer Center , Ann Arbor , MI , USA
| | - Silvana Sabato
- a Department of Biomedical and Specialty Surgical Sciences, School of Medicine , Institute of Psychiatry, University of Ferrara , Ferrara , Italy
| | - Rosangela Caruso
- a Department of Biomedical and Specialty Surgical Sciences, School of Medicine , Institute of Psychiatry, University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatry Unit, Program on Psycho-Oncology and Psychiatry in Palliative Care Integrated Department of Mental Health and Addictive Behavior , University Hospital and Health Authorities , Ferrara , Italy
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Broyd A, Jolley S, Johns L. Determinants of subjective well-being in people with psychosis referred for psychological therapy in South London. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2016; 55:429-440. [DOI: 10.1111/bjc.12112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 03/31/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Annabel Broyd
- Department of Psychology; Institute of Psychiatry, Psychology and Neuroscience (IoPPN); King's College, London; UK
| | - Suzanne Jolley
- Department of Psychology; Institute of Psychiatry, Psychology and Neuroscience (IoPPN); King's College, London; UK
| | - Louise Johns
- Department of Psychology; Institute of Psychiatry, Psychology and Neuroscience (IoPPN); King's College, London; UK
- Department of Psychiatry; Oxford University; UK
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Smith GC. Revisiting formulation: part 2. The task of addressing the concept of the unique individual. Remediating problems with formulation. Australas Psychiatry 2014; 22:28-31. [PMID: 24235089 DOI: 10.1177/1039856213511672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this paper is to review the theoretical basis of addressing the concept of the unique individual, one of the tasks prescribed in the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Formulation guidelines for candidates, and to propose a rational basis for remediation of the problems that many candidates and other professionals have with formulation. CONCLUSION The difficulty that RANZCP candidates and other mental health professionals have in producing a completely integrated account of an individual is multi-determined, but is partly explainable on theoretical grounds. Understanding why this task (and other tasks of formulation) is problematic requires knowledge of its intellectual history, its rationale, the tools of reasoning that it requires and the nature of the challenges that it can pose to individuals. The paper argues that a rational plan for remediation of a professional's problems with formulation requires first a 'formulation' of those problems, drawing on the theories discussed and acknowledging the uniqueness of that individual. In answering the question, 'Why is this person having difficulty formulating this patient at this time?', one needs to address cultural, social and systemic factors, and psychological factors such as the degree of psychological mindedness of the person seeking remediation. Hypotheses based on the formulation about the professional's difficulty should be developed and tested by interventions.
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Affiliation(s)
- Graeme C Smith
- Emeritus Professor, Discipline of Psychiatry, School of Psychology and Psychiatry, Monash University, Melbourne, VIC, Australia
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Smith GC. Revisiting formulation: part 1. The tasks of formulation: their rationale and philosophic basis. Australas Psychiatry 2014; 22:23-7. [PMID: 24235088 DOI: 10.1177/1039856213511671] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This paper notes the continuing problems that Royal Australian and New Zealand College of Psychiatry (RANZCP) candidates and other professionals have with the task of formulation. It re-establishes this as a problematic to be understood and reviews its intellectual history, its rationale, the tools of reasoning that it requires and the nature of the challenges that it can pose to individuals. Its premise is that an understanding of the theoretical basis of formulation is required prior to application of pedagogical tools in teaching and remediation. Four tasks of formulation implied in the definition provided in the RANZCP Formulation Guidelines for Candidates are identified, and their rationale and theoretical status reviewed. CONCLUSION Task 1, classification, must address both diagnoses and problems. Task 2, using theory to infer meaning, ideally requires multiple models and theories in development of a set of hypotheses, using inductive inference (plausibility). Task 3, prioritising hypotheses, requires abduction, defined as inference to the best explanation. Task 4, integrating hypotheses, may aim for reconciling systems (syncretism), but is likely to use the more problematic eclecticism. The task of formulation is thus challenging but well prescribed by philosophers for thousands of years.
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Affiliation(s)
- Graeme C Smith
- Emeritus Professor, Discipline of Psychiatry, School of Psychology and Psychiatry, Monash University, Melbourne, VIC, Australia
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Plagnol A. Psychiatrie et médecine fondée sur les valeurs. ANNALES MEDICO-PSYCHOLOGIQUES 2013. [DOI: 10.1016/j.amp.2013.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schrank B, Bird V, Tylee A, Coggins T, Rashid T, Slade M. Conceptualising and measuring the well-being of people with psychosis: Systematic review and narrative synthesis. Soc Sci Med 2013; 92:9-21. [DOI: 10.1016/j.socscimed.2013.05.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 03/20/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
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Austin P, Henderson S, Power I, Jirwe M, Alander T. An international Delphi study to assess the need for multiaxial criteria in diagnosis and management of functional gastrointestinal disorders. J Psychosom Res 2013; 75:128-34. [PMID: 23915768 DOI: 10.1016/j.jpsychores.2013.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess agreement, consensus, and disagreement between experts in different domains in the evaluation of functional gastrointestinal disorders (FGIDs). METHODS We conducted a modified Delphi study using 90 purposively sampled experts using an online survey tool to develop, distribute and analyse the Delphi rounds. Experts were sent 132 items generated from a literature review examining present and proposed future FGID evaluation. The survey items examined contributory factors and were divided into four sections examining risk and contributing factors, the therapeutic relationship, domains of measurement and the pros and cons of multiaxial assessment. The consensus level was set at 75%. KEY RESULTS 36 of 68 eligible participants (52%) replied to round one and 96 items gained consensus. Using expert feedback, we used thematic analysis to generate 33 additional items for round two. 31 of 36 participants (86%) replied to rounds two and three. In round two, 19 items gained consensus, and in round three, nine items gained consensus. Agreement was high concerning systematic approaches for both physiological and psychosocial components of FGIDs (91%) using laboratory and self-reporting findings (83%). Opinion was divided regarding physical risk factors such as previous surgery (53%) and genetic association (71%). Overall, 124 of the 167 items gained consensus. CONCLUSION AND INFERENCES We have identified expert consensus and disagreement on domains of information relevant to the evaluation of FGIDs. Experts agreed there is an immediate need for multi-axial assessment. Physiological and genetic risk factors are not fully accepted and require further study.
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Affiliation(s)
- Philip Austin
- Department of Anaesthesia and Pain Medicine, University of Edinburgh, Edinburgh, UK.
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Schrank B, Woppmann A, Grant Hay A, Sibitz I, Zehetmayer S, Lauber C. Validation of the Integrative Hope Scale in people with psychosis. Psychiatry Res 2012; 198:395-9. [PMID: 22425469 DOI: 10.1016/j.psychres.2011.12.052] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 11/22/2011] [Accepted: 12/31/2011] [Indexed: 11/17/2022]
Abstract
Hope is an important variable in mental health, particularly in the emergent field of research focused on recovery and well-being. This study validates the "Integrative Hope Scale" (IHS) for use in people with severe mental illness. Two hundred participants diagnosed with schizophrenia or schizoaffective disorder were assessed using the IHS, the Centre for Epidemiological Studies Depression Scale, and the Positive and Negative Syndrome Scale. Sixty participants were re-assessed after 14 days to establish re-test reliability. Confirmatory factor analysis was carried out; correlations between the scales and kappa coefficients were used to establish validity and reliability. The factor analysis confirmed a four-factor solution with excellent model fit, after minor modifications to the initial model. Discriminant validity and internal consistency were excellent. Test-retest reliability was good except for one item. This study suggests the scale to be a valid, reliable and feasible tool for the assessment of hope in people with severe mental illness. It provides a sound basis for future research on hope in mental health. For use in people with psychosis, we suggest some minor modifications to the scale.
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Affiliation(s)
- Beate Schrank
- King's College London, Institute of Psychiatry, Denmark Hill, London SE5 8AF, United Kingdom.
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Fulford KWM. Values-based practice: a new partner to evidence-based practice and a first for psychiatry? Mens Sana Monogr 2011; 6:10-21. [PMID: 22013346 PMCID: PMC3190543 DOI: 10.4103/0973-1229.40565] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Revised: 12/21/2007] [Accepted: 12/22/2007] [Indexed: 11/04/2022] Open
Affiliation(s)
- K W M Fulford
- Professor of Philosophy and Mental Health, University of Warwick and Member of the Philosophy Faculty, Honorary Consultant Psychiatrist, and Fellow of St Cross College, University of Oxford, United Kingdom
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Fulford KWM. The value of evidence and evidence of values: bringing together values-based and evidence-based practice in policy and service development in mental health. J Eval Clin Pract 2011; 17:976-87. [PMID: 21951930 DOI: 10.1111/j.1365-2753.2011.01732.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Angst J, Gamma A, Clarke D, Ajdacic-Gross V, Rössler W, Regier D. Subjective distress predicts treatment seeking for depression, bipolar, anxiety, panic, neurasthenia and insomnia severity spectra. Acta Psychiatr Scand 2010; 122:488-98. [PMID: 20550521 DOI: 10.1111/j.1600-0447.2010.01580.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine correlates of mental health treatment seeking such as gender, diagnosis, impairment, distress and mastery. METHOD Longitudinal epidemiological data from the Zurich Study of common psychiatric syndromes, including unipolar and bipolar depression, panic, anxiety, neurasthenia and insomnia, were utilized. In longitudinal Generalized Estimating Equations, treatment seeking was regressed on measures of subjective distress and impairment, childhood family problems, mastery and number of comorbid diagnoses. RESULTS Approximately half of all treated participants across all six syndromes suffered from subthreshold disorders. Meeting full or subthreshold diagnostic criteria was associated with treatment seeking for insomnia. Being female was associated with treatment seeking for depression. The only variable highly and consistently associated with treatment seeking, across all syndromes, was subjective distress. Treated participants reported high levels of distress, work and social impairment in both diagnostic and subthreshold groups. CONCLUSION Subjective distress may be a better indicator of treatment seeking than symptom count.
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Affiliation(s)
- J Angst
- Zurich University Psychiatric Hospital, Switzerland.
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Denton WH, Nakonezny PA, Burwell SR. Reliability and validity of the global assessment of relational functioning (GARF) in a psychiatric family therapy clinic. JOURNAL OF MARITAL AND FAMILY THERAPY 2010; 36:376-387. [PMID: 20618583 DOI: 10.1111/j.1752-0606.2009.00144.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The reliability and validity of the Diagnostic and Statistical Manual of Mental Disorders-IV Global Assessment of Relational Functioning (GARF) was evaluated in consenting participants presenting to a family therapy training clinic. The purpose of this study was to (a) assess whether the GARF could be administered quickly in a marriage and family therapy training clinic, (b) assess the inter-rater and internal reliability of GARF ratings of intake sessions, (c) examine the relationship of GARF ratings to established measures of relationship functioning, and (d) compare GARF ratings to a measure of depressive symptoms. Study participants completed the General Functioning Subscale of the Family Assessment Device (GFS/FAD), the Quality of Marriage Index (QMI), and the Center for Epidemiologic Studies-Depression Scale (CES-D). After intake sessions were conducted with study participants, GARF ratings were made by an American Association for Marriage and Family Therapy Approved Supervisor or Supervisor-in-Training, a therapist trainee, and two observing trainees who had observed the session from behind a one-way mirror. Cronbach's coefficient alphas and the average intraclass correlation coefficients were both .82 when ratings of the supervisor and two observers were compared and .78 and .79, respectively, when ratings of the supervisor, two observers, and therapist were evaluated. There was significant agreement between GARF ratings made by the supervisor and therapist (but not observers) and scores on the GFS/FAD, QMI, and CES-D. Results suggest that GARF ratings can be made quickly and reliably, especially among raters with greater clinical experience, and are related to measures of relational functioning and depression. Implications for research and marriage and family therapy training are discussed.
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Affiliation(s)
- Wayne H Denton
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9121, USA.
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Mezzich JE. World Psychiatric Association perspectives on person-centered psychiatry and medicine. Int J Integr Care 2010; 10 Suppl:e003. [PMID: 20228900 PMCID: PMC2834894 DOI: 10.5334/ijic.473] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Juan E Mezzich
- International Center for Mental Health, Mount Sinai School of Medicine, New York University, USA; World Psychiatric Association President 2005-2008
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Bäärnhielm S, Scarpinati Rosso M. The cultural formulation: A model to combine nosology and patients' life context in psychiatric diagnostic practice. Transcult Psychiatry 2009; 46:406-28. [PMID: 19837779 DOI: 10.1177/1363461509342946] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article discusses the experience of adapting and applying the Outline for a Cultural Formulation in DSM-IV to the Swedish context. Findings from a research project on the Cultural Formulation highlight the value of combining psychiatric nosological categorization with an understanding of patients' cultural life context in order to increase the validity of categorization and to formulate individualized treatment plans. In clinical care practitioners need models and tools that help them take into account patients' cultural backgrounds, needs, and resources in psychiatric diagnostic practice. We present a summary of a Swedish manual for conducting a Cultural Formulation interview. The need for further development of the Cultural Formulation is also discussed.
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Zou YZ, Cui JF, Han B, Ma AL, Li MY, Fan HZ. Chinese psychiatrists views on global features of CCMD-III, ICD-10 and DSM-IV. Asian J Psychiatr 2008; 1:56-9. [PMID: 23050999 DOI: 10.1016/j.ajp.2008.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 09/25/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To survey psychiatrists' opinions about psychiatric classification in China, and provide information and suggestions for developing a new version of classificatory system. METHOD The questionnaire about psychiatry classification written by Professor Graham Mellsop, New Zealand, was translated and modified into Chinese. An anonymous field survey of 380 psychiatry professionals was undertaken in Beijing. RESULTS A total of 181 questionnaires were eligible for analysis. The Chinese Classification of Mental Disorders version 3 (CCMD-III) is the most commonly used in China (63.8%), then ICD-10 (28.5%) and DSM-IV (7.7%). Half of the respondents (53.0%) agreed that the most important diagnostic classification is for communication among physicians, and then for communication between physician and patient (21.0%). Most professionals (90.0%) agree that classification should include less than 100 diagnostic options. Disagreement presents on cross-culture application of the ICD-10 and DSM-III: 75.1% professionals agreed that they are "useful and reliable regardless of patient ethnicity and culture", while 46.8% found "sometimes difficult to apply across cultures", and 35.8% thought classification is "over-embedded in European cultural concepts and values". CONCLUSION There is a strong trend of convergence and unification of China's diagnostic standards with international standards inevitable. A classification that is less complicated and confused, easy-to-communicate and understand and cross-cultural/nation applicable is expected by most Chinese psychiatrists. Such classification should also be reflective of the advances in understanding of aetiology of disorders and helpful in clinical management.
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Affiliation(s)
- Yi-Zhuang Zou
- Beijing Huilongguan Hospital, Peking University, PR China
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Musalek M, Scheibenbogen O. From categorical to dimensional diagnostics: deficiency-oriented versus person-centred diagnostics. Eur Arch Psychiatry Clin Neurosci 2008; 258 Suppl 5:18-21. [PMID: 18985289 DOI: 10.1007/s00406-008-5007-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The problem of inhomogeneous categories and the difficulty of drawing boundaries as well as individual progression of the severity of psychopathologic phenomena necessitate a change of paradigm from categorical to dimensional diagnostics. Not only pathogenetic factors but also disorder maintaining factors such as the stigmatization and the significance of the disorder for the patient must be factored into the diagnostic process to ensure therapy relevancy. In addition to this deficiency-oriented approach holistic person-centred diagnostics focuses on the integration of resources, i.e. the abilities and skills, talents and inclinations of the patient, in order to adequately help a patient to resume/live an autonomous life that is as happy as possible.
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Affiliation(s)
- Michael Musalek
- Anton Proksch Institute, Gräfin Zichy Strasse 6, Vienna, Austria.
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Abstract
Based on historical and current contributions, the operational diagnostic approach is examined from a psychopathological point of view. Operational diagnostic systems in psychiatry are characterised by an atomising approach. In this context, psychopathological symptoms are interpreted as elementary entities which can be combined into a specific diagnostic category. Many years before operational diagnostic systems were introduced into psychiatry, however, such an atomising procedure was criticised by authors like Karl Jaspers, Willy Mayer-Gross or Klaus Conrad. Furthermore, validation of diagnostic criteria of operational diagnostic systems has not succeeded so far using biological findings or results of family and follow-up studies. This may be one reason for the fact that categorical approaches in psychiatric diagnosis are questioned increasingly and dimensional diagnostic models are suggested.
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Fink M, Taylor MA. The medical evidence-based model for psychiatric syndromes: return to a classical paradigm. Acta Psychiatr Scand 2008; 117:81-4. [PMID: 18199152 DOI: 10.1111/j.1600-0447.2007.01146.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mezzich JE. WPA's achievements 2005-2008: institutional consolidation, global impact, and Psychiatry for the Person. World Psychiatry 2008; 7:65-7. [PMID: 18560489 PMCID: PMC2408403 DOI: 10.1002/j.2051-5545.2008.tb00157.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Diversity. Curr Opin Psychiatry 2007; 20:570-2. [PMID: 17921756 DOI: 10.1097/yco.0b013e3282f10e76] [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: 11/26/2022]
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