Integrating DSM/ICD, Research Domain Criteria, and Descriptive Psychopathology in Teaching and Practice of Psychiatry

Introducing a depression-like syndrome for translational neuropsychiatry: a plea for taxonomical validity and improved comparability between humans and mice

Depressive disorders are the most burdensome psychiatric disorders worldwide. Although huge efforts have been made to advance treatment, outcomes remain unsatisfactory. Many factors contribute to this gridlock including suboptimal animal models. Especially limited study comparability and replicability due to imprecise terminology concerning depressive-like states are major problems. To overcome these issues, new approaches are needed. Here, we introduce a taxonomical concept for modelling depression in laboratory mice, which we call depression-like syndrome (DLS). It hinges on growing evidence suggesting that mice possess advanced socioemotional abilities and can display non-random symptom patterns indicative of an evolutionary conserved disorder-like phenotype. The DLS approach uses a combined heuristic method based on clinical depression criteria and the Research Domain Criteria to provide a biobehavioural reference syndrome for preclinical rodent models of depression. The DLS criteria are based on available, species-specific evidence and are as follows: (I) minimum duration of phenotype, (II) significant sociofunctional impairment, (III) core biological features, (IV) necessary depressive-like symptoms. To assess DLS presence and severity, we have designed an algorithm to ensure statistical and biological relevance of findings. The algorithm uses a minimum combined threshold for statistical significance and effect size (p value ≤ 0.05 plus moderate effect size) for each DLS criterion. Taken together, the DLS is a novel, biologically founded, and species-specific minimum threshold approach. Its long-term objective is to gradually develop into an inter-model validation standard and microframework to improve phenotyping methodology in translational research.

How a transdiagnostic approach can improve the treatment of emotional disorders: Insights from clinical psychology and neuroimaging

Multiple psychological treatments for emotional disorders have been developed and implemented, improving the quality of life of individuals. Nevertheless, relapse and poor response to psychotherapy are common. This article argues that a greater understanding of both the psychological and neurobiological mechanisms of change in psychotherapy is essential to improve treatment for emotional disorders. It aims to demonstrate how an understanding of these mechanisms provides a basis for (i) reconceptualizing some mental disorders, (ii) refining and establishing the evidence for existing therapeutic techniques and (iii) designing new techniques that precisely target the processes that maintain these disorders. Possible future directions for researchers and practitioners working at the intersection of neuropsychology and clinical psychology are discussed.

Classifying major mental disorders genetically

Typically, mental disorders are defined and classified based on clinical symptoms and syndromes. Although clinically useful, current diagnostic systems for psychiatry cause concerns due to the lack of biological mechanisms. Deciphering the relationships among psychiatric traits according to their genetic basis may facilitate understanding the biological mechanisms of psychiatric disorders. Ten mental disorders were classified by genomic structural equation modeling (SEM), which leverages summary results of genome-wide association studies. Attention-deficit/hyperactivity disorder (ADHD), anorexia nervosa (AN), anxiety disorder (ANX), autism spectrum disorder (ASD), bipolar disorder (BD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), schizophrenia (SZ), and Tourette syndrome (TS) were included. The analysis indicates that they are genetically inter-correlated with one another and can be separated based on their general psychopathology. Most disorders have a close partner, forming pairs of traits; only TS is a relatively distinctive condition. At a higher level, MDD, ANX, ADHD, ASD, and PTSD cluster together, while OCD, AN, and TS cluster together. Together, the ten traits constitute a hierarchical classificatory system. This study allows inference of genetically determined classification of the ten mental disorders, which may biologically inform the current diagnostic framework and treatment regimens for mental disorders.

Training Psychiatry Residents in Descriptive Psychopathology: A Systematic Review

PURPOSE

Descriptive psychopathology (DP, sometimes called psychopathology or phenomenology) is the language of psychiatry and is dedicated to the description of mental symptoms. Due to its importance, there is an ongoing case to put it back at the heart of psychiatry and its training. This study seeks to examine the literature on how to train psychiatry residents in DP, including reported educational interventions and educational methods.

METHOD

The authors conducted a systematic review following the PRISMA and BEME guidelines to identify literature on how to train psychiatry residents in DP. In May 2019, they searched in Embase, ERIC, PsycINFO, PubMed, Scopus, and Web of Science; of 7,199 initial results, 26 sources were finally included for analysis. The assessment tools were the CRAAP test, Kirkpatrick's 4 levels, and (when applicable) the Medical Education Research Study Quality Instrument (MERSQI).

RESULTS

The mean CRAAP score was 38.885 of a possible 50 (SD 0.983; range: 36.859-40.910). Fourteen sources (53.8%) had some kind of training evaluation: Kirkpatrick's level 1 was present in nearly all (13) and was the highest in half of them (7). Regarding the educational interventions, the mean MERSQI score was 10.592 of a possible 18 (SD 2.371; range 9.085-12.098). Lectures were the most widely reported educational method (5); among those in clinical settings, the live supervised interview with feedback was the most usual (4).

CONCLUSIONS

Despite its core importance as the language of psychiatry, the literature about training psychiatry residents in DP is scarce and heterogeneous. General lack of training evaluation and ongoing overemphasis on Kirkpatrick's levels 1-2 at the expense of levels 3-4 are causes for concern. During the review process, the authors identified a selection of educational interventions that could serve as the basis for the design of new training efforts in both clinical and nonclinical settings. Topics for future research are also suggested, such as the role of DP in competency-based training frameworks now in vogue and a series of neglected contents. Finally, the combined use of the CRAAP test and the MERSQI may be useful for future systematic reviews in medical education.

Predictors of hospital admission for patients presenting with psychiatric emergencies: A retrospective, cohort study

BACKGROUND

Rising psychiatric visits represent a significant and growing burden for emergency departments (EDs) across Canada. For individual psychiatric conditions, there are likely a variety of demographic and social variables that may increase risk of resource intensive hospital admission.

METHODS

We conducted a retrospective cohort study of all patients admitted into inpatient psychiatric units from two EDs in Kingston, Ontario, Canada from 2015 to 2018. We collected demographic and social variables from an electronic ED information system inclusive of all patients presenting to the ED with a mental health or addictions-related chief complaint. We used multivariate logistic regression models to identify predictors of psychiatric admission.

RESULTS

A total of 23,814 patients (49.1% male, median age 33) were identified. Admitted patients (n=1838) tended to be older (49 vs. 31 years), have lower Canadian Triage Acuity Scale scores (2.6 vs. 3.0), arrive by ambulance (51% vs. 35%) or police (18% vs. 9%), and have longer lengths of stay (8.4 vs. 4.9 hours). Individuals with mood and psychotic disorders were more likely to require a hospital admission.

CONCLUSION

A variety of clinical and demographic variables increased the risk of hospital admissions for individuals with a variety of psychiatric disorders.

Recurring sequences of multimodal non-verbal and verbal communication during a human psycho-social stress test: A temporal pattern analysis

BACKGROUND

The Trier Social Stress Test (TSST) is a widely used protocol to study human psycho-social stress responses. Quantitative reports of non-verbal behaviors have been carried out by means of the Ethological Coding System for Interviews (ECSI). However, no data have described whether and how non-verbal and verbal behaviors take part in the composition of multimodal sequences of communication during the test.

METHOD

Five non-verbal ECSI categories and four verbal behaviors related with communication were included in the Ethogram. A focal sampling was employed to ensure a high temporal resolution of the behavioral annotation. T-Pattern Analysis was employed to detect statistically-grounded behavioral sequences.

RESULTS

As a first step, frequency, overall duration and mean time length were reported for each component of the Ethogram. Besides, T-Pattern Analysis revealed that communication during TSST is organized according to a complex temporal patterning. We found 51 different sequences (T-patterns): 8 T-patterns included exclusively non-verbal behaviors; 17 T-patterns included verbal behaviors and 26 T-patterns encompassed mixed non-verbal and verbal behaviors. T-patterns were discussed depending on their putative functional meaning since non-verbal behaviors almost did not overlap within patterns.

CONCLUSIONS

The implementation of an Ethogram including non-verbal and verbal components highlights the multimodal human communication in TSST. T-Pattern Analysis unveils the real-time interplay among these components. In this study results are discussed according to Jakobson's six constitutive factors of communication.