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Moreno MA, Dixon LB, Jankowski S, Adler DA, Berlant J, Brunette MF, Castillo EG, Edwards ML, Erlich MD, First MB, Kozloff N, Oslin D, Siris S, Talley RM. The Need to Adapt the Psychiatric Clinical Assessment to the Digital Age: A Practical Approach. Psychiatr Serv 2024:appips20230399. [PMID: 38477835 DOI: 10.1176/appi.ps.20230399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
The use of electronic devices and social media is becoming a ubiquitous part of most people's lives. Although researchers are exploring the sequelae of such use, little attention has been given to the importance of digital media use in routine psychiatric assessments of patients. The nature of technology use is relevant to understanding a patient's lifestyle and activities, the same way that it is important to evaluate the patient's occupation, functioning, and general activities. The authors propose a framework for psychiatric inquiry into digital media use, emphasizing that such inquiry should focus on quality of use, including emotional and behavioral consequences, rather than simply the amount of use.
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Affiliation(s)
- Marcos A Moreno
- Department of Psychiatry, Yale School of Medicine, New Haven (Moreno); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Dixon, Jankowski, Erlich, First); Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston (Adler); Canyon Manor Mental Health Rehabilitation Center, Novato, California (Berlant); Geisel School of Medicine, Hanover, and Dartmouth Institute, Lebanon, New Hampshire (Brunette); Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles (Castillo); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (Edwards); Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Kozloff); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin, Talley); U.S. Department of Veterans Affairs, Corporal Michael J. Crescenz Medical Center, Philadelphia (Oslin); Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Siris)
| | - Lisa B Dixon
- Department of Psychiatry, Yale School of Medicine, New Haven (Moreno); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Dixon, Jankowski, Erlich, First); Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston (Adler); Canyon Manor Mental Health Rehabilitation Center, Novato, California (Berlant); Geisel School of Medicine, Hanover, and Dartmouth Institute, Lebanon, New Hampshire (Brunette); Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles (Castillo); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (Edwards); Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Kozloff); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin, Talley); U.S. Department of Veterans Affairs, Corporal Michael J. Crescenz Medical Center, Philadelphia (Oslin); Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Siris)
| | - Samantha Jankowski
- Department of Psychiatry, Yale School of Medicine, New Haven (Moreno); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Dixon, Jankowski, Erlich, First); Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston (Adler); Canyon Manor Mental Health Rehabilitation Center, Novato, California (Berlant); Geisel School of Medicine, Hanover, and Dartmouth Institute, Lebanon, New Hampshire (Brunette); Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles (Castillo); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (Edwards); Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Kozloff); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin, Talley); U.S. Department of Veterans Affairs, Corporal Michael J. Crescenz Medical Center, Philadelphia (Oslin); Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Siris)
| | - David A Adler
- Department of Psychiatry, Yale School of Medicine, New Haven (Moreno); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Dixon, Jankowski, Erlich, First); Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston (Adler); Canyon Manor Mental Health Rehabilitation Center, Novato, California (Berlant); Geisel School of Medicine, Hanover, and Dartmouth Institute, Lebanon, New Hampshire (Brunette); Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles (Castillo); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (Edwards); Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Kozloff); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin, Talley); U.S. Department of Veterans Affairs, Corporal Michael J. Crescenz Medical Center, Philadelphia (Oslin); Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Siris)
| | - Jeff Berlant
- Department of Psychiatry, Yale School of Medicine, New Haven (Moreno); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Dixon, Jankowski, Erlich, First); Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston (Adler); Canyon Manor Mental Health Rehabilitation Center, Novato, California (Berlant); Geisel School of Medicine, Hanover, and Dartmouth Institute, Lebanon, New Hampshire (Brunette); Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles (Castillo); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (Edwards); Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Kozloff); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin, Talley); U.S. Department of Veterans Affairs, Corporal Michael J. Crescenz Medical Center, Philadelphia (Oslin); Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Siris)
| | - Mary F Brunette
- Department of Psychiatry, Yale School of Medicine, New Haven (Moreno); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Dixon, Jankowski, Erlich, First); Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston (Adler); Canyon Manor Mental Health Rehabilitation Center, Novato, California (Berlant); Geisel School of Medicine, Hanover, and Dartmouth Institute, Lebanon, New Hampshire (Brunette); Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles (Castillo); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (Edwards); Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Kozloff); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin, Talley); U.S. Department of Veterans Affairs, Corporal Michael J. Crescenz Medical Center, Philadelphia (Oslin); Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Siris)
| | - Enrico G Castillo
- Department of Psychiatry, Yale School of Medicine, New Haven (Moreno); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Dixon, Jankowski, Erlich, First); Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston (Adler); Canyon Manor Mental Health Rehabilitation Center, Novato, California (Berlant); Geisel School of Medicine, Hanover, and Dartmouth Institute, Lebanon, New Hampshire (Brunette); Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles (Castillo); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (Edwards); Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Kozloff); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin, Talley); U.S. Department of Veterans Affairs, Corporal Michael J. Crescenz Medical Center, Philadelphia (Oslin); Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Siris)
| | - Matthew L Edwards
- Department of Psychiatry, Yale School of Medicine, New Haven (Moreno); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Dixon, Jankowski, Erlich, First); Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston (Adler); Canyon Manor Mental Health Rehabilitation Center, Novato, California (Berlant); Geisel School of Medicine, Hanover, and Dartmouth Institute, Lebanon, New Hampshire (Brunette); Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles (Castillo); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (Edwards); Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Kozloff); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin, Talley); U.S. Department of Veterans Affairs, Corporal Michael J. Crescenz Medical Center, Philadelphia (Oslin); Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Siris)
| | - Matthew D Erlich
- Department of Psychiatry, Yale School of Medicine, New Haven (Moreno); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Dixon, Jankowski, Erlich, First); Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston (Adler); Canyon Manor Mental Health Rehabilitation Center, Novato, California (Berlant); Geisel School of Medicine, Hanover, and Dartmouth Institute, Lebanon, New Hampshire (Brunette); Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles (Castillo); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (Edwards); Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Kozloff); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin, Talley); U.S. Department of Veterans Affairs, Corporal Michael J. Crescenz Medical Center, Philadelphia (Oslin); Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Siris)
| | - Michael B First
- Department of Psychiatry, Yale School of Medicine, New Haven (Moreno); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Dixon, Jankowski, Erlich, First); Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston (Adler); Canyon Manor Mental Health Rehabilitation Center, Novato, California (Berlant); Geisel School of Medicine, Hanover, and Dartmouth Institute, Lebanon, New Hampshire (Brunette); Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles (Castillo); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (Edwards); Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Kozloff); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin, Talley); U.S. Department of Veterans Affairs, Corporal Michael J. Crescenz Medical Center, Philadelphia (Oslin); Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Siris)
| | - Nicole Kozloff
- Department of Psychiatry, Yale School of Medicine, New Haven (Moreno); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Dixon, Jankowski, Erlich, First); Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston (Adler); Canyon Manor Mental Health Rehabilitation Center, Novato, California (Berlant); Geisel School of Medicine, Hanover, and Dartmouth Institute, Lebanon, New Hampshire (Brunette); Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles (Castillo); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (Edwards); Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Kozloff); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin, Talley); U.S. Department of Veterans Affairs, Corporal Michael J. Crescenz Medical Center, Philadelphia (Oslin); Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Siris)
| | - David Oslin
- Department of Psychiatry, Yale School of Medicine, New Haven (Moreno); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Dixon, Jankowski, Erlich, First); Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston (Adler); Canyon Manor Mental Health Rehabilitation Center, Novato, California (Berlant); Geisel School of Medicine, Hanover, and Dartmouth Institute, Lebanon, New Hampshire (Brunette); Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles (Castillo); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (Edwards); Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Kozloff); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin, Talley); U.S. Department of Veterans Affairs, Corporal Michael J. Crescenz Medical Center, Philadelphia (Oslin); Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Siris)
| | - Sam Siris
- Department of Psychiatry, Yale School of Medicine, New Haven (Moreno); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Dixon, Jankowski, Erlich, First); Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston (Adler); Canyon Manor Mental Health Rehabilitation Center, Novato, California (Berlant); Geisel School of Medicine, Hanover, and Dartmouth Institute, Lebanon, New Hampshire (Brunette); Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles (Castillo); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (Edwards); Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Kozloff); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin, Talley); U.S. Department of Veterans Affairs, Corporal Michael J. Crescenz Medical Center, Philadelphia (Oslin); Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Siris)
| | - Rachel M Talley
- Department of Psychiatry, Yale School of Medicine, New Haven (Moreno); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Dixon, Jankowski, Erlich, First); Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston (Adler); Canyon Manor Mental Health Rehabilitation Center, Novato, California (Berlant); Geisel School of Medicine, Hanover, and Dartmouth Institute, Lebanon, New Hampshire (Brunette); Department of Psychiatry, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and David Geffen School of Medicine, Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles (Castillo); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California (Edwards); Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Kozloff); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oslin, Talley); U.S. Department of Veterans Affairs, Corporal Michael J. Crescenz Medical Center, Philadelphia (Oslin); Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Siris)
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2
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Brunette MF, Erlich MD, Edwards ML, Adler DA, Berlant J, Dixon L, First MB, Oslin DW, Siris SG, Talley RM. Addressing the Increasing Mental Health Distress and Mental Illness Among Young Adults in the United States. J Nerv Ment Dis 2023; 211:961-967. [PMID: 38015186 DOI: 10.1097/nmd.0000000000001734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT Recent surveys show rising numbers of young people who report anxiety and depression. Although much attention has focused on mental health of adolescent youth, less attention has been paid to young people as they transition into adulthood. Multiple factors may have contributed to this steady increase: greater exposure to social media, information, and distressing news via personal electronic devices; increased concerns regarding social determinants of health and climate change; and changing social norms due to increased mental health literacy and reduced stigma. The COVID-19 pandemic may have temporarily exacerbated symptoms and impacted treatment availability. Strategies to mitigate causal factors for depression and anxiety in young adults may include education and skills training for cognitive, behavioral, and social coping strategies, as well as healthier use of technology and social media. Policies must support the availability of health insurance and treatment, and clinicians can adapt interventions to encompass the specific concerns and needs of young adults.
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Affiliation(s)
- Mary F Brunette
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Matthew D Erlich
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, New York
| | - Matthew L Edwards
- Department of Psychiatry, Stanford University, Palo Alto, California
| | - David A Adler
- Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Jeffrey Berlant
- Canyon Manor Mental Health Rehabilitation, Novato, California
| | - Lisa Dixon
- Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, New York
| | - Michael B First
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, New York
| | - David W Oslin
- Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pennsylvania
| | - Samuel G Siris
- Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Rachel M Talley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
The DSM-5 text revision (DSM-5-TR) is the first published revision of the DSM-5 since its publication in 2013. Like the previous text revision (DSM-IV-TR), the main goal of the DSM-5-TR is to comprehensively update the descriptive text accompanying each DSM disorder on the basis of reviews of the literature over the past 10 years. In contrast to the DSM-IV-TR, in which updates were confined almost exclusively to the text, the DSM-5-TR includes many other changes and enhancements of interest to practicing clinicians, such as the addition of diagnostic categories (prolonged grief disorder, stimulant-induced mild neurocognitive disorder, unspecified mood disorder, and a category to indicate the absence of a diagnosis); the provision of ICD-10-CM symptom codes for reporting suicidal and nonsuicidal self-injurious behavior; modifications, mostly for clarity, of the diagnostic criteria for more than 70 disorders; and updates in terminology (e.g., replacing "neuroleptic medications" with "antipsychotic medications or other dopamine receptor blocking agents" throughout the text and replacing "desired gender" with "experienced gender" in the text for gender dysphoria). Finally, the entire text was reviewed by an Ethnoracial Equity and Inclusion Work Group to ensure appropriate attention to risk factors such as the experience of racism and discrimination, as well as the use of nonstigmatizing language.
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Affiliation(s)
- Michael B First
- Division of Behavioral Health and Policy Research (First) and Center for Law, Ethics and Psychiatry (Appelbaum), Department of Psychiatry, Columbia University Irving Medical Center, New York City; Division of Research (Clarke, Yousif, Gogtay) and American Psychiatric Association Publishing (Eng), American Psychiatric Association, Washington, D.C.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke); New York State Psychiatric Institute, New York City (Appelbaum)
| | - Diana E Clarke
- Division of Behavioral Health and Policy Research (First) and Center for Law, Ethics and Psychiatry (Appelbaum), Department of Psychiatry, Columbia University Irving Medical Center, New York City; Division of Research (Clarke, Yousif, Gogtay) and American Psychiatric Association Publishing (Eng), American Psychiatric Association, Washington, D.C.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke); New York State Psychiatric Institute, New York City (Appelbaum)
| | - Lamyaa Yousif
- Division of Behavioral Health and Policy Research (First) and Center for Law, Ethics and Psychiatry (Appelbaum), Department of Psychiatry, Columbia University Irving Medical Center, New York City; Division of Research (Clarke, Yousif, Gogtay) and American Psychiatric Association Publishing (Eng), American Psychiatric Association, Washington, D.C.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke); New York State Psychiatric Institute, New York City (Appelbaum)
| | - Ann M Eng
- Division of Behavioral Health and Policy Research (First) and Center for Law, Ethics and Psychiatry (Appelbaum), Department of Psychiatry, Columbia University Irving Medical Center, New York City; Division of Research (Clarke, Yousif, Gogtay) and American Psychiatric Association Publishing (Eng), American Psychiatric Association, Washington, D.C.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke); New York State Psychiatric Institute, New York City (Appelbaum)
| | - Nitin Gogtay
- Division of Behavioral Health and Policy Research (First) and Center for Law, Ethics and Psychiatry (Appelbaum), Department of Psychiatry, Columbia University Irving Medical Center, New York City; Division of Research (Clarke, Yousif, Gogtay) and American Psychiatric Association Publishing (Eng), American Psychiatric Association, Washington, D.C.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke); New York State Psychiatric Institute, New York City (Appelbaum)
| | - Paul S Appelbaum
- Division of Behavioral Health and Policy Research (First) and Center for Law, Ethics and Psychiatry (Appelbaum), Department of Psychiatry, Columbia University Irving Medical Center, New York City; Division of Research (Clarke, Yousif, Gogtay) and American Psychiatric Association Publishing (Eng), American Psychiatric Association, Washington, D.C.; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Clarke); New York State Psychiatric Institute, New York City (Appelbaum)
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Zachar P, First MB, Kendler KS. Prolonged Grief Disorder and the DSM: A History. J Nerv Ment Dis 2023; 211:386-392. [PMID: 37040140 DOI: 10.1097/nmd.0000000000001618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
ABSTRACT In the early 1990s, a research group that included Holly Prigerson and Charles Reynolds established that disordered grief overlaps with depression and anxiety but is not the same. They also developed a research inventory for studying disordered grief. Subsequently, Prigerson focused on measuring disordered grief using advanced psychometric techniques. Because treatment for grief-related depression reduced symptoms of depression but not grief, Katherine Shear was recruited to develop a more effective therapy. Prigerson came to conceptualize disordered grief as prolonged grief that is associated with negative outcomes. Shear came to conceptualize disordered grief as intense grief that is complicated by features that interfere with adaption to the loss. In 2013 a hybrid disorder composed of criteria from both groups was placed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) appendix. Under the leadership of the DSM Steering Committee, a summit meeting in 2019 helped break an impasse, and a revised prolonged grief disorder became an official DSM diagnosis.
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Affiliation(s)
- Peter Zachar
- Department of Psychology, Auburn University Montgomery, Montgomery, Alabama
| | - Michael B First
- Department of Psychiatry, Columbia University, New York, New York
| | - Kenneth S Kendler
- Virginia Institute for Psychiatry and Behavioral Genetics and Departments of Psychiatry and Human Genetics, Medical College of Virginia of Virginia Commonwealth University, Richmond, Virginia
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5
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First MB. What to do about atypical anorexia nervosa? Commentary on Walsh et al. (2023). Int J Eat Disord 2023; 56:821-823. [PMID: 36722504 DOI: 10.1002/eat.23903] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/10/2023] [Accepted: 01/15/2023] [Indexed: 02/02/2023]
Abstract
Changes made to the DSM Eating Disorders over the years have aimed to reduce the prevalence of the residual DSM Eating Disorder categories (e.g., Other Specified Eating Disorder). Atypical Anorexia Nervosa (AN), included since DSM-IV as an example of a presentation not meeting criteria for a specific eating disorder, appears to be more prevalent than AN. It is defined as meeting all of the criteria for AN except that, after significant weight loss, weight is at or above normal. As suggested by the Walsh et al. review, lack of definitional precision will likely complicate efforts to determine whether atypical AN is best considered a variant of AN or a distinct category. Problems with the current definition of atypical AN include (1) a lack of precision regarding what constitutes "significant" weight loss; (2) whether the weight loss can occur at any point in the individual's lifetime; and (3) whether there an upper limit to weight being above normal. It is suggested that researchers develop consensus diagnostic criteria and assessment tools to facilitate the collection of empirical data about atypical AN in order to lay the groundwork for future decisions about its nosological status.
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Affiliation(s)
- Michael B First
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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6
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Kotov R, Cicero DC, Conway CC, DeYoung CG, Dombrovski A, Eaton NR, First MB, Forbes MK, Hyman SE, Jonas KG, Krueger RF, Latzman RD, Li JJ, Nelson BD, Regier DA, Rodriguez-Seijas C, Ruggero CJ, Simms LJ, Skodol AE, Waldman ID, Waszczuk MA, Watson D, Widiger TA, Wilson S, Wright AGC. The Hierarchical Taxonomy of Psychopathology (HiTOP) in psychiatric practice and research. Psychol Med 2022; 52:1666-1678. [PMID: 35650658 DOI: 10.1017/s0033291722001301] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) has emerged out of the quantitative approach to psychiatric nosology. This approach identifies psychopathology constructs based on patterns of co-variation among signs and symptoms. The initial HiTOP model, which was published in 2017, is based on a large literature that spans decades of research. HiTOP is a living model that undergoes revision as new data become available. Here we discuss advantages and practical considerations of using this system in psychiatric practice and research. We especially highlight limitations of HiTOP and ongoing efforts to address them. We describe differences and similarities between HiTOP and existing diagnostic systems. Next, we review the types of evidence that informed development of HiTOP, including populations in which it has been studied and data on its validity. The paper also describes how HiTOP can facilitate research on genetic and environmental causes of psychopathology as well as the search for neurobiologic mechanisms and novel treatments. Furthermore, we consider implications for public health programs and prevention of mental disorders. We also review data on clinical utility and illustrate clinical application of HiTOP. Importantly, the model is based on measures and practices that are already used widely in clinical settings. HiTOP offers a way to organize and formalize these techniques. This model already can contribute to progress in psychiatry and complement traditional nosologies. Moreover, HiTOP seeks to facilitate research on linkages between phenotypes and biological processes, which may enable construction of a system that encompasses both biomarkers and precise clinical description.
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Affiliation(s)
- Roman Kotov
- Stony Brook University, Stony Brook, New York, USA
| | | | | | | | | | | | - Michael B First
- Columbia University College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | | | - Steven E Hyman
- Stanley Center for Psychiatric Research at the Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | | | | | | | - James J Li
- University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Darrel A Regier
- Uniformed Services University, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | | | | | | | - Andrew E Skodol
- University of Arizona College of Medicine, Tucson, Arizona, USA
| | | | - Monika A Waszczuk
- Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | | | | | - Sylia Wilson
- University of Minnesota, Minneapolis, Minnesota, USA
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8
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Reed GM, First MB, Billieux J, Cloitre M, Briken P, Achab S, Brewin CR, King DL, Kraus SW, Bryant RA. Emerging experience with selected new categories in the ICD-11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. World Psychiatry 2022; 21:189-213. [PMID: 35524599 PMCID: PMC9077619 DOI: 10.1002/wps.20960] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more effective treatments. Given the major implications for the field and for World Health Organization (WHO) member states, it is important to examine the impact of these new categories during the early phase of the ICD-11 implementation. This paper focuses on four disorders: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. These categories were selected because they have been the focus of considerable activity and/or controversy and because their inclusion in the ICD-11 represents a different decision than was made for the DSM-5. The lead authors invited experts on each of these disorders to provide insight into why it was considered important to add it to the ICD-11, implications for care of not having that diagnostic category, important controversies about adding the disorder, and a review of the evidence generated and other developments related to the category since the WHO signaled its intention to include it in the ICD-11. Each of the four diagnostic categories appears to describe a population with clinically important and distinctive features that had previously gone unrecognized as well as specific treatment needs that would otherwise likely go unmet. The introduction of these categories in the ICD-11 has been followed by a substantial expansion of research in each area, which has generally supported their validity and utility, and by a significant increase in the availability of appropriate services.
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Affiliation(s)
- Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Michael B First
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals, Lausanne, Switzerland
| | - Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sophia Achab
- Outpatient Treatment Unit for Addictive Behaviors ReConnecte, Geneva University Hospitals, Geneva, Switzerland
- Psychological and Sociological Research and Training Unit, Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Daniel L King
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA, Australia
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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First MB, Lieberman JA. How should we diagnose schizophrenia: Don't throw the baby out with the bath water. Schizophr Res 2022; 242:81-83. [PMID: 35241315 DOI: 10.1016/j.schres.2022.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Michael B First
- Columbia University Irving Medical Center, New York, NY, United States of America; New York State Psychiatric Institute, New York, NY, United States of America
| | - Jeffrey A Lieberman
- Columbia University Irving Medical Center, New York, NY, United States of America; New York State Psychiatric Institute, New York, NY, United States of America.
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10
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Zachar P, First MB, Kendler KS. Revising Substance-Related Disorders in the DSM-5: A History. J Stud Alcohol Drugs 2022; 83:99-105. [PMID: 35040765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE This article narrates a history of several important changes to the substance-related disorders chapter in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), based on interviews with people involved in the pre-planning and the development of the revisions. These changes include collapsing substance abuse and substance dependence into a single substance use disorder, adding craving as a diagnostic criterion, and incorporating a behavioral addiction--gambling disorder--into the substance-related disorders chapter. Studies using Item Response Theory (IRT) supported the new substance use disorder diagnosis. The IRT analyses demonstrated that the abuse and dependence items can be ordered on a single latent dimension and that some of the presumably milder abuse items indexed a greater level of severity than the presumably more pathological dependence items. Those who opposed collapsing abuse and dependence emphasized the validity and clinical utility of the dependence syndrome on which much important treatment research was based. Both those who favored and those who opposed adding craving agreed that it was redundant with the other diagnostic criteria and did not improve the performance of the criterion set. Nevertheless, some clinicians supported adding craving because of its importance in the conceptualization of substance use disorders, and some researchers supported it because of its potential to be validated as a diagnostically useful biomarker. Those who opposed adding craving argued that considering the validity of an individual criterion alone rather than its contribution to the incremental validity of the criterion set represented a major shift in diagnostic philosophy that had potentially far-reaching implications for future revisions of the DSM. CONCLUSIONS We conclude by observing that, unlike what occurred in the broader DSM-5 process, despite differences of opinion the work group reached consensus. In part, this may be explained by some shared standards within the work group versus the disagreement about standards across the broader DSM-5 process.
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Affiliation(s)
- Peter Zachar
- Department of Psychology, Auburn University at Montgomery, Montgomery, Alabama
| | - Michael B First
- Department of Psychiatry, Columbia University, New York, New York
| | - Kenneth S Kendler
- Virginia Institute for Psychiatry and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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11
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Zachar P, First MB, Kendler KS. Revising Substance-Related Disorders in the DSM-5: A History. J Stud Alcohol Drugs 2022. [DOI: 10.15288/jsad.2022.83.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Peter Zachar
- Department of Psychology, Auburn University at Montgomery, Montgomery, Alabama
| | - Michael B. First
- Department of Psychiatry, Columbia University, New York, New York
| | - Kenneth S. Kendler
- Virginia Institute for Psychiatry and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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12
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Talley RM, Edwards ML, Berlant J, Wagner ES, Adler DA, Erlich MD, Goldman B, Dixon LB, First MB, Oslin DW, Siris SG. Structural Racism and Psychiatric Practice: A Call for Sustained Change. J Nerv Ment Dis 2022; 210:2-5. [PMID: 34731092 DOI: 10.1097/nmd.0000000000001442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Structural racism has received renewed focus over the past year, fueled by the convergence of major political and social events. Psychiatry as a field has been forced to confront a legacy of systemic inequities. Here, we use examples from our clinical and supervisory work to highlight the urgent need to integrate techniques addressing racial identity and racism into psychiatric practice and teaching. This urgency is underlined by extensive evidence of psychiatry's long-standing systemic inequities. We argue that our field suffers not from a lack of available techniques, but rather a lack of sustained commitment to understand and integrate those techniques into our work; indeed, there are multiple published examples of strategies to address racism and racial identity in psychiatric clinical practice. We conclude with recommendations geared toward more firmly institutionalizing a focus on racism and racial identity in psychiatry, and suggest applications of existing techniques to our initial clinical examples.
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Affiliation(s)
| | | | | | | | | | | | - Beth Goldman
- Group for Advancement of Psychiatry, New York, New York
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13
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Kogan CS, Maj M, Rebello TJ, Keeley JW, Kulygina M, Matsumoto C, Robles R, Huang J, Zhong N, Chakrabarti S, Figueira ML, Stein DJ, Strakowski SM, Garcia-Pacheco JA, Burns S, Montoya M, Andrade L, Ayuso-Mateos JL, Arango I, Balhara YPS, Bryant R, Cournos F, Porto JAD, Meyer TD, Medina-Mora ME, Gureje O, First MB, Gaebel W, Khoury B, Krasnov VN, de Jesus Mari J, Maruta T, Pike KM, Roberts MC, Sharan P, Zhao M, Reed GM. A global field study of the international classification of diseases (ICD-11) mood disorders clinical descriptions and diagnostic guidelines. J Affect Disord 2021; 295:1138-1150. [PMID: 34706426 DOI: 10.1016/j.jad.2021.08.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/18/2021] [Accepted: 08/21/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND We report results of an internet-based field study evaluating the diagnostic guidelines for ICD-11 mood disorders. Accuracy of clinicians' diagnostic judgments applying draft ICD-11 as compared to the ICD-10 guidelines to standardized case vignettes was assessed as well as perceived clinical utility. METHODS 1357 clinician members of the World Health Organization's Global Clinical Practice Network completed the study in English, Spanish, Japanese or Russian. Participants were randomly assigned to apply ICD-11 or ICD-10 guidelines to one of eleven pairs of case vignettes. RESULTS Clinicians using the ICD-11 and ICD-10 guidelines achieved similar levels of accuracy in diagnosing mood disorders depicted in vignettes. Those using the ICD-11 were more accurate in identifying depressive episode in recurrent depressive disorder. There were no statistically significant differences detected across classifications in the accuracy of identifying dysthymic or cyclothymic disorder. Circumscribed problems with the proposed ICD-11 guidelines were identified including difficulties differentiating bipolar type I from bipolar type II disorder and applying revised severity ratings to depressive episodes. Clinical utility of ICD-11 bipolar disorders was found to be significantly lower than for ICD-10 equivalent categories. LIMITATIONS Standardized case vignettes were manipulated to evaluate specific changes. The degree of accuracy of clinicians' diagnostic judgments may not reflect clinical decision-making with patients. CONCLUSIONS Alignment of the ICD-11 with current research appears to have been achieved without sacrificing diagnostic accuracy or clinical utility though specific training may be necessary as ICD-11 is implemented worldwide. Areas in which the ICD-11 guidelines did not perform as intended resulted in further revisions.
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Affiliation(s)
- Cary S Kogan
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt., Vanier Building, Ottawa, Ontario K1N 6N5, Canada.
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Tahilia J Rebello
- Global Mental Health Program, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Jared W Keeley
- Department of Psychology, Virginia Commonwealth University, 800 W. Franklin Street, P.O. Box 842018, Richmond, VA, 23284-2018, USA
| | - Maya Kulygina
- Moscow Research Institute of Psychiatry, Poteshnaya 3, 107076, Moscow, Russian Federation
| | - Chihiro Matsumoto
- National Study Coordinator for ICD-11 Field Studies, ICD-11 Committee, Japanese Society of Psychiatry and Neurology, Hongo-Yumicho Building, 2-38-4, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Rebeca Robles
- Instituto Nacional de Psiquiatría 'Ramón de la Fuente', WHO Collaborating Centre on Addictions and Mental Health, Calzada Mexico-Xochimilco 101, Tlalpan, ZC 14370, Ciudad de México, Mexico
| | - Jingjing Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, 600 Wan Ping Nan Rd., Shanghai, 200030, People's Republic of China
| | - Na Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, 600 Wan Ping Nan Rd., Shanghai, 200030, People's Republic of China
| | - Subho Chakrabarti
- Dept. Of Psychiatry, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, - 160012, India
| | - Maria Luisa Figueira
- Department of Psychiatry, Faculty of Medicine, University of Lisbon, 1699, Lisboa Codex, Portugal
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town and Groote Schuur Hospital, J-Block, Anzio Road, Observatory 7925, South Africa
| | - Stephen M Strakowski
- Dell Medical School, University of Texas at Austin, Health Learning Building, 1501 Red River St., Austin, Texas, 78712, USA
| | - José A Garcia-Pacheco
- Centro de Investigación y Docencia Económica, Carr. México-Toluca 3655, Santa Fe, Altavista, Álvaro Obregón, 01210, Ciudad de México, México
| | - Samantha Burns
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt., Vanier Building, Ottawa, Ontario K1N 6N5, Canada
| | - Madeline Montoya
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt., Vanier Building, Ottawa, Ontario K1N 6N5, Canada
| | - Laura Andrade
- Institute of Psychiatry, School of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, 01246903, Brazil
| | - José L Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Ivan Arango
- Instituto Nacional de Psiquiatría 'Ramón de la Fuente', WHO Collaborating Centre on Addictions and Mental Health, Calzada Mexico-Xochimilco 101, Tlalpan, ZC 14370, Ciudad de México, Mexico
| | - Yatan Pal Singh Balhara
- National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | | | - Francine Cournos
- Departments of Epidemiology and Psychiatry, Columbia University Medical Center, 722 West 168th St, 10032, New York, NY
| | - José Alberto Del Porto
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Borges Lagoa 570 - 1° andar, Vila Clementino- São Paulo-SP, 04038-000, Brazil
| | - Thomas D Meyer
- Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas HSC at Houston, 1941 East Road, Houston, Texas, 77054, USA
| | - Maria-Elena Medina-Mora
- The Health Management Center, Seitoku University, 550 Iwase, Matsudo City, Chiba Prefecture, 271-8555, Japan
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, University College Hospital, PMB, 5116 Ibadan, Nigeria
| | - Michael B First
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 722 West 168th St, 10032, New York, NY
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, WHO Collaborating Centre for Quality Assurance and Empowerment in Mental Health, Bergische Landstr. 2, 40629, Düsseldorf, Germany
| | - Brigitte Khoury
- Department of Psychiatry, American University of Beirut Medical Center, P.O. Box 11-0236 - Riad El Solh 1107 2020 Beirut, Lebanon
| | - Valery N Krasnov
- Moscow Research Institute of Psychiatry, Poteshnaya 3, 107076, Moscow, Russian Federation
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Borges Lagoa 570 - 1° andar, Vila Clementino- São Paulo-SP, 04038-000, Brazil
| | - Toshimasa Maruta
- The Health Management Center, Seitoku University, 550 Iwase, Matsudo City, Chiba Prefecture, 271-8555, Japan
| | - Kathleen M Pike
- Global Mental Health Program, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Michael C Roberts
- University of Kansas, Clinical Child Psychology Program, Dole Human Development Center, Lawrence, KS, 66045, USA
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, 600 Wan Ping Nan Rd., Shanghai, 200030, People's Republic of China
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA, and Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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14
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Adler DA, Erlich MD, Goldman B, Berlant J, Edwards ML, First MB, Oslin DW, Siris SG, Talley RM, Wagner ES. Psychiatry in the Time of COVID: Credibility, Uncertainty, and Self-Reflection. J Nerv Ment Dis 2021; 209:779-782. [PMID: 34468441 PMCID: PMC9207939 DOI: 10.1097/nmd.0000000000001404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Public trust in the credibility of medicine and physicians has been severely tested amid the COVID-19 pandemic and growing sociopolitical fissures in the United States. Physicians are being asked to be ambassadors to the public of scientific information. Psychiatrists have an opportunity to help the public understand and accept a "new normal" during a time of such uncertainty. Using a case example, we review the impact of uncertainty and fear on scientific and medical credibility. Although the pandemic provides an opportunity for systemic change, the consequences of any change remain unknown. To help patients navigate the uncertainty, we conclude by offering four guidelines to clinicians: the public has little interest in understanding the scientific method; we need to acknowledge that we do not have all the answers; credibility and trustworthiness are linked to our ability to be trusted, believable messengers; and we can retain scientific credibility while acknowledging uncertainty.
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Affiliation(s)
- David A. Adler
- Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Matthew D. Erlich
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, New York
| | | | - Jeffrey Berlant
- Optum Idaho, Boise, Idaho
- Canyon Manor Mental Health Rehabilitation, Novato, California
| | | | - Michael B. First
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, New York
| | - David W. Oslin
- Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pennsylvania
| | - Samuel G. Siris
- Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Rachel M. Talley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth S. Wagner
- Department of Psychiatry, Brown University Alpert Medical School, Providence, Rhode Island
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15
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Keeley JW, Briken P, Evans SC, First MB, Klein V, Krueger RB, Matsumoto C, Fresán A, Rebello TJ, Robles R, Sharan P, Reed GM. Can Clinicians Use Dimensional Information to Make a Categorical Diagnosis of Paraphilic Disorders? An ICD-11 Field Study. J Sex Med 2021; 18:1592-1606. [PMID: 37057432 DOI: 10.1016/j.jsxm.2021.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/11/2021] [Accepted: 06/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The diagnosis of paraphilic disorder is a complicated clinical judgment based on the integration of information from multiple dimensions to arrive at a categorical (present/absent) conclusion. The recent update of the guidelines for paraphilic disorders in ICD-11 presents an opportunity to investigate how mental health professionals use the diagnostic guidelines to arrive at a diagnosis which thereby can optimize the guidelines for clinical use. AIM This study examined clinicians' ability to use the ICD-11 diagnostic guidelines for paraphilic disorders which contain multiple dimensions that must be simultaneously assessed to arrive at a diagnosis. METHODS The study investigated the ability of 1,263 international clinicians to identify the dimensions of paraphilic disorder in the context of written case vignettes that varied on a single dimension only. OUTCOMES Participants provided diagnoses for the case vignettes along with dimensional ratings of the degree of presence of five dimensions of paraphilic disorder (arousal, consent, action, distress, and risk). RESULTS Across a series of analyses, clinicians demonstrated a clear ability to recognize and appropriately integrate the dimensions of paraphilic disorders; however, there was some evidence that clinicians may over-diagnose non-pathological cases. CLINICAL TRANSLATION Clinicians would likely benefit from targeted training on the ICD-11 definition of paraphilic disorder and should be cautious of over-diagnosing. STRENGTHS AND LIMITATIONS This study represents a large international sample of health professionals and is the first to examine clinicians' ability to apply the ICD-11 diagnostic guidelines for paraphilic disorders. Important limitations include not generalizing to all clinicians and acknowledging that results may be different in direct clinical interactions vs written case vignettes. CONCLUSION These results indicate that clinicians appear capable of interpreting and implementing the diagnostic guidelines for paraphilic disorders in ICD-11.
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Affiliation(s)
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry University Medical Center Hamburg-Eppendorf
| | | | - Michael B First
- Columbia University Vagelos College of Physicians and Surgeons
- New York State Psychiatric Institute
| | - Verena Klein
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry University Medical Center Hamburg-Eppendorf
| | - Richard B Krueger
- Columbia University Vagelos College of Physicians and Surgeons
- New York State Psychiatric Institute
| | | | - Ana Fresán
- National Institute of Psychiatry Ramon de la Fuente Muniz
| | - Tahilia J Rebello
- Columbia University Vagelos College of Physicians and Surgeons
- New York State Psychiatric Institute
| | - Rebeca Robles
- National Institute of Psychiatry Ramon de la Fuente Muniz
| | | | - Geoffrey M Reed
- Columbia University Vagelos College of Physicians and Surgeons
- World Health Organization
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16
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First MB, Gaebel W, Maj M, Stein DJ, Kogan CS, Saunders JB, Poznyak VB, Gureje O, Lewis-Fernández R, Maercker A, Brewin CR, Cloitre M, Claudino A, Pike KM, Baird G, Skuse D, Krueger RB, Briken P, Burke JD, Lochman JE, Evans SC, Woods DW, Reed GM. An organization- and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5. World Psychiatry 2021; 20:34-51. [PMID: 33432742 PMCID: PMC7801846 DOI: 10.1002/wps.20825] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In 2013, the American Psychiatric Association (APA) published the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In 2019, the World Health Assembly approved the 11th revision of the International Classification of Diseases (ICD-11). It has often been suggested that the field would benefit from a single, unified classification of mental disorders, although the priorities and constituencies of the two sponsoring organizations are quite different. During the development of the ICD-11 and DSM-5, the World Health Organization (WHO) and the APA made efforts toward harmonizing the two systems, including the appointment of an ICD-DSM Harmonization Group. This paper evaluates the success of these harmonization efforts and provides a guide for practitioners, researchers and policy makers describing the differences between the two systems at both the organizational and the disorder level. The organization of the two classifications of mental disorders is substantially similar. There are nineteen ICD-11 disorder categories that do not appear in DSM-5, and seven DSM-5 disorder categories that do not appear in the ICD-11. We compared the Essential Features section of the ICD-11 Clinical Descriptions and Diagnostic Guidelines (CDDG) with the DSM-5 criteria sets for 103 diagnostic entities that appear in both systems. We rated 20 disorders (19.4%) as having major differences, 42 disorders (40.8%) as having minor definitional differences, 10 disorders (9.7%) as having minor differences due to greater degree of specification in DSM-5, and 31 disorders (30.1%) as essentially identical. Detailed descriptions of the major differences and some of the most important minor differences, with their rationale and related evidence, are provided. The ICD and DSM are now closer than at any time since the ICD-8 and DSM-II. Differences are largely based on the differing priorities and uses of the two diagnostic systems and on differing interpretations of the evidence. Substantively divergent approaches allow for empirical comparisons of validity and utility and can contribute to advances in the field.
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Affiliation(s)
- Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - John B Saunders
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD, Australia
| | - Vladimir B Poznyak
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Chris R Brewin
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
| | - Angelica Claudino
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Kathleen M Pike
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Gillian Baird
- Newcomen Centre, Evelina Children's Hospital, Guys & St. Thomas NHS Foundation Trust, London, UK
| | - David Skuse
- Brain and Behaviour Science Unit, Institute of Child Health, University College London, London, UK
| | - Richard B Krueger
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeffrey D Burke
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - John E Lochman
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - Douglas W Woods
- Offiice of the Provost and Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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17
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Brucato G, First MB, Dishy GA, Samuel SS, Xu Q, Wall MM, Small SA, Masucci MD, Lieberman JA, Girgis RR. Recency and intensification of positive symptoms enhance prediction of conversion to syndromal psychosis in clinical high-risk patients. Psychol Med 2021; 51:112-120. [PMID: 31658912 DOI: 10.1017/s0033291719003040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early detection and intervention strategies in patients at clinical high-risk (CHR) for syndromal psychosis have the potential to contain the morbidity of schizophrenia and similar conditions. However, research criteria that have relied on severity and number of positive symptoms are limited in their specificity and risk high false-positive rates. Our objective was to examine the degree to which measures of recency of onset or intensification of positive symptoms [a.k.a., new or worsening (NOW) symptoms] contribute to predictive capacity. METHODS We recruited 109 help-seeking individuals whose symptoms met criteria for the Progression Subtype of the Attenuated Positive Symptom Psychosis-Risk Syndrome defined by the Structured Interview for Psychosis-Risk Syndromes and followed every three months for two years or onset of syndromal psychosis. RESULTS Forty-one (40.6%) of 101 participants meeting CHR criteria developed a syndromal psychotic disorder [mostly (80.5%) schizophrenia] with half converting within 142 days (interquartile range: 69-410 days). Patients with more NOW symptoms were more likely to convert (converters: 3.63 ± 0.89; non-converters: 2.90 ± 1.27; p = 0.001). Patients with stable attenuated positive symptoms were less likely to convert than those with NOW symptoms. New, but not worsening, symptoms, in isolation, also predicted conversion. CONCLUSIONS Results suggest that the severity and number of attenuated positive symptoms are less predictive of conversion to syndromal psychosis than the timing of their emergence and intensification. These findings also suggest that the earliest phase of psychotic illness involves a rapid, dynamic process, beginning before the syndromal first episode, with potentially substantial implications for CHR research and understanding the neurobiology of psychosis.
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Affiliation(s)
- Gary Brucato
- Department of Psychiatry, The Center of Prevention & Evaluation (COPE), Columbia University College of Physicians & Surgeons, Columbia University Medical Center, New York State Psychiatric Institute, NY, USA
| | - Michael B First
- Columbia University College of Physicians & Surgeons, Columbia University Medical Center, New York State Psychiatric Institute, NY, USA
| | | | | | - Qing Xu
- New York State Psychiatric Institute, NY, USA
| | - Melanie M Wall
- Columbia University College of Physicians & Surgeons, Columbia University Medical Center, New York State Psychiatric Institute, NY, USA
| | - Scott A Small
- Alzheimer's Disease Research Center, Departments of Neurology, Psychiatry, Radiology, Columbia University, NY, USA
| | | | - Jeffrey A Lieberman
- Columbia University, Vagelos College of Physicians and Surgeons, Director, New York State Psychiatric Institute Psychiatrist-in-Chief, New York Presbyterian Hospital-Columbia University Medical Center, NY, USA
| | - Ragy R Girgis
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York> State Psychiatric Institute, NY, USA
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18
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Talley RM, Brunette MF, Adler DA, Dixon LB, Berlant J, Erlich MD, Goldman B, First MB, Koh S, Oslin DW, Siris SG. Telehealth and the Community SMI Population: Reflections on the Disrupter Experience of COVID-19. J Nerv Ment Dis 2021; 209:49-53. [PMID: 33003053 DOI: 10.1097/nmd.0000000000001254] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The novel coronavirus pandemic and the resulting expanded use of telemedicine have temporarily transformed community-based care for individuals with serious mental illness (SMI), challenging traditional treatment paradigms. We review the rapid regulatory and practice shifts that facilitated broad use of telemedicine, the literature on the use of telehealth and telemedicine for individuals with SMI supporting the feasibility/acceptability of mobile interventions, and the more limited evidence-based telemedicine practices for this population. We provide anecdotal reflections on the opportunities and challenges for telemedicine drawn from our daily experiences providing services and overseeing systems for this population during the pandemic. We conclude by proposing that a continued, more prominent role for telemedicine in the care of individuals with SMI be sustained in the post-coronavirus landscape, offering future directions for policy, technical assistance, training, and research to bring about this change.
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Affiliation(s)
| | | | | | | | | | | | - Beth Goldman
- Group for Advancement of Psychiatry, New York, New York
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19
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Krueger RF, Kotov R, Watson D, Forbes MK, Eaton NR, Ruggero CJ, Simms LJ, Widiger TA, Achenbach TM, Bach B, Bagby RM, Bornovalova MA, Carpenter WT, Chmielewski M, Cicero DC, Clark LA, Conway C, DeClercq B, DeYoung CG, Docherty AR, Drislane LE, First MB, Forbush KT, Hallquist M, Haltigan JD, Hopwood CJ, Ivanova MY, Jonas KG, Latzman RD, Markon KE, Miller JD, Morey LC, Mullins-Sweatt SN, Ormel J, Patalay P, Patrick CJ, Pincus AL, Regier DA, Reininghaus U, Rescorla LA, Samuel DB, Sellbom M, Shackman AJ, Skodol A, Slade T, South SC, Sunderland M, Tackett JL, Venables NC, Waldman ID, Waszczuk MA, Waugh MH, Wright AG, Zald DH, Zimmermann J. Les progrès dans la réalisation de la classification quantitative de la psychopathologie ☆. Ann Med Psychol (Paris) 2021; 179:95-106. [PMID: 34305151 PMCID: PMC8309948 DOI: 10.1016/j.amp.2020.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level" dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity" by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.
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Affiliation(s)
- Robert F. Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Miriam K. Forbes
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Nicholas R. Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Camilo J. Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Leonard J. Simms
- Department of Psychology, University at Buffalo, State University of New York, New York, NY, USA
| | - Thomas A. Widiger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | | | - Bo Bach
- Psychiatric Research Unit, Slagelse Psychiatric Hospital, Slagelse, Denmark
| | - R. Michael Bagby
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | | | - David C. Cicero
- Department of Psychology, University of Hawaii, Honolulu, HI, USA
| | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Christopher Conway
- Department of Psychology, College of William and Mary, Williamsburg, VA, USA
| | - Barbara DeClercq
- Department of Developmental, Personality, and Social Psychology, Ghent University, Ghent, Belgium
| | - Colin G. DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Anna R. Docherty
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Laura E. Drislane
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Michael B. First
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Michael Hallquist
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - John D. Haltigan
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Masha Y. Ivanova
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | - Robert D. Latzman
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Joshua D. Miller
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Leslie C. Morey
- Department of Psychology, Texas A&M University, College Station, TX, USA
| | | | - Johan Ormel
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Praveetha Patalay
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | | | - Aaron L. Pincus
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - Darrel A. Regier
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA
| | - Ulrich Reininghaus
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | | | - Douglas B. Samuel
- Department of Psychology, Purdue University, West Lafayette, IN, USA
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | | | - Andrew Skodol
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
| | - Tim Slade
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Susan C. South
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Matthew Sunderland
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | | | - Noah C. Venables
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Mark H. Waugh
- Oak Ridge National Laboratory, University of Tennessee, Oak Ridge, TN, USA
| | - Aidan G.C. Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - David H. Zald
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
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20
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Dixon LB, Adler DA, Berlant J, Brunette MF, Erlich M, First MB, Goldman B, Koh S, Levine B, Oslin DW, Siris S. Managing Our Public Selves. Psychiatr Serv 2020; 71:1196-1198. [PMID: 32517644 DOI: 10.1176/appi.ps.202000078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Internet has fundamentally altered mental health clinicians' "public selves," challenging previous models of self-disclosure and maintenance of boundaries within treatment. The conception of a public self altered by the digital age presents both opportunities and pitfalls in clinical practice. Information about clinicians available online may be professional or personal; accurate or inaccurate; and publicly accessible, purchased, or hacked. Clinicians must consider how to manage their public selves in work with patients and the community. This Open Forum outlines a set of recommendations for managing the public self in the digital age as a routine part of therapeutic work.
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Affiliation(s)
| | | | | | | | | | | | | | - Steven Koh
- Group for Advancement of Psychiatry, New York
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21
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Kobayashi D, First MB, Shimbo T, Kanba S, Hirano Y. Association of self-reported religiosity with the development of major depression in multireligious country Japan. Psychiatry Clin Neurosci 2020; 74:535-541. [PMID: 32618044 PMCID: PMC7586836 DOI: 10.1111/pcn.13087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 01/12/2023]
Abstract
AIM In Western Christian countries, religiosity is generally believed to be associated with a lower risk for depression, which is supported by epidemiological evidence. However, the association between religiosity and depression in multireligious countries is unknown. The objective was to evaluate the association between religiosity and subsequent depression in a multireligious population. METHODS A longitudinal study was conducted in a large hospital in Tokyo, Japan, from 2005 to 2018. All participants who underwent health check-ups without a prior history of depression or depression at baseline were included. Our outcome was development of major depressive disorder (MDD), which was compared according to the degree of religiosity, adjusting for potential confounders. RESULTS Among 67 723 adult participants, those who were more religious tended to be older, female, married, and to have healthier habits but also more medical comorbidities at baseline. During a median follow-up of 2528 days, 1911 (2.8%) participants developed MDD. Compared to the reference group, religious group participants tended to have higher odds ratios (OR) for developing MDD in a dose-dependent manner. Among them, the extremely religious group (OR, 1.51; 95% confidence interval [CI], 1.28-1.78) and the moderately religious group (OR, 1.30; 95% CI, 1.14-1.49) were statistically associated with increased development of MDD compared to the not-religious-at-all group. Those who had increased their religiosity from baseline had statistically lower development of MDD (OR, 0.85; 95% CI, 0.75-0.97) compared to those who remained in the same degree of religiosity from baseline. CONCLUSION Religiosity was associated with future MDD in a dose-dependent manner in a multireligious population, which was in the opposite direction from that seen in previous Western longitudinal studies.
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Affiliation(s)
- Daiki Kobayashi
- Division of General Internal Medicine, Department of Medicine, St. Luke's International Hospital, Tokyo, Japan.,Department of Epidemiology, St. Luke's International University Graduate School of Public Health, Tokyo, Japan.,Fujita Heath University, Toyoake, Japan
| | - Michael B First
- Department of Psychiatry, Columbia University, New York, USA
| | | | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoji Hirano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Psychiatry, Harvard Medical School, Boston, USA
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22
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Abstract
This article narrates a consensus history of the proposal to include diagnostic criteria for a psychosis risk syndrome in the DSM-5, in part, to document what happened, but also to potentially help focus future efforts at clinically useful early detection. The purpose of diagnosing a risk state would be to slow and ideally prevent the development of the full disorder. Concerns about diagnosing a psychosis risk state included a high false positive rate, potentially harmful use of anti-psychotic medication with people who would not transition to psychosis, and stigmatization. Others argued that educating professionals about what 'risk' entails could reduce inappropriate treatments. During the revision, the proposal shifted from diagnosing risk to emphasizing current clinical need associated with attenuated psychotic symptoms. Within the community of researchers who studied psychosis risk, people disagreed about whether risk and/or attenuated symptoms should be an official DSM-5 diagnosis. Once it became clear that the DSM-5 field trials did not include enough cases to establish the reliability of the proposed criteria, everyone agreed that the criteria should be put in a section on conditions for further study rather the main section of the DSM-5. We close with recommendations about some practical benchmarks that should be met for including criteria for early detection in the classification system.
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Affiliation(s)
- Peter Zachar
- Department of Psychology, Auburn University Montgomery, Montgomery, AL, USA
| | - Michael B First
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Kenneth S Kendler
- Virginia Institute for Psychiatry and Behavioral Genetics and Departments of Psychiatry, and Human Genetics, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA, USA
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23
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Provenzano FA, Guo J, Wall MM, Feng X, Sigmon HC, Brucato G, First MB, Rothman DL, Girgis RR, Lieberman JA, Small SA. Hippocampal Pathology in Clinical High-Risk Patients and the Onset of Schizophrenia. Biol Psychiatry 2020; 87:234-242. [PMID: 31771861 DOI: 10.1016/j.biopsych.2019.09.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND We examined neuroimaging-derived hippocampal biomarkers in subjects at clinical high risk (CHR) for psychosis to further characterize the pathophysiology of early psychosis. We hypothesized that glutamate hyperactivity, reflected by increased metabolic activity derived from functional magnetic resonance imaging in the CA1 hippocampal subregion and from proton magnetic resonance spectroscopy-derived hippocampal levels of glutamate/glutamine, represents early hippocampal dysfunction in CHR subjects and is predictive of conversion to syndromal psychosis. METHODS We enrolled 75 CHR individuals with attenuated positive symptom psychosis-risk syndrome as defined by the Structured Interview for Psychosis-risk Syndromes. We used optimized magnetic resonance imaging techniques to measure 3 validated in vivo pathologies of hippocampal dysfunction-focal cerebral blood volume, focal atrophy, and evidence of elevated glutamate concentrations. All patients were imaged at baseline and were followed for up to 2 years to assess for conversion to psychosis. RESULTS At baseline, compared with control subjects, CHR individuals had high glutamate/glutamine and elevated focal cerebral blood volume on functional magnetic resonance imaging, but only baseline focal hippocampal atrophy predicted progression to syndromal psychosis. CONCLUSIONS These findings provide evidence that CHR patients with attenuated psychotic symptoms have glutamatergic abnormalities, although only CHR patients who develop syndromal psychosis exhibit focal hippocampal atrophy. Furthermore, these results support the growing evidence that hippocampal dysfunction is an early feature of schizophrenia and related psychotic disorders.
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Affiliation(s)
| | - Jia Guo
- Department of Psychiatry, Columbia University, New York, New York
| | - Melanie M Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Xinyang Feng
- Department of Neurology, Columbia University, New York, New York; Department of Biomedical Engineering, Columbia University, New York, New York
| | - Hannah C Sigmon
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Gary Brucato
- Department of Psychiatry, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York
| | | | - Douglas L Rothman
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut; Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Ragy R Girgis
- Department of Psychiatry, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York.
| | - Scott A Small
- Department of Neurology, Columbia University, New York, New York.
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24
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Brunette MF, Oslin DW, Dixon LB, Adler DA, Berlant J, Erlich M, First MB, Goldman B, Levine B, Siris S, Winston H. The Opioid Epidemic and Psychiatry: The Time for Action Is Now. Psychiatr Serv 2019; 70:1168-1171. [PMID: 31500545 DOI: 10.1176/appi.ps.201800582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The number of people with opioid use disorder and the number of overdose deaths in the United States have increased dramatically over the past 20 years. U.S. Congress passed the SUPPORT for Patients and Communities Act, which was signed into law in 2018, authorizing almost $8 billion to address the crisis. As experts in the treatment of central nervous systems disorders, psychiatrists can play a leading role in expanding treatment for people with opioid use disorder and in advocating for policy changes to support community treatment for this group.
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Affiliation(s)
- Mary F Brunette
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - David W Oslin
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Lisa B Dixon
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - David A Adler
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Jeffrey Berlant
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Matthew Erlich
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Michael B First
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Beth Goldman
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Bruce Levine
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Samuel Siris
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
| | - Helena Winston
- Group for the Advancement of Psychiatry, Dallas (all authors); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Brunette); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia (Oslin); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York (Dixon, Erlich, First); Department of Psychiatry, Tufts Medical Center, Boston (Adler); Optum Idaho, Boise (Berlant); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York (Siris); Department of Psychiatry, University of Colorado School of Medicine, Aurora (Winston)
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25
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Zoghbi AW, Bernanke JA, Gleichman J, Masucci MD, Corcoran CM, Califano A, Segovia J, Colibazzi T, First MB, Brucato G, Girgis RR. Schizotypal personality disorder in individuals with the Attenuated Psychosis Syndrome: Frequent co-occurrence without an increased risk for conversion to threshold psychosis. J Psychiatr Res 2019; 114:88-92. [PMID: 31054454 PMCID: PMC6546532 DOI: 10.1016/j.jpsychires.2019.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/07/2019] [Accepted: 04/18/2019] [Indexed: 01/02/2023]
Abstract
The Attenuated Psychosis Syndrome (APS), proposed as a condition warranting further study in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is a controversial diagnostic construct originally developed to identify individuals at clinical high-risk for psychosis. The relationship of APS and Schizotypal Personality Disorder (SPD) remains unclear with respect to their potential co-occurrence and the effect of SPD on risk for conversion to threshold psychosis. We examined the prevalence and effect on conversion of SPD in a cohort of 218 individuals whose symptoms met APS criteria. Results indicated that SPD was highly prevalent (68%), and that SPD did not influence risk for conversion. Rather, total positive symptom burden measured by the Structured Interview for Psychosis-Risk Syndromes (SIPS; OR 1.12, p = 0.02) emerged as the strongest predictor of conversion. These data suggest that when encountering a patient whose presentation meets SPD criteria, the clinician should assess whether APS criteria are also met and, for 1-2 years, carefully monitor positive symptoms for possible conversion to threshold psychosis.
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Affiliation(s)
- Anthony W. Zoghbi
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA,Corresponding author: Anthony Zoghbi, MD, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA; tel: +1(646) 774-5553, fax: +1(646) 774-5237,
| | - Joel A. Bernanke
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Julia Gleichman
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Michael D. Masucci
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Cheryl M. Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA,Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peter Veterans Affairs Medical Center, 130 West Kingsbridge Rd, Bronx, NY, 10468, USA
| | - Allegra Califano
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Justin Segovia
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Tiziano Colibazzi
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Michael B. First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Gary Brucato
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
| | - Ragy R. Girgis
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA
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26
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McIntyre RS, Zimmerman M, Goldberg JF, First MB. Differential Diagnosis of Major Depressive Disorder Versus Bipolar Disorder: Current Status and Best Clinical Practices. J Clin Psychiatry 2019; 80. [PMID: 31091027 DOI: 10.4088/jcp.ot18043ah2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this article is to provide psychiatrists and other health care professionals who treat patients with major depressive disorder and bipolar disorder a set of best practices, tools, and other methods to improve their ability to make a more accurate diagnosis between major depressive disorder and bipolar disorder and to reach this diagnosis sooner, given a particular set of patient-related circumstances and comorbidities..
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry & Pharmacology, University of Toronto, Toronto, Ontario, Canada.,Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | | | | | - Michael B First
- Department of Psychiatry, Columbia University, New York, New York, USA
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27
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Hansen SJ, Christensen S, Kongerslev MT, First MB, Widiger TA, Simonsen E, Bach B. Mental health professionals' perceived clinical utility of the ICD-10 vs. ICD-11 classification of personality disorders. Personal Ment Health 2019; 13:84-95. [PMID: 30989832 DOI: 10.1002/pmh.1442] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/23/2019] [Accepted: 02/22/2019] [Indexed: 11/09/2022]
Abstract
AIM The ICD-11 classification of personality disorders (PDs) has adopted a dimensional approach which includes three levels of severity (mild, moderate and severe) with the option of specifying five trait qualifiers (negative affectivity, detachment, dissociality, disinhibition and anankastia) and one borderline pattern qualifier. This study examined mental health professionals' perceived clinical utility of the ICD-11 PD framework compared with the ICD-10 categorical PD framework. METHOD A sample of 163 mental health professionals (primarily psychologists, nurses and medical doctors) completed a survey in which they were asked to apply the ICD-10 and ICD-11 PD classifications on one of their patients followed by judgement of their clinical utility. RESULTS The ICD-11 PD framework was generally rated as being slightly more useful than the ICD-10 framework even when accounting for educational background and years of experience. This advantage particularly involved the utility for treatment planning, communicating with patients, comprehensiveness and ease of use. The two frameworks showed no significant differences with respect to utility for communicating with other professionals and describing global personality. CONCLUSION This study provided initial evidence that mental health professionals perceive the ICD-11 PD classification as slightly more useful for clinical practice than the ICD-10 classification. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- Signe Joost Hansen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Sune Christensen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Mickey T Kongerslev
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Psychiatric Research Unit, Region Zealand, Copenhagen University Hospital, Slagelse, Denmark
| | - Michael B First
- Department of Psychiatry, University of Columbia, New York, NY, USA
| | - Thomas A Widiger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Copenhagen University Hospital, Slagelse, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bo Bach
- Psychiatric Research Unit, Region Zealand, Copenhagen University Hospital, Slagelse, Denmark
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28
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Reed GM, First MB, Kogan CS, Hyman SE, Gureje O, Gaebel W, Maj M, Stein DJ, Maercker A, Tyrer P, Claudino A, Garralda E, Salvador‐Carulla L, Ray R, Saunders JB, Dua T, Poznyak V, Medina‐Mora ME, Pike KM, Ayuso‐Mateos JL, Kanba S, Keeley JW, Khoury B, Krasnov VN, Kulygina M, Lovell AM, de Jesus Mari J, Maruta T, Matsumoto C, Rebello TJ, Roberts MC, Robles R, Sharan P, Zhao M, Jablensky A, Udomratn P, Rahimi‐Movaghar A, Rydelius P, Bährer‐Kohler S, Watts AD, Saxena S. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry 2019; 18:3-19. [PMID: 30600616 PMCID: PMC6313247 DOI: 10.1002/wps.20611] [Citation(s) in RCA: 292] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Following approval of the ICD-11 by the World Health Assembly in May 2019, World Health Organization (WHO) member states will transition from the ICD-10 to the ICD-11, with reporting of health statistics based on the new system to begin on January 1, 2022. The WHO Department of Mental Health and Substance Abuse will publish Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders following ICD-11's approval. The development of the ICD-11 CDDG over the past decade, based on the principles of clinical utility and global applicability, has been the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders. Innovations in the ICD-11 include the provision of consistent and systematically characterized information, the adoption of a lifespan approach, and culture-related guidance for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence, are more compatible with recovery-based approaches, eliminate artificial comorbidity, and more effectively capture changes over time. Here we describe major changes to the structure of the ICD-11 classification of mental disorders as compared to the ICD-10, and the development of two new ICD-11 chapters relevant to mental health practice. We illustrate a set of new categories that have been added to the ICD-11 and present the rationale for their inclusion. Finally, we provide a description of the important changes that have been made in each ICD-11 disorder grouping. This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD-11 and in preparing for implementation in their own professional contexts.
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Affiliation(s)
- Geoffrey M. Reed
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland,Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA
| | - Michael B. First
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA,New York State Psychiatric InstituteNew YorkNYUSA
| | - Cary S. Kogan
- School of PsychologyUniversity of OttawaOttawaONCanada
| | - Steven E. Hyman
- Stanley Center for Psychiatric ResearchBroad Institute of Harvard and Massachusetts Institute of TechnologyCambridgeMAUSA
| | - Oye Gureje
- Department of PsychiatryUniversity of IbadanIbadanNigeria
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical FacultyHeinrich‐Heine UniversityDüsseldorfGermany
| | - Mario Maj
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
| | - Dan J. Stein
- Department of PsychiatryUniversity of Cape Town, and South African Medical Research Council Unit on Risk and Resilience in Mental DisordersCape TownSouth Africa
| | | | - Peter Tyrer
- Centre for Mental HealthImperial CollegeLondonUK
| | - Angelica Claudino
- Department of PsychiatryUniversidade Federal de São Paulo (UNIFESP/EPM)São PauloBrazil
| | | | - Luis Salvador‐Carulla
- Research School of Population HealthAustralian National UniversityCanberraACTAustralia
| | - Rajat Ray
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - John B. Saunders
- Centre for Youth Substance Abuse ResearchUniversity of QueenslandBrisbaneQLDAustralia
| | - Tarun Dua
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland
| | - Vladimir Poznyak
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland
| | | | - Kathleen M. Pike
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA
| | - José L. Ayuso‐Mateos
- Department of PsychiatryUniversidad Autonoma de Madrid; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Instituto de Investigación Sanitaria La PrincesaMadridSpain
| | | | - Jared W. Keeley
- Department of PsychologyVirginia Commonwealth UniversityRichmondVAUSA
| | - Brigitte Khoury
- Department of PsychiatryAmerican University of Beirut Medical CenterBeirutLebanon
| | - Valery N. Krasnov
- Moscow Research Institute of PsychiatryNational Medical Research Centre for Psychiatry and NarcologyMoscowRussian Federation
| | - Maya Kulygina
- Moscow Research Institute of PsychiatryNational Medical Research Centre for Psychiatry and NarcologyMoscowRussian Federation
| | - Anne M. Lovell
- Institut National de la Santé et de la Recherche Médicale U988ParisFrance
| | - Jair de Jesus Mari
- Department of PsychiatryUniversidade Federal de São Paulo (UNIFESP/EPM)São PauloBrazil
| | | | | | - Tahilia J. Rebello
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA,New York State Psychiatric InstituteNew YorkNYUSA
| | - Michael C. Roberts
- Office of Graduate Studies and Clinical Child Psychology ProgramUniversity of KansasLawrenceKSUSA
| | - Rebeca Robles
- National Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | - Pratap Sharan
- Department of PsychiatryAll India Institute of Medical SciencesNew DelhiIndia
| | - Min Zhao
- Shanghai Mental Health Center and Department of PsychiatryShanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
| | - Assen Jablensky
- Centre for Clinical Research in NeuropsychiatryUniversity of Western AustraliaPerthWAAustralia
| | - Pichet Udomratn
- Department of PsychiatryPrince of Songkla UniversityHat YaiThailand
| | - Afarin Rahimi‐Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical SciencesTehranIran
| | - Per‐Anders Rydelius
- Department of Child and Adolescent PsychiatryKarolinska InstituteStockholmSweden
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29
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Keeley JW, Gaebel W, First MB, Peterson DL, Rebello T, Sharan P, Reed GM. Psychotic disorder symptom rating scales: Are dichotomous or multi-point scales more clinically useful?-An ICD-11 field study. Schizophr Res 2018; 202:254-259. [PMID: 30017460 DOI: 10.1016/j.schres.2018.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 04/25/2018] [Accepted: 07/01/2018] [Indexed: 01/01/2023]
Abstract
Classifications of psychotic disorders are moving towards utilizing dimensional symptom domains as the preferred mechanism for describing psychotic symptomatology. The ICD-11 has proposed six symptom domains (Positive symptoms, Negative symptoms, Depressive symptoms, Manic symptoms, Psychomotor symptoms, and Cognitive symptoms) that would be rated in addition to providing a psychotic disorder diagnosis. This study investigated clinicians' use of dichotomous versus multi-point scales for rating these six domains. Global mental health professionals (n = 273) rated case vignettes using both a 2-point and 4-point version of a rating scale for the six domains. Clinicians were more accurate using the 2-point scale in absolute terms, but after correcting for chance guessing and disagreements, the two versions of the scale were equally accurate. Clinicians believed the 2-point scale would be easier to use, although they also indicated that the 4-point scale would provide richer clinical information. Participants were able to detect the presence of psychotic symptom domains in the vignettes with good reliability with no special training using either scale. We recommend that clinicians and researchers use the version of the scale that best matches their purpose (i.e., to maximize accuracy or enhance case description). Future work should develop the implementation characteristics of the scale to improve its potential for global application.
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Affiliation(s)
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Germany
| | - Michael B First
- Global Mental Health Program, Columbia University Medical Center, USA; New York State Psychiatric Institute, USA
| | | | - Tahilia Rebello
- Global Mental Health Program, Columbia University Medical Center, USA; New York State Psychiatric Institute, USA
| | | | - Geoffrey M Reed
- Global Mental Health Program, Columbia University Medical Center, USA; World Health Organization, Switzerland
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30
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Hock RS, Bryce CP, Fischer L, First MB, Fitzmaurice GM, Costa PT, Galler JR. Childhood malnutrition and maltreatment are linked with personality disorder symptoms in adulthood: Results from a Barbados lifespan cohort. Psychiatry Res 2018; 269:301-308. [PMID: 30172187 PMCID: PMC6267931 DOI: 10.1016/j.psychres.2018.05.085] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 05/05/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
Abstract
Both childhood malnutrition and maltreatment are associated with mental health problems that can persist into adulthood. Previously we reported that in Barbados, those with a history of infant malnutrition were more likely to report having experienced childhood maltreatment. Few studies, however, address the long-term outcomes of those who have been exposed to both. We assessed the unique and combined associations of a history of early malnutrition and childhood maltreatment with personality pathology in mid-adulthood in participants of the 47-year longitudinal Barbados Nutrition Study. We used the Structured Clinical Interview for DSM-IV-TR Axis II Personality Disorders Personality Questionnaire (SCID-II-PQ) and NEO Personality Inventory-Revised derived Five-Factor Model (NEO PI-R FFM) personality disorder (PD) scores to assess personality pathology, the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to assess childhood maltreatment, and clinical documentation of malnutrition in infancy. We tested the associations of malnutrition and maltreatment with PD scores using linear regression models, unadjusted and adjusted for other childhood adversities. We found increased scores for paranoid, schizoid, avoidant, and dependent PDs among those who had been malnourished and increased scores for paranoid, schizoid, schizotypal, and avoidant PDs among those with higher childhood maltreatment scores. Overall, those exposed to both adversities had even greater PD scores.
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Affiliation(s)
- Rebecca S Hock
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Cyralene P Bryce
- Harvard Medical School, Boston, MA, USA; Barbados Nutrition Study, Bridgetown, Barbados
| | - Laura Fischer
- Children's National Medical Center, Washington, DC, USA
| | - Michael B First
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Garrett M Fitzmaurice
- McLean Hospital, Belmont, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paul T Costa
- Behavioral Medicine Research Center, Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC, USA
| | - Janina R Galler
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Center on the Developing Child, Harvard University, Cambridge, MA, USA
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31
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Abstract
BACKGROUND The ICD-11 classification of Personality Disorders focuses on core personality dysfunction, while allowing the practitioner to classify three levels of severity (Mild Personality Disorder, Moderate Personality Disorder, and Severe Personality Disorder) and the option of specifying one or more prominent trait domain qualifiers (Negative Affectivity, Detachment, Disinhibition, Dissociality, and Anankastia). Additionally, the practitioner is also allowed to specify a Borderline Pattern qualifier. This article presents how the ICD-11 Personality Disorder classification may be applied in clinical practice using five brief cases. CASE PRESENTATION (1) a 29-year-old woman with Severe Personality Disorder, Borderline Pattern, and prominent traits of Negative Affectivity, Disinhibition, and Dissociality; (2) a 36-year-old man with Mild Personality Disorder, and prominent traits of Negative Affectivity and Detachment; (3) a 26-year-old man with Severe Personality Disorder, and prominent traits of Dissociality, Disinhibition, and Detachment; (4) a 19-year-old woman with Personality Difficulty, and prominent traits of Negative Affectivity and Anankastia; (5) a 53-year-old man with Moderate Personality Disorder, and prominent traits of Anankastia and Dissociality. CONCLUSIONS The ICD-11 Personality Disorder classification was applicable to five clinical cases, which were classified according to Personaity Disorder severity and trait domain qualifiers. We propose that the classification of severity may help inform clinical prognosis and intensity of treatment, whereas the coding of trait qualifiers may help inform the focus and style of treatment. Empirical investigation of such important aspects of clinical utility are warranted.
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Affiliation(s)
- Bo Bach
- Center of Excellence on Personality Disorder, Psychiatric Research Unit, Region Zealand, Slagelse Psychiatric Hospital, Fælledvej 6, Bygning 3, 4200 Slagelse, Denmark
| | - Michael B First
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY USA
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32
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Reed GM, Keeley JW, Rebello TJ, First MB, Gureje O, Ayuso-Mateos JL, Kanba S, Khoury B, Kogan CS, Krasnov VN, Maj M, de Jesus Mari J, Sharan P, Stein DJ, Zhao M, Akiyama T, Andrews HF, Asevedo E, Cheour M, Domínguez-Martínez T, El-Khoury J, Fiorillo A, Grenier J, Gupta N, Kola L, Kulygina M, Leal-Leturia I, Luciano M, Lusu B, Martínez-López JNI, Matsumoto C, Odunleye M, Onofa LU, Paterniti S, Purnima S, Robles R, Sahu MK, Sibeko G, Zhong N, Gaebel W, Lovell AM, Maruta T, Pike KM, Roberts MC, Medina-Mora ME. Clinical utility of ICD-11 diagnostic guidelines for high-burden mental disorders: results from mental health settings in 13 countries. World Psychiatry 2018; 17:306-315. [PMID: 30192090 PMCID: PMC6127762 DOI: 10.1002/wps.20581] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In this paper we report the clinical utility of the diagnostic guidelines for ICD-11 mental, behavioural and neurodevelopmental disorders as assessed by 339 clinicians in 1,806 patients in 28 mental health settings in 13 countries. Clinician raters applied the guidelines for schizophrenia and other primary psychotic disorders, mood disorders (depressive and bipolar disorders), anxiety and fear-related disorders, and disorders specifically associated with stress. Clinician ratings of the clinical utility of the proposed ICD-11 diagnostic guidelines were very positive overall. The guidelines were perceived as easy to use, corresponding accurately to patients' presentations (i.e., goodness of fit), clear and understandable, providing an appropriate level of detail, taking about the same or less time than clinicians' usual practice, and providing useful guidance about distinguishing disorder from normality and from other disorders. Clinicians evaluated the guidelines as less useful for treatment selection and assessing prognosis than for communicating with other health professionals, though the former ratings were still positive overall. Field studies that assess perceived clinical utility of the proposed ICD-11 diagnostic guidelines among their intended users have very important implications. Classification is the interface between health encounters and health information; if clinicians do not find that a new diagnostic system provides clinically useful information, they are unlikely to apply it consistently and faithfully. This would have a major impact on the validity of aggregated health encounter data used for health policy and decision making. Overall, the results of this study provide considerable reason to be optimistic about the perceived clinical utility of the ICD-11 among global clinicians.
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Affiliation(s)
- Geoffrey M Reed
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Jared W Keeley
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Tahilia J Rebello
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Kyushu University, Fukuoka City, Japan
| | - Brigitte Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Valery N Krasnov
- Moscow Research Institute of Psychiatry, National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Min Zhao
- Shanghai Mental Health Center and Department of Psychiatry, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | | | - Howard F Andrews
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Biostatistics, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Elson Asevedo
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Majda Cheour
- Department of Psychiatry, Tunis Al Manar University and Al Razi Hospital, Tunis, Tunisia
| | - Tecelli Domínguez-Martínez
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
- Cátedras CONACYT, National Council for Science and Technology, Mexico City, Mexico
| | - Joseph El-Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Jean Grenier
- Institut du Savoir Montfort - Hôpital Montfort & Université d'Ottawa, Ottawa, ON, Canada
| | - Nitin Gupta
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Lola Kola
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Maya Kulygina
- Moscow Research Institute of Psychiatry, National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Itziar Leal-Leturia
- Department of Psychiatry, Universidad Autonoma de Madrid; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Bulumko Lusu
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Mayokun Odunleye
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | | | - Sabrina Paterniti
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, and Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Shivani Purnima
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rebeca Robles
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Manoj K Sahu
- Pt. Jawahar Lal Nehru Memorial Medical College, Raipur, Chhattisgarh, India
| | - Goodman Sibeko
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Na Zhong
- Shanghai Mental Health Center and Department of Psychiatry, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Anne M Lovell
- Institut National de la Santé et de la Recherche Médicale U988, Paris, France
| | - Toshimasa Maruta
- Health Management Center, Seitoku University, Matsudo City, Japan
| | - Kathleen M Pike
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Michael C Roberts
- Office of Graduate Studies and Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
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Lichtenthal WG, Maciejewski PK, Craig Demirjian C, Roberts KE, First MB, Kissane DW, Neimeyer RA, Breitbart W, Slivjak E, Jankauskaite G, Napolitano S, Maercker A, Prigerson HG. Evidence of the clinical utility of a prolonged grief disorder diagnosis. World Psychiatry 2018; 17:364-365. [PMID: 30229568 PMCID: PMC6127759 DOI: 10.1002/wps.20544] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Wendy G. Lichtenthal
- Memorial Sloan Kettering Cancer CenterNew YorkNYUSA,Weill Cornell MedicineNew YorkNYUSA
| | | | | | | | | | - David W. Kissane
- Memorial Sloan Kettering Cancer CenterNew YorkNYUSA,Weill Cornell MedicineNew YorkNYUSA,Monash UniversityClaytonVICAustralia
| | | | - William Breitbart
- Memorial Sloan Kettering Cancer CenterNew YorkNYUSA,Weill Cornell MedicineNew YorkNYUSA
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Krueger RF, Kotov R, Watson D, Forbes MK, Eaton NR, Ruggero CJ, Simms LJ, Widiger TA, Achenbach TM, Bach B, Bagby RM, Bornovalova MA, Carpenter WT, Chmielewski M, Cicero DC, Clark LA, Conway C, DeClercq B, DeYoung CG, Docherty AR, Drislane LE, First MB, Forbush KT, Hallquist M, Haltigan JD, Hopwood CJ, Ivanova MY, Jonas KG, Latzman RD, Markon KE, Miller JD, Morey LC, Mullins-Sweatt SN, Ormel J, Patalay P, Patrick CJ, Pincus AL, Regier DA, Reininghaus U, Rescorla LA, Samuel DB, Sellbom M, Shackman AJ, Skodol A, Slade T, South SC, Sunderland M, Tackett JL, Venables NC, Waldman ID, Waszczuk MA, Waugh MH, Wright AGC, Zald DH, Zimmermann J. Progress in achieving quantitative classification of psychopathology. World Psychiatry 2018; 17:282-293. [PMID: 30229571 PMCID: PMC6172695 DOI: 10.1002/wps.20566] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 12/13/2022] Open
Abstract
Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level" dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity" by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.
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Affiliation(s)
- Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Miriam K Forbes
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, State University of New York, New York, NY, USA
| | - Thomas A Widiger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | | | - Bo Bach
- Psychiatric Research Unit, Slagelse Psychiatric Hospital, Slagelse, Denmark
| | - R Michael Bagby
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | | | - David C Cicero
- Department of Psychology, University of Hawaii, Honolulu, HI, USA
| | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Christopher Conway
- Department of Psychology, College of William and Mary, Williamsburg, VA, USA
| | - Barbara DeClercq
- Department of Developmental, Personality, and Social Psychology, Ghent University, Ghent, Belgium
| | - Colin G DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Anna R Docherty
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Laura E Drislane
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Michael B First
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Michael Hallquist
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - John D Haltigan
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Masha Y Ivanova
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Katherine G Jonas
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Robert D Latzman
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Joshua D Miller
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Leslie C Morey
- Department of Psychology, Texas A&M University, College Station, TX, USA
| | | | - Johan Ormel
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Praveetha Patalay
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | | | - Aaron L Pincus
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - Darrel A Regier
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA
| | - Ulrich Reininghaus
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | | | - Douglas B Samuel
- Department of Psychology, Purdue University, West Lafayette, IN, USA
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | | | - Andrew Skodol
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
| | - Tim Slade
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Susan C South
- Department of Psychology, Purdue University, West Lafayette, IN, USA
| | - Matthew Sunderland
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | | | - Noah C Venables
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Irwin D Waldman
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Monika A Waszczuk
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Mark H Waugh
- Oak Ridge National Laboratory, University of Tennessee, Oak Ridge, TN, USA
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - David H Zald
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
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Oslin D, Dixon L, Adler DA, Winston H, Erlich MD, Levine B, Berlant J, Goldman B, First MB, Siris SG. Adaptation in Delivering Integrated Care: The Tension Between Care and Evidence-Based Practice. Psychiatr Serv 2018; 69:1029-1031. [PMID: 29962306 DOI: 10.1176/appi.ps.201800028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Clinical practice is assumed to be informed and supported by evidence-based clinical research. Nonetheless, clinical practice often deviates from the research evidence base, sometimes leading and sometimes lagging. Two examples from integrated care in mental health care (care for serious mental illness and collaborative mental health care in primary care settings) illustrate the natural space and therefore tension between evidence and implementation that needs to be better understood. Using the tools and perspectives of both examples, the authors present a framework for the connected relationship between practice and research that is founded on measurement and uses iterative adaptation guided by oversight of and feedback from the stakeholders in this process.
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Affiliation(s)
- David Oslin
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Lisa Dixon
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - David A Adler
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Helena Winston
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Matthew D Erlich
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Bruce Levine
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Jeffrey Berlant
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Beth Goldman
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Michael B First
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
| | - Samuel G Siris
- Dr. Oslin is with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Dr. Dixon is with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Adler is with the Department of Psychiatry, Tufts Medical Center, Boston. Dr. Winston is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Erlich is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute. Dr. Levine is with the Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs, New York, and the James J. Peters Veterans Affairs Medical Center, Bronx, New York. Dr. Berlant is with Optum Health, Meridian, Idaho. Dr. Goldman is with Blue Cross-Blue Shield, Detroit. Dr. First is with the New York-Presbyterian Hospital, New York. Dr. Siris is with the Department of Psychiatry, Zucker-Hillside Hospital, Glen Oaks, New York
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First MB, Drevets WC, Carter C, Dickstein DP, Kasoff L, Kim KL, McConathy J, Rauch S, Saad ZS, Savitz J, Seymour KE, Sheline YI, Zubieta JK. Clinical Applications of Neuroimaging in Psychiatric Disorders. Am J Psychiatry 2018; 175:915-916. [PMID: 30173550 PMCID: PMC6583905 DOI: 10.1176/appi.ajp.2018.1750701] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Jeffrey A Lieberman
- From the Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and the New York State Psychiatric Institute - both in New York
| | - Michael B First
- From the Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and the New York State Psychiatric Institute - both in New York
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38
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Brodey BB, Addington J, First MB, Perkins DO, Woods SW, Walker EF, Walsh B, Nieri JM, Nunn MB, Putz J, Brodey IS. The Early Psychosis Screener (EPS): Item development and qualitative validation. Schizophr Res 2018; 197:504-508. [PMID: 29254878 PMCID: PMC6003837 DOI: 10.1016/j.schres.2017.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/06/2017] [Accepted: 11/24/2017] [Indexed: 11/17/2022]
Abstract
A panel of experts assembled and analyzed a comprehensive item bank from which a highly sensitive and specific early psychosis screener could be developed. Twenty well-established assessments relating to the prodromal stage, early psychosis, and psychosis were identified. Using DSM-5 criteria, we identified the core concepts represented by each of the items in each of the assessments. These granular core concepts were converted into a uniform set of 490 self-report items using a Likert scale and a 'past 30days' time frame. Partial redundancy was allowed to assure adequate concept coverage. A panel of experts and TeleSage staff rated these items and eliminated 189 items, resulting in 301 items. The items were subjected to five rounds of cognitive interviewing with 16 individuals at clinically high risk for psychosis and 26 community mental health center patients. After each round, the expert panel iteratively reviewed, rated, revised, added, or deleted items to maximize clarity and centrality to the concept. As a result of the interviews, 36 items were revised, 52 items were added, and 205 items were deleted. By the last round of cognitive interviewing, all of the items were clearly understood by all participants. In future work, responses to the final set of 148 items and machine learning techniques will be used to quantitatively identify the subset of items that will best predict clinical high-risk status and conversion.
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Affiliation(s)
- BB Brodey
- TeleSage, Inc. 201 East Rosemary St. Chapel Hill, NC 27514, USA
| | - J Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.
| | - MB First
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - DO Perkins
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA
| | - SW Woods
- PRIME Psychosis Prodrome Research Clinic, Connecticut Mental Health Center B-38, 34 Park Street, New Haven, CT 06519, USA
| | - EF Walker
- Departments of Psychology and Psychiatry, Emory University, 36 Eagle Row, Atlanta, GA 30322, USA
| | - B Walsh
- PRIME Psychosis Prodrome Research Clinic, Connecticut Mental Health Center, B-38, 34 Park Street, New Haven, CT 06519, USA.
| | - JM Nieri
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA
| | - MB Nunn
- Centerstone Tennessee, 1921 Ransom Place, Nashville, TN 37217, USA
| | - J Putz
- Centerstone Research Institute, 645 South Rogers Street, Bloomington, IN 47403, USA.
| | - IS Brodey
- TeleSage, Inc. 201 East Rosemary St. Chapel Hill, NC 27514, USA
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39
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Reed GM, Sharan P, Rebello TJ, Keeley JW, Elena Medina-Mora M, Gureje O, Luis Ayuso-Mateos J, Kanba S, Khoury B, Kogan CS, Krasnov VN, Maj M, de Jesus Mari J, Stein DJ, Zhao M, Akiyama T, Andrews HF, Asevedo E, Cheour M, Domínguez-Martínez T, El-Khoury J, Fiorillo A, Grenier J, Gupta N, Kola L, Kulygina M, Leal-Leturia I, Luciano M, Lusu B, Nicolas J, Martínez-López I, Matsumoto C, Umukoro Onofa L, Paterniti S, Purnima S, Robles R, Sahu MK, Sibeko G, Zhong N, First MB, Gaebel W, Lovell AM, Maruta T, Roberts MC, Pike KM. The ICD-11 developmental field study of reliability of diagnoses of high-burden mental disorders: results among adult patients in mental health settings of 13 countries. World Psychiatry 2018; 17:174-186. [PMID: 29856568 PMCID: PMC5980511 DOI: 10.1002/wps.20524] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Reliable, clinically useful, and globally applicable diagnostic classification of mental disorders is an essential foundation for global mental health. The World Health Organization (WHO) is nearing completion of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11). The present study assessed inter-diagnostician reliability of mental disorders accounting for the greatest proportion of global disease burden and the highest levels of service utilization - schizophrenia and other primary psychotic disorders, mood disorders, anxiety and fear-related disorders, and disorders specifically associated with stress - among adult patients presenting for treatment at 28 participating centers in 13 countries. A concurrent joint-rater design was used, focusing specifically on whether two clinicians, relying on the same clinical information, agreed on the diagnosis when separately applying the ICD-11 diagnostic guidelines. A total of 1,806 patients were assessed by 339 clinicians in the local language. Intraclass kappa coefficients for diagnoses weighted by site and study prevalence ranged from 0.45 (dysthymic disorder) to 0.88 (social anxiety disorder) and would be considered moderate to almost perfect for all diagnoses. Overall, the reliability of the ICD-11 diagnostic guidelines was superior to that previously reported for equivalent ICD-10 guidelines. These data provide support for the suitability of the ICD-11 diagnostic guidelines for implementation at a global level. The findings will inform further revision of the ICD-11 diagnostic guidelines prior to their publication and the development of programs to support professional training and implementation of the ICD-11 by WHO member states.
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Affiliation(s)
- Geoffrey M Reed
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Tahilia J Rebello
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Jared W Keeley
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Nigeria
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid, IIS-P and Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Kyushu University, Fukuoka City, Japan
| | - Brigitte Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Valery N Krasnov
- Moscow Research Institute of Psychiatry, National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Min Zhao
- Shanghai Mental Health Center and Department of Psychiatry, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | | | - Howard F Andrews
- New York State Psychiatric Institute, New York, NY, USA
- Departments of Biostatistics and Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Elson Asevedo
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Majda Cheour
- Department of Psychiatry, Tunis Al Manar University and Al Razi Hospital, Tunis, Tunisia
| | - Tecelli Domínguez-Martínez
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
- Cátedras CONACYT, National Council for Science and Technology, Mexico City, Mexico
| | - Joseph El-Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Jean Grenier
- Institut du Savoir Montfort - Hôpital Montfort & Université d'Ottawa, Ottawa, Ontario, Canada
| | - Nitin Gupta
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Lola Kola
- Department of Psychiatry, University of Ibadan, Nigeria
| | - Maya Kulygina
- Moscow Research Institute of Psychiatry, National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Itziar Leal-Leturia
- Department of Psychiatry, Universidad Autonoma de Madrid, IIS-P and Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Bulumko Lusu
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | | | - I Martínez-López
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | | | - Sabrina Paterniti
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, and Department of Psychiatry, University of Ottawa, Ontario, Canada
| | - Shivani Purnima
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rebeca Robles
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Manoj K Sahu
- Pt. Jawahar Lal Nehru Memorial Medical College, Raipur, Chhattisgarh, India
| | - Goodman Sibeko
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Na Zhong
- Shanghai Mental Health Center and Department of Psychiatry, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Anne M Lovell
- Institut National de la Santé et de la Recherche Médicale U988, Paris, France
| | - Toshimasa Maruta
- Health Management Center, Seitoku University, Matsudo City, Japan
| | - Michael C Roberts
- Office of Graduate Studies and Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Kathleen M Pike
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
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First MB, Rebello TJ, Keeley JW, Bhargava R, Dai Y, Kulygina M, Matsumoto C, Robles R, Stona A, Reed GM. Do mental health professionals use diagnostic classifications the way we think they do? A global survey. World Psychiatry 2018; 17:187-195. [PMID: 29856559 PMCID: PMC5980454 DOI: 10.1002/wps.20525] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
We report on a global survey of diagnosing mental health professionals, primarily psychiatrists, conducted as a part of the development of the ICD-11 mental and behavioural disorders classification. The survey assessed these professionals' use of various components of the ICD-10 and the DSM, their attitudes concerning the utility of these systems, and usage of "residual" (i.e., "other" or "unspecified") categories. In previous surveys, most mental health professionals reported they often use a formal classification system in everyday clinical work, but very little is known about precisely how they are using those systems. For example, it has been suggested that most clinicians employ only the diagnostic labels or codes from the ICD-10 in order to meet administrative requirements. The present survey was conducted with clinicians who were members of the Global Clinical Practice Network (GCPN), established by the World Health Organization as a tool for global participation in ICD-11 field studies. A total of 1,764 GCPN members from 92 countries completed the survey, with 1,335 answering the questions with reference to the ICD-10 and 429 to the DSM (DSM-IV, DSM-IV-TR or DSM-5). The most frequent reported use of the classification systems was for administrative or billing purposes, with 68.1% reporting often or routinely using them for that purpose. A bit more than half (57.4%) of respondents reported often or routinely going through diagnostic guidelines or criteria systematically to determine whether they apply to individual patients. Although ICD-10 users were more likely than DSM-5 users to utilize the classification for administrative purposes, other differences were either slight or not significant. Both classifications were rated to be most useful for assigning a diagnosis, communicating with other health care professionals and teaching, and least useful for treatment selection and determining prognosis. ICD-10 was rated more useful than DSM-5 for administrative purposes. A majority of clinicians reported using "residual" categories at least sometimes, with around 12% of ICD-10 users and 19% of DSM users employing them often or routinely, most commonly for clinical presentations that do not conform to a specific diagnostic category or when there is insufficient information to make a more specific diagnosis. These results provide the most comprehensive available information about the use of diagnostic classifications of mental disorders in ordinary clinical practice.
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Affiliation(s)
- Michael B. First
- Department of PsychiatryColumbia University, College of Physicians and Surgeons and New York State Psychiatric InstituteNew YorkNYUSA
| | - Tahilia J. Rebello
- Global Mental Health ProgramColumbia University, College of Physicians and Surgeons and Research Foundation for Mental HygieneNew YorkNYUSA
| | - Jared W. Keeley
- Department of PsychologyVirginia Commonwealth UniversityRichmondVAUSA
| | | | - Yunfei Dai
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
| | - Maya Kulygina
- Moscow Research Institute of Psychiatry, National Medical Research Centre for Psychiatry and NarcologyMoscowRussian Federation
| | | | - Rebeca Robles
- National Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | | | - Geoffrey M. Reed
- Global Mental Health ProgramColumbia University, College of Physicians and Surgeons and Research Foundation for Mental HygieneNew YorkNYUSA,World Health OrganizationGenevaSwitzerland
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41
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Kraus SW, Krueger RB, Briken P, First MB, Stein DJ, Kaplan MS, Voon V, Abdo CH, Grant JE, Atalla E, Reed GM. Compulsive sexual behaviour disorder in the ICD-11. World Psychiatry 2018; 17:109-110. [PMID: 29352554 PMCID: PMC5775124 DOI: 10.1002/wps.20499] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Shane W. Kraus
- Edith Nourse Rogers Memorial Veterans HospitalBedfordMAUSA
| | - Richard B. Krueger
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric InstituteNew YorkNYUSA
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg‐EppendorfHamburgGermany
| | - Michael B. First
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric InstituteNew YorkNYUSA
| | - Dan J. Stein
- Department of PsychiatryUniversity of Cape Town and Groote Schuur HospitalCape TownSouth Africa
| | - Meg S. Kaplan
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric InstituteNew YorkNYUSA
| | - Valerie Voon
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Carmita H.N. Abdo
- Department of Psychiatry, Faculty of MedicineUniversity of São PauloSão PauloBrazil
| | - Jon E. Grant
- Department of Psychiatry and Behavioral NeuroscienceUniversity of ChicagoChicagoILUSA
| | - Elham Atalla
- Primary Care and Public Health Directorate, Ministry of HealthManamaBahrain
| | - Geoffrey M. Reed
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland,Global Mental Health Program, Columbia University Medical CenterNew YorkNYUSA
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42
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Bhugra D, Tasman A, Pathare S, Priebe S, Smith S, Torous J, Arbuckle MR, Langford A, Alarcón RD, Chiu HFK, First MB, Kay J, Sunkel C, Thapar A, Udomratn P, Baingana FK, Kestel D, Ng RMK, Patel A, Picker LD, McKenzie KJ, Moussaoui D, Muijen M, Bartlett P, Davison S, Exworthy T, Loza N, Rose D, Torales J, Brown M, Christensen H, Firth J, Keshavan M, Li A, Onnela JP, Wykes T, Elkholy H, Kalra G, Lovett KF, Travis MJ, Ventriglio A. The WPA-Lancet Psychiatry Commission on the Future of Psychiatry. Lancet Psychiatry 2017; 4:775-818. [PMID: 28946952 DOI: 10.1016/s2215-0366(17)30333-4] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/28/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Dinesh Bhugra
- Department of Health Services and Population Research, King's College London and South London and Maudsley NHS Foundation Trust, London, UK; World Psychiatric Association, Geneva, Switzerland.
| | - Allan Tasman
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Shubulade Smith
- Department of Forensic and Neurodevelopmental Science, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - John Torous
- Department of Psychiatry and Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Melissa R Arbuckle
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Alex Langford
- Psychological Medicine Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Renato D Alarcón
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA; Department of Psychiatry, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Helen Fung Kum Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Michael B First
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Jerald Kay
- Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Charlene Sunkel
- SA Federation for Mental Health, Johannesburg, South Africa; Movement for Global Mental Health, Johannesburg, South Africa
| | - Anita Thapar
- Child & Adolescent Psychiatry Section, Division of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics & Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Florence K Baingana
- Mental Health Lead Basic Package of Essential Health Services Cluster, WHO Sierra Leone Country Office, Freetown, Sierra Leone
| | - Dévora Kestel
- Mental Health and Substance Use Unit, Pan American Health Organization/World Health Organization, Washington DC, USA
| | | | - Anita Patel
- Centre for Primary Care & Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Livia De Picker
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
| | - Kwame Julius McKenzie
- Wellesley Institute, Toronto, Ontario, Canada; General Psychiatry and Health Systems, Centre for Addictions and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Driss Moussaoui
- Ibn Rushd University Psychiatric Center, Casablanca, Morocco
| | - Matt Muijen
- Danish Mental Health Association, Copenhagen, Denmark
| | - Peter Bartlett
- School of Law and Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Sophie Davison
- State Forensic Mental Health Service, Department of Health, Clinical Research Centre, Mount Claremont, WA, Australia; School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia
| | - Tim Exworthy
- Department of Forensic and Neurodevelopmental Science, King's College London and South London and Maudsley NHS Foundation Trust, London, UK; Cygnet Healthcare, Stevenage, UK
| | | | - Diana Rose
- Service User Research Enterprise, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - Julio Torales
- Department of Psychiatry, National University of Asunción, San Lorenzo, Paraguay
| | | | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Joseph Firth
- NICM, School of Science and Health, University of Western Sydney, Sydney, NSW, Australia
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ang Li
- Department of Psychology, Beijing Forestry University, Beijing, China
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Til Wykes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - Hussien Elkholy
- World Psychiatric Association, Geneva, Switzerland; Institute of Psychiatry, Neurology and Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Gurvinder Kalra
- Flynn Adult Inpatient Psychiatric Unit, Latrobe Regional Hospital Mental Health Services (LRH-MHS), Traralgon, VIC, Australia; School of Rural Health (La Trobe Valley & West Gippsland), Monash University, VIC, Australia
| | | | - Michael J Travis
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Krueger RB, Reed GM, First MB, Marais A, Kismodi E, Briken P. Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11). Arch Sex Behav 2017; 46:1529-1545. [PMID: 28210933 PMCID: PMC5487931 DOI: 10.1007/s10508-017-0944-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 05/12/2023]
Abstract
The World Health Organization is currently developing the 11th revision of the International Classifications of Diseases and Related Health Problems (ICD-11), with approval of the ICD-11 by the World Health Assembly anticipated in 2018. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was created and charged with reviewing and making recommendations for categories related to sexuality that are contained in the chapter of Mental and Behavioural Disorders in ICD-10 (World Health Organization 1992a). Among these categories was the ICD-10 grouping F65, Disorders of sexual preference, which describes conditions now widely referred to as Paraphilic Disorders. This article reviews the evidence base, rationale, and recommendations for the proposed revisions in this area for ICD-11 and compares them with DSM-5. The WGSDSH recommended that the grouping, Disorders of sexual preference, be renamed to Paraphilic Disorders and be limited to disorders that involve sexual arousal patterns that focus on non-consenting others or are associated with substantial distress or direct risk of injury or death. Consistent with this framework, the WGSDSH also recommended that the ICD-10 categories of Fetishism, Fetishistic Transvestism, and Sadomasochism be removed from the classification and new categories of Coercive Sexual Sadism Disorder, Frotteuristic Disorder, Other Paraphilic Disorder Involving Non-Consenting Individuals, and Other Paraphilic Disorder Involving Solitary Behaviour or Consenting Individuals be added. The WGSDSH's proposals for Paraphilic Disorders in ICD-11 are based on the WHO's role as a global public health agency and the ICD's function as a public health reporting tool.
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Affiliation(s)
- Richard B Krueger
- Department of Psychiatry, College of Physicians and Surgeons, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
- Department of Psychiatry, New York Presbyterian Hospital, New York, NY, USA.
- Sexual Behavior Clinic, New York State Psychiatric Institute, 1051 Riverside Drive, Unit #45, New York, NY, 10032, USA.
| | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
- Global Mental Health Program, Columbia University Medical Center, New York, NY, USA
| | - Michael B First
- Department of Psychiatry, College of Physicians and Surgeons, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Adele Marais
- Department of Psychiatry and Mental Health, Groote Schur Hospital, University of Cape Town, Observatory, South Africa
| | - Eszter Kismodi
- , Geneva, Switzerland
- Global Health Justice Partnership, Yale Law School, New Haven, CT, USA
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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44
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Mauro C, Shear MK, Reynolds CF, Simon NM, Zisook S, Skritskaya N, Wang Y, Lebowitz B, Duan N, First MB, Ghesquiere A, Gribbin C, Glickman K. Performance characteristics and clinical utility of diagnostic criteria proposals in bereaved treatment-seeking patients. Psychol Med 2017; 47:608-615. [PMID: 27821201 DOI: 10.1017/s0033291716002749] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Persistent complex bereavement disorder (PCBD) is a protracted form of grief included in DSM Section 3 indicating a need for more research. Two other criteria sets [prolonged grief disorder (PGD) and complicated grief (CG) disorder] are also currently in use by researchers. This study evaluates rates of diagnosis of each proposed criteria set in a clinical sample of bereaved individuals participating in clinical research. METHOD Two groups in which persistent grief was judged to be present or absent completed an assessment instrument that included items needed to diagnose PCBD as well as PGD and CG. One group included grief treatment-seeking participants in our multicenter National Institute of Mental Health (NIMH)-sponsored study who scored ⩾30 on the Inventory of Complicated Grief (ICG) and the other comprised bereaved adults enrolled in clinical research studies who scored <20 on the ICG. Rates of diagnosis were determined for proposed PCBD, PGD and CG criteria. RESULTS PCBD criteria diagnosed 70 [95% confidence interval (CI) 64.2-75.8] % of the grief treatment-seeking group, PGD criteria identified 59.6 (95% CI 53.4-65.8) % of these individuals and CG criteria identified 99.6 (95% CI 98.8-100.0) %. None of the three proposed criteria identified any cases in the bereaved comparison group. CONCLUSIONS Both proposed DSM-5 criteria for PCBD and criteria for PGD appear to be too restrictive as they failed to identify substantial numbers of treatment-seeking individuals with clinically significant levels of grief-related distress and impairment. Use of CG criteria or a similar algorithm appears to be warranted.
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Affiliation(s)
- C Mauro
- Department of Biostatistics,Mailman School of Public Health,Columbia University,New York, NY,USA
| | - M K Shear
- Columbia University School of Social Work,New York, NY, USA
| | - C F Reynolds
- Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh, PA,USA
| | - N M Simon
- Center for Anxiety and Traumatic Stress Disorders,Massachusetts General Hospital,Boston, MA,USA
| | - S Zisook
- Department of Psychiatry,University of California,San Diego,La Jolla, CA,USA
| | - N Skritskaya
- Columbia University School of Social Work,New York, NY, USA
| | - Y Wang
- Department of Biostatistics,Mailman School of Public Health,Columbia University,New York, NY,USA
| | - B Lebowitz
- Department of Psychiatry,University of California,San Diego,La Jolla, CA,USA
| | - N Duan
- Division of Biostatistics,Department of Psychiatry,Columbia University,New York, NY,USA
| | - M B First
- Department of Psychiatry,Columbia University,College of Physicians and Surgeons,New York State Psychiatric Institute and New York Presbyterian Hospital,New York, NY,USA
| | - A Ghesquiere
- Brookdale Center for Healthy Aging,Hunter College,New York, NY,USA
| | - C Gribbin
- Columbia University School of Social Work,New York, NY, USA
| | - K Glickman
- Department of Social Work,York College/CUNY,Jamaica, NY,USA
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45
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Affiliation(s)
- Michael B First
- Division of Clinical Phenomenology, New York State Psychiatric Institute, New York2Department of Psychiatry, Columbia University Medical Center, New York, New York
| | - Kenneth S Kendler
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond4Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond
| | - Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Emotion, and Development Branch, National Institute of Mental Health, Bethesda, Maryland
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46
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Abstract
From DSM-III onward, successive DSM editions have strived to ground the diagnostic definitions in empirical evidence. DSM-IV established a three-stage process of empirical review, consisting of comprehensive and systematic literature reviews, secondary analyses of datasets, and field trials to provide reliability and validity data for the most substantial or controversial proposals. DSM-IV Work Group members were required to review the empirical literature to document explicitly the evidence supporting the text and criteria published in DSM-IV. As noted by Kendler and Solomon (2016), in contrast to the emphasis on systematic reviews in medicine which is a manifestation of the evidence-based medicine movement, such systematic evidence-based reviews have not been consistently integrated into the development of DSM-5, raising questions about empirical rigor underlying the DSM-5 revision. It is likely that this regression in terms of anchoring the revision process in a comprehensive review of empirical data stemmed from the emphasis during the DSM-5 revision process on trying to move DSM-5 from its categorical descriptive approach towards a more etiological dimensional approach. Although such a shift ultimately did not occur, the effort spent on trying to achieve a paradigm shift likely came at the expense of the hard work of conducting systematic empirical reviews. For the DSM to continue to remain credible in the current era of evidence-based medicine, it is essential that the developers of future editions of the DSM avoid taking their eye off the empirical ball and insure that the manual remains grounded in solid empirical evidence.
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Affiliation(s)
- M B First
- Department of Psychiatry,Columbia University,1051 Riverside Drive - Unit 60,New York,NY 10032,USA
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47
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Abstract
Assessment of clinical course to aid in the diagnosis of patients and to guide treatment planning has gained momentum in recent years. A course-graphing scale for the DSM-5 Mood Disorders is presented to facilitate clinical history-taking and diagnosis of the mood disorders during the screening interview. The scale can be administered in the more traditional historytaking portion of the screening interview. The only difference is that it is a more systematic approach especially when the clinician suspects the presence of a mood disorder. The Timeline Course Graphing Scale for the DSM-5 Mood Disorders (TCGS) is described and accompanied with guidelines for administration.
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48
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Kogan CS, Stein DJ, Maj M, First MB, Emmelkamp PMG, Reed GM. The Classification of Anxiety and Fear-Related Disorders in the ICD-11. Depress Anxiety 2016; 33:1141-1154. [PMID: 27411108 DOI: 10.1002/da.22530] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 01/21/2023] Open
Abstract
Anxiety disorders are highly prevalent worldwide and engender substantial economic costs and disability. The World Health Organization is currently developing the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11), which represents the first opportunity to improve the validity, clinical utility, and global applicability of the classification in more than 25 years. This article describes changes in the organization and diagnostic guidelines for anxiety and fear-related disorders proposed by the ICD-11 Working Group on the Classification of Mood and Anxiety Disorders and the rationale and evidence base for the proposals. In ICD-11, anxiety and fear-related disorders that manifest across the lifespan are brought together under a new grouping, and are partly distinguished by their focus of apprehension. The focus of apprehension is the stimulus or situation that triggers the fear or anxiety and may be highly specific as in specific phobia or relate to a broader class of situations as in social anxiety disorder. The guidelines also clarify the relationship between panic disorder and agoraphobia and a qualifier is provided for panic attacks in the context of other disorders. A standardized format emphasizing essential features of anxiety disorders is intended to improve clinical utility. Guidelines will be further refined based on findings from two types of field studies: those using a case-controlled vignette methodology disseminated via the Internet to practitioners worldwide (http://gcp.network) and clinic-based field trials implemented globally at participating field study centers.
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Affiliation(s)
- Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town Groote Schuur Hospital, Cape Town, South Africa
| | - Mario Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Michael B First
- Department of Psychiatry, Columbia University New York State Psychiatric Institute, New York, New York
| | - Paul M G Emmelkamp
- Department of Clinical Psychology, University of Amsterdam and The Netherlands Institute for Advanced Study, Amsterdam, The Netherlands
| | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.,Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
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49
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Affiliation(s)
- Michael B. First
- Columbia University Department of PsychiatryNew York State Psychiatric InstituteNew YorkNYUSA
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50
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Reed GM, Drescher J, Krueger RB, Atalla E, Cochran SD, First MB, Cohen‐Kettenis PT, Arango‐de Montis I, Parish SJ, Cottler S, Briken P, Saxena S. Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations. World Psychiatry 2016; 15:205-221. [PMID: 27717275 PMCID: PMC5032510 DOI: 10.1002/wps.20354] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In the World Health Organization's forthcoming eleventh revision of the International Classification of Diseases and Related Health Problems (ICD-11), substantial changes have been proposed to the ICD-10 classification of mental and behavioural disorders related to sexuality and gender identity. These concern the following ICD-10 disorder groupings: F52 Sexual dysfunctions, not caused by organic disorder or disease; F64 Gender identity disorders; F65 Disorders of sexual preference; and F66 Psychological and behavioural disorders associated with sexual development and orientation. Changes have been proposed based on advances in research and clinical practice, and major shifts in social attitudes and in relevant policies, laws, and human rights standards. This paper describes the main recommended changes, the rationale and evidence considered, and important differences from the DSM-5. An integrated classification of sexual dysfunctions has been proposed for a new chapter on Conditions Related to Sexual Health, overcoming the mind/body separation that is inherent in ICD-10. Gender identity disorders in ICD-10 have been reconceptualized as Gender incongruence, and also proposed to be moved to the new chapter on sexual health. The proposed classification of Paraphilic disorders distinguishes between conditions that are relevant to public health and clinical psychopathology and those that merely reflect private behaviour. ICD-10 categories related to sexual orientation have been recommended for deletion from the ICD-11.
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Affiliation(s)
- Geoffrey M. Reed
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland,School of PsychologyUniversidad Nacional Autónoma de MéxicoMexico CityMexico
| | - Jack Drescher
- Department of PsychiatryNew York Medical CollegeNew YorkNYUSA
| | - Richard B. Krueger
- Department of PsychiatryColumbia University, College of Physicians and Surgeons, New York State Psychiatric Institute and New York Presbyterian HospitalNew YorkNYUSA
| | - Elham Atalla
- Primary Care and Public Health Directorate, Ministry of HealthManamaBahrain
| | - Susan D. Cochran
- Fielding School of Public HealthUniversity of CaliforniaLos AngelesCAUSA
| | - Michael B. First
- Department of PsychiatryColumbia University, College of Physicians and Surgeons, New York State Psychiatric Institute and New York Presbyterian HospitalNew YorkNYUSA
| | - Peggy T. Cohen‐Kettenis
- Department of Medical PsychologyVU University Medical Centre, and Center of Expertise on Gender DysphoriaAmsterdamThe Netherlands
| | | | - Sharon J. Parish
- Departments of Medicine and PsychiatryWeill Cornell Medical College and New York Presbyterian Hospital/Westchester DivisionWhite PlainsNYUSA
| | - Sara Cottler
- Department of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg‐EppendorfHamburgGermany
| | - Shekhar Saxena
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland
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