1
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Gale SA. Language and Meaning: Asymptomatic Alzheimer's Disease in the Clinic and Society. J Alzheimers Dis 2024:JAD240195. [PMID: 38701152 DOI: 10.3233/jad-240195] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
As the biological, biomarker-driven framework of Alzheimer's disease (AD) becomes formalized through revised, consensus clinical criteria, clinicians will confront more and more patients in the earliest, asymptomatic stages of disease. The language and diction used by practitioners to characterize these early patients, whether they are diagnosed with AD, and how their condition is documented in medical and legal records have important implications for both their care and their medical-legal status outside of the health system. Investigation is needed urgently to better understand clinicians' views and practices regarding early AD, as we adapt to new disease definitions in this unprecedented era of care.
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Affiliation(s)
- Seth A Gale
- Department of Neurology, Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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2
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Castagnini AC. Historical and conceptual features of acute polymorphic psychosis: a myth of European psychiatry from bouffée délirante to ICD-11 acute and transient psychotic disorder. Hist Psychiatry 2024:957154X241245886. [PMID: 38641948 DOI: 10.1177/0957154x241245886] [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] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
This paper deals with the history and epistemology of acute polymorphic psychosis. We undertook a comparative study of short-lived psychotic disorders used in different European countries since the late nineteenth century. The theory of degeneration offered a speculative basis to conceptualization of conditions such as bouffée délirante, cycloid psychosis and reactive psychosis, but it seems likely that different factors contributed to the profusion of clinical concepts with adverse effects on both nomenclature and classification. The resulting picture suggests that earlier nosological concepts tend to converge on common descriptive features and challenge the diagnostic categories for short-lived psychotic disorders listed in modern symptom-based psychiatric classifications.
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3
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Verma S. A case for re-conceptualizing the 'atypical'-A lived experience perspective. Int J Eat Disord 2024; 57:1026-1028. [PMID: 37897094 DOI: 10.1002/eat.24086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Sumedha Verma
- Eating Disorders Victoria, Abbotsford, Victoria, Australia
- InsideOut Institute for Eating Disorders, Central Clinical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
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4
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Riva A, D'Onofrio G, Ferlazzo E, Pascarella A, Pasini E, Franceschetti S, Panzica F, Canafoglia L, Vignoli A, Coppola A, Badioni V, Beccaria F, Labate A, Gambardella A, Romeo A, Capovilla G, Michelucci R, Striano P, Belcastro V. Myoclonus: Differential diagnosis and current management. Epilepsia Open 2024; 9:486-500. [PMID: 38334331 PMCID: PMC10984309 DOI: 10.1002/epi4.12917] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
Myoclonus classically presents as a brief (10-50 ms duration), non-rhythmic jerk movement. The etiology could vary considerably ranging from self-limited to chronic or even progressive disorders, the latter falling into encephalopathic pictures that need a prompt diagnosis. Beyond the etiological classification, others evaluate myoclonus' body distribution (i.e., clinical classification) or the location of the generator (i.e., neurophysiological classification); particularly, knowing the anatomical source of myoclonus gives inputs on the observable clinical patterns, such as EMG bursts duration or EEG correlate, and guides the therapeutic choices. Among all the chronic disorders, myoclonus often presents itself as a manifestation of epilepsy. In this context, myoclonus has many facets. Myoclonus occurs as one, or the only, seizure manifestation while it can also present as a peculiar type of movement disorder; moreover, its electroclinical features within specific genetically determined epileptic syndromes have seldom been investigated. In this review, following a meeting of recognized experts, we provide an up-to-date overview of the neurophysiology and nosology surrounding myoclonus. Through the dedicated exploration of epileptic syndromes, coupled with pragmatic guidance, we aim to furnish clinicians and researchers alike with practical advice for heightened diagnostic management and refined treatment strategies. PLAIN LANGUAGE SUMMARY: In this work, we described myoclonus, a movement characterized by brief, shock-like jerks. Myoclonus could be present in different diseases and its correct diagnosis helps treatment.
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Affiliation(s)
- Antonella Riva
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto “Giannina Gaslini”GenoaItaly
| | - Gianluca D'Onofrio
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto “Giannina Gaslini”GenoaItaly
| | - Edoardo Ferlazzo
- Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
- Regional Epilepsy CentreGreat Metropolitan “Bianchi‐Melacrino‐Morelli Hospital”Reggio CalabriaItaly
| | - Angelo Pascarella
- Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
- Regional Epilepsy CentreGreat Metropolitan “Bianchi‐Melacrino‐Morelli Hospital”Reggio CalabriaItaly
| | - Elena Pasini
- IRCCS‐Istituto delle Scienze Neurologiche di Bologna, Unit of NeurologyBellaria HospitalBolognaItaly
| | - Silvana Franceschetti
- Department of Diagnostics and TechnologyFondazione IRCCS Istituto Neurologio Carlo BestaMilanItaly
| | - Ferruccio Panzica
- Department of Diagnostics and TechnologyFondazione IRCCS Istituto Neurologio Carlo BestaMilanItaly
| | - Laura Canafoglia
- Department of Diagnostics and TechnologyFondazione IRCCS Istituto Neurologio Carlo BestaMilanItaly
| | - Aglaia Vignoli
- Childhood and Adolescence Neurology and Psychiatry Unit, ASST GOM Niguarda, Health Sciences DepartmentUniversità degli Studi di MilanoMilanoItaly
| | - Antonietta Coppola
- Department of Neuroscience, Odontostomatology and Reproductive SciencesFederico II University of NaplesNaplesItaly
| | | | | | - Angelo Labate
- Neurophysiology and Movement Disorders UnitUniversity of MessinaMessinaItaly
| | - Antonio Gambardella
- Department of Medical and Surgical SciencesMagna Græcia University of CatanzaroCatanzaroItaly
| | - Antonino Romeo
- Pediatric Neurology Unit and Epilepsy Center, Department of Neuroscience“Fatebenefratelli e Oftalmico" HospitalMilanoItaly
| | | | - Roberto Michelucci
- IRCCS‐Istituto delle Scienze Neurologiche di Bologna, Unit of NeurologyBellaria HospitalBolognaItaly
| | - Pasquale Striano
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto “Giannina Gaslini”GenoaItaly
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5
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Więckiewicz M, Lavigne G, Martynowicz H. Decrypting the putative interrelation between sleep bruxism, masticatory muscle pain and sleep breathing disorders: Nosology and the role of hypoxia. Dent Med Probl 2024; 61:165-167. [PMID: 38488764 DOI: 10.17219/dmp/175686] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 04/17/2024] Open
Abstract
This commentary on sleep medicine explores whether the potential relationship between sleep bruxism (SB), masticatory muscle pain (MMP) and sleep breathing disorders (SBDs)contributes to improving the management of co-occurring conditions.The paper is divided into 2 sections: (1) reviewing the debate on SB nosology; and (2) based on the publications from the Martynowicz & Wieckiewicz research group, exploringthe role of intermittent hypoxia as a putative mechanism endotype that may link such co-occurrence among individuals for whom characteristics are not yet clear.
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Affiliation(s)
| | - Gilles Lavigne
- Faculty of Dental Medicine, Université de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal and CHUM, Montreal, Canada
| | - Helena Martynowicz
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension, and Clinical Oncology, Wroclaw Medical University, Poland
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6
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Robbins NM, Bernat JL. Ethical issues of nosology in disorders of consciousness. NeuroRehabilitation 2024; 54:3-9. [PMID: 38277312 DOI: 10.3233/nre-230120] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
The current classification scheme for severe disorders of consciousness (DoC) has several shortcomings. First, there is no consensus on how to incorporate patients with covert consciousness. Second, there is a mismatch between the definitions of severe DoC, based on consciousness, and the diagnosis of these same DoC, which is based on observable motoric responsiveness. Third, current categories are grouped into large heterogeneous syndromes which share phenotype, but do not incorporate underlying pathophysiology. Here we discuss several ethical issues pertaining to the current nosology of severe DoC. We conclude by proposing a revised nosology which addresses these shortcomings.
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Affiliation(s)
- Nathaniel M Robbins
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - James L Bernat
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Green J, Shaughnessy N. Autistic phenomenology: past, present, and potential future. Front Psychol 2023; 14:1287209. [PMID: 38222846 PMCID: PMC10788129 DOI: 10.3389/fpsyg.2023.1287209] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/08/2023] [Indexed: 01/16/2024] Open
Abstract
We are now at a transition point in autism conceptualisation, science, and clinical practise, where phenomenology could play a key role. This paper takes a broad view of the history of phenomenological perspectives on the autism concept and how this has evolved over time, including contemporaneous theory and methods. Early inquiry from a clinical perspective within the tradition of classical continental phenomenology, linked closely to the consideration of schizophrenia, is contrasted with emerging observations of child development and a period in the second half of the twentieth century of scientific inquiry into a behavioural autistic phenotype where there was little or no phenomenological aspect; a phenotype that has determined the recent scientific and clinical conceptualisation of autism within current nosology. We then mark a more recent reawakening of interdisciplinary interest in subjective experience and phenomenological inquiry, which itself coincides with the increasing prominence and salience of the neurodiversity movement, autistic advocacy, and critical autism studies. We review this emerging phenomenological work alongside a contemporaneous clinical phenomenology perspective and representations of autistic experience from within the extensive literature (including life writing) from autistic people themselves; all perspectives that we argue need now be brought into juxtaposition and dialogue as the field moves forward. We argue from this for a future which could build on such accounts at a greater scale, working toward a more co-constructed, systematic, representative, and empirical autistic phenomenology, which would include citizen and participatory science approaches. Success in this would not only mean that autistic experience and subjectivity would be re-integrated back into a shared understanding of the autism concept, but we also argue that there could be the eventual goal of an enhanced descriptive nosology, in which key subjective and phenomenological experiences, discriminating for autism, could be identified alongside current behavioural and developmental descriptors. Such progress could have major benefits, including increased mutual empathy and common language between professionals and the autistic community, the provision of crucial new foci for research through aspects of autistic experience previously neglected, and potential new supportive innovations for healthcare and education. We outline a programme and methodological considerations to this end.
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Affiliation(s)
- Jonathan Green
- Division of Psychology and Mental Health, University of Manchester, and Royal Manchester Children's Hospital, Manchester, United Kingdom
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8
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Oude Voshaar RC. The 'discontinuity hypothesis' of depression in later life-clinical and research implications. Age Ageing 2023; 52:afad239. [PMID: 38156879 PMCID: PMC10756079 DOI: 10.1093/ageing/afad239] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/08/2023] [Indexed: 01/03/2024] Open
Abstract
The term depression is overused as an umbrella term for a variety of conditions, including depressed mood and various psychiatric disorders. According to psychiatric diagnostic criteria, depressive disorders impact nearly all aspects of human life and are a leading cause of disability worldwide. The widespread assumption that different types of depression lie on a continuum of severity has stimulated important research on subthreshold depression in later life. This view assumes that depressed mood is a precursor of a depressive disorder. The present narrative review argues why in later life depressed mood might either (i) lie on a continuum with depressive disorders among people vulnerable for a depressive disorder or (ii) be an ageing-related epiphenomenon of underlying physical illnesses in people who are resilient to depressive disorders ('discontinuity hypothesis'). Three arguments are discussed. First, the course of depressed mood and depressive disorders differs across the life span. Second, screening instruments for depression have low predictive value for depressive disorders in later life. Third, a dose-response relationship has not been consistently found across different types of depression and detrimental health outcomes. Using the umbrella term depression may partly explain why pharmacological treatment is less effective with increasing age, and negative health-related outcomes might be overestimated. The discontinuity hypothesis may prevent pharmacological overtreatment of milder subtypes of depression and may stimulate comprehensive multidisciplinary assessment as well as the development of separate treatment algorithms for depressed mood and depressive disorders.
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Affiliation(s)
- Richard C Oude Voshaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherland
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9
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Engstrom EJ. Classic Text No. 136 'On the question of unitary psychosis', by Harry Marcuse (1926). Hist Psychiatry 2023; 34:476-493. [PMID: 37434540 DOI: 10.1177/0957154x231181453] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
In his article 'On the question of unitary psychosis' (1926), Harry Marcuse (1876-1931) undertook a thought experiment in which he challenged clinical psychiatrists to entertain the possibility that the concept of unitary psychosis could be a useful diagnostic and nosological tool. Drawing on the psychology of Friedrich Jodl (1849-1914) and contemporary notions of energeticism, Marcuse proposed a non-empirical, 'analytic' method of overcoming growing dissatisfaction with Kraepelinian categories in the 1910s and 1920s.
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10
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Nyhuis CC, Fernandez-Mendoza J. Insomnia nosology: a systematic review and critical appraisal of historical diagnostic categories and current phenotypes. J Sleep Res 2023; 32:e13910. [PMID: 37122153 DOI: 10.1111/jsr.13910] [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] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/02/2023]
Abstract
Insomnia nosology has significantly evolved since the Diagnostic and Statistical Manual (DSM)-III-R first distinguished between 'primary' and 'secondary' insomnia. Prior International Classification of Sleep Disorders (ICSD) nosology 'split' diagnostic phenotypes to address insomnia's heterogeneity and the DSM nosology 'lumped' them into primary insomnia, while both systems assumed causality for insomnia secondary to health conditions. In this systematic review, we discuss the historical phenotypes in prior insomnia nosology, present findings for currently proposed insomnia phenotypes based on more robust approaches, and critically appraise the most relevant ones. Electronic databases PsychINFO, PubMED, Web of Science, and references of eligible articles, were accessed to find diagnostic manuals, literature on insomnia phenotypes, including systematic reviews or meta-analysis, and assessments of the reliability or validity of insomnia diagnoses, identifying 184 articles. The data show that previous insomnia diagnoses lacked reliability and validity, leading current DSM-5-TR and ICSD-3 nosology to 'lump' phenotypes into a single diagnosis comorbid with health conditions. However, at least two new, robust insomnia phenotyping approaches were identified. One approach is multidimensional-multimethod and provides evidence for self-reported insomnia with objective short versus normal sleep duration linked to clinically relevant outcomes, while the other is multidimensional and provides evidence for two to five clusters (phenotypes) based on self-reported trait, state, and/or life-history data. Some approaches still need replication to better support whether their findings identify true phenotypes or simply different patterns of symptomatology. Regardless, these phenotyping efforts aim at improving insomnia nosology both as a classification system and as a mechanism to guide treatment.
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Affiliation(s)
- Casandra C Nyhuis
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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Spoelma MJ, Serafimovska A, Parker G. Differentiating melancholic and non-melancholic depression via biological markers: A review. World J Biol Psychiatry 2023; 24:761-810. [PMID: 37259772 DOI: 10.1080/15622975.2023.2219725] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 01/12/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Melancholia is a severe form of depression that is typified by greater genetic and biological influence, distinct symptomatology, and preferential response to physical treatment. This paper sought to broadly overview potential biomarkers of melancholia to benefit differential diagnosis, clinical responses and treatment outcomes. Given nuances in distinguishing melancholia as its own condition from other depressive disorder, we emphasised studies directly comparing melancholic to non-melancholic depression. METHODS A comprehensive literature search was conducted. Key studies were identified and summarised qualitatively. RESULTS 105 studies in total were identified. These studies covered a wide variety of biomarkers, and largely fell into three domains: endocrinological (especially cortisol levels, particularly in response to the dexamethasone suppression test), neurological, and immunological (particularly inflammatory markers). Less extensive evidence also exists for metabolic, genetic, and cardiovascular markers. CONCLUSIONS Definitive conclusions were predominantly limited due to substantial heterogeneity in how included studies defined melancholia. Furthermore, this heterogeneity could be responsible for the between- and within-group variability observed in the candidate biomarkers that were examined. Therefore, clarifying these definitional parameters may help identify underlying patterns in biomarker expression to improve diagnostic and therapeutic precision for the depressive disorders.
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Affiliation(s)
- Michael J Spoelma
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | | | - Gordon Parker
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
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Ploumpidis D, Triantafylloudis I, Stefanatou P, Kalogerakis Z. Diagnoses in the Psychiatric Hospital of Kerkyra (Corfu) (1838-2000). Psychiatriki 2023; 34:212-220. [PMID: 36436219 DOI: 10.22365/jpsych.2022.100] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The Psychiatric Hospital of Corfu was founded in 1838 by the (British) Ionian State and was joined in Greek territory in 1864. It was the unique psychiatric hospital in Greece, until the establishment of Dromokaition Hospital of Athens, in 1887. In its long history many of the patients' admissions had a local character, mainly from Corfu, the Ionian Islands, and later from Western Greece. Until the 1950s, we can follow efforts to improve buildings and patient care, but we note also long hospitalizations of men and women and high death rates. It had been an isolated institution until it joined the National Health System in 1983. It closed its doors in 2006, after a long reform process started in 1986. In its place today there is a network of community psychiatric care and rehabilitation units. Based on the medical and social hospital's books data, this paper focuses on the time of appearance and eventually withdrawal of the main diagnoses. 15844 admissions were recorded from 1838 to 2000. We note the time of first description of a diagnosis in European and Greek literature. In the 19th century, the wide diagnosis of dementia also included cases of chronic schizophrenia of our days. The diagnoses of lipomania (from 1855 to 1888), monomania (from 1845 to 1885), and degeneration insanity (from 1902 to 1952) depended on the scientific audience of these theories. Schizophrenia, as expected, was the leading one diagnosis, from 1915. Dementia praecox (πρωτογόνος άνοια in Greek) and precocious dementia were present from 1862 to 1945. Throughout the history of this institution, a large number of cases of mania and melancholia were also observed. Since 1859, the intermittent or cyclic nature of these two symptoms has been recorded, as well as since 1916, Kraepelin's manic-depressive insanity. From 1950, with the use of antibiotics, general paralysis (syphilis of the CNS) will disappear. The presence of many other diagnoses is discussed. From the end of the 19th century, the concept of widely used psychosis has gradually replaced insanity and phrenitis. From the 1940's, we also observe the use of "syndrome" in order also to describe clinical pictures of psychosis and affective disorders. This use of syndrome is probably related to the will of the medical directors of a freer use of diagnoses, compared to those included in the known nosography criteria. The homogenization of diagnoses in Greece was essentially accomplished by introducing ICD-10 in 1990s.
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Affiliation(s)
- Dimitris Ploumpidis
- First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens
| | | | - Pentagiotissa Stefanatou
- First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens
| | - Zacharias Kalogerakis
- First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens
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Espay AJ, Fasano A. The Existential Essentialism in Tremor Nosology - 7 Pitfalls, 2 Remedies, and a Path Ahead. Mov Disord Clin Pract 2023; 10:S36-S41. [PMID: 37637985 PMCID: PMC10448133 DOI: 10.1002/mdc3.13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/23/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alberto J. Espay
- James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of NeurologyUniversity of CincinnatiCincinnatiOhioUSA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's DiseaseMorton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
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Restifo S. Existential depression: A meaningful diagnostic entity? Australas Psychiatry 2023; 31:502-504. [PMID: 37288818 DOI: 10.1177/10398562231180492] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To examine the construct of existential depression and whether it represents a distinct diagnostic entity. METHOD Descriptive psychopathology and phenomenology are used to define the characteristics of existential depression and for comparison with other presentations of low mood. RESULTS Existential depression can be differentiated from other forms of depression by careful appraisal of symptomatology. Drawing attention to this, and likewise other distinguishable yet under-recognised forms of depression, may help stimulate interest in further research on the classification of mood disorders with the prospect of greater diagnostic specificity and more precise treatment matching. CONCLUSION Existential depression is a clinically discernible diagnostic entity.
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Affiliation(s)
- Sam Restifo
- Midland Community Mental Health Service, Midland, WA, Australia
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15
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Menéndez-González M. Toward a new nosology of neurodegenerative diseases. Alzheimers Dement 2023; 19:3731-3737. [PMID: 36960767 DOI: 10.1002/alz.13041] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/25/2023]
Abstract
New "omic" technologies are revealing shared and distinct biological pathways within and across neurodegenerative diseases (NDDs), allowing a better understanding of endophenotypes that exceeds the boundaries of the current diagnostic criteria. Moreover, a diagnostic framework is needed that can accommodate the co-pathology and the clinical overlap and heterogeneity of NDDs. Apart from dissecting the reasons for a revolution in how we conceive NDD, this article aims to prompt a change in how we diagnose and classify NDD, drafting a general scheme for a new nosology. As identifying a cause is the key to using the term "disease" properly, we propose using a tridimensional classification based on three axes: (1) etiology or pathogenic mechanism, (2) pathology markers and molecular biomarkers, (3) anatomic-clinical; and three hierarchical levels of etiology: (1) genetic/sporadic (2) cellular pathways and processes, and function of fluidic brain systems, and (3) risk factors.
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Affiliation(s)
- Manuel Menéndez-González
- Department of Medicine, Universidad de Oviedo, Oviedo, Spain
- Department of Neurology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Neurology Research Group, Instituto de Investigación Sanitaria, Oviedo, Spain
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16
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Curtis JL. Understanding COPD Etiology, Pathophysiology, and Definition. Respir Care 2023; 68:859-870. [PMID: 37353333 PMCID: PMC10289621 DOI: 10.4187/respcare.10873] [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] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
COPD, one of the leading worldwide health problems, currently lacks truly disease-modifying medical therapies applicable to most patients. Developing such novel therapies has been hampered by the marked heterogeneity of phenotypes between individuals with COPD. Such heterogeneity suggests that, rather than a single cause (particularly just direct inhalation of tobacco products), development and progression of COPD likely involve both complex gene-by-environment interactions to multiple inhalational exposures and a variety of molecular pathways. However, there has been considerable recent progress toward understanding how specific pathological processes can lead to discrete COPD phenotypes, particularly that of small airways disease. Advances in imaging techniques that correlate to specific types of histological damage, and in the immunological mechanisms of lung damage in COPD, hold promise for development of personalized therapies. At the same time, there is growing recognition that the current diagnostic criteria for COPD, based solely on spirometry, exclude large numbers of individuals with very similar disease manifestations. This concise review summarizes current understanding of the etiology and pathophysiology of COPD and provides background explaining the increasing calls to expand the diagnostic criteria used to diagnose COPD and some challenges in doing so.
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Affiliation(s)
- Jeffrey L Curtis
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Division of Pulmonary and Critical Care Medicine, Michigan Medicine, Ann Arbor, Michigan; and Graduate Program in Immunology, University of Michigan, Ann Arbor, Michigan.
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Downs J. Care pathways for longstanding eating disorders must offer paths to recovery, not managed decline. BJPsych Bull 2023:1-5. [PMID: 37287111 DOI: 10.1192/bjb.2023.38] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Eating disorders are historically underserved in healthcare, but are increasingly prevalent and recognised for their high costs regarding mortality, quality of life and the economy. Those with longstanding eating disorders are commonly labelled 'severe and enduring' (SEED), which has been challenged for its conceptual vagueness and potential to discourage patients. Attempts to define individuals from this cohort as having 'terminal' illness have also gained traction in recent years. This paper is grounded in lived/living experience and relevant research. It challenges the logical coherence and utility of SEED, arguing that the word 'enduring' unhelpfully situates intractability of longstanding illness within patients themselves and the nature of their illness. This risks a sense of inevitability and overlooks the important role of contextual factors such as lacking resources and insufficient evidence for withholding active treatment. Recommendations suggest approaches to dismantling unhelpful binaries between early intervention and intensive support, recovery and decline.
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Affiliation(s)
- James Downs
- Patient Representative, Faculty of Eating Disorders, Royal College of Psychiatrists, UK
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18
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Cvijovic M, Polster A. Network medicine: facilitating a new view on complex diseases. Front Bioinform 2023; 3:1163445. [PMID: 37293293 PMCID: PMC10244535 DOI: 10.3389/fbinf.2023.1163445] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
Complex diseases are prevalent medical conditions which are characterized by inter-patient heterogeneity with regards to symptom profiles, disease trajectory, comorbidities, and treatment response. Their pathophysiology involves a combination of genetic, environmental, and psychosocial factors. The intricacies of complex diseases, encompassing different levels of biological organization in the context of environmental and psychosocial factors, makes them difficult to study, understand, prevent, and treat. The field of network medicine has progressed our understanding of these complex mechanisms and highlighted mechanistic overlap between diagnoses as well as patterns of symptom co-occurrence. These observations call into question the traditional conception of complex diseases, where diagnoses are treated as distinct entities, and prompts us to reconceptualize our nosological models. Thus, this manuscript presents a novel model, in which the individual disease burden is determined as a function of molecular, physiological, and pathological factors simultaneously, and represented as a state vector. In this conceptualization the focus shifts from identifying the underlying pathophysiology of diagnosis cohorts towards identifying symptom-determining traits in individual patients. This conceptualization facilitates a multidimensional approach to understanding human physiology and pathophysiology in the context of complex diseases. This may provide a useful concept to address both the significant interindividual heterogeneity of diagnose cohorts as well as the lack of clear distinction between diagnoses, health, and disease, thus facilitating the progression towards personalized medicine.
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Affiliation(s)
- Marija Cvijovic
- Department of Applied Mathematics and Statistics, University of Gothenburg, Gothenburg, Sweden
| | - Annikka Polster
- Division of Systems and Synthetic Biology, Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden
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19
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Batra S, Anand A, Singh A, Verma S. Chronic Mania: Diagnostic Dilemma and the Need for Addition in Nosology. Cureus 2023; 15:e38703. [PMID: 37292529 PMCID: PMC10246484 DOI: 10.7759/cureus.38703] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Chronic mania is a mental health disorder that has been described by various psychiatrists in the past but currently is not a part of nosology. Robust epidemiological data for chronic mania are lacking with regard to its prevalence and clinical features. The present case report is of a 48-year-old male with a six-year history of mood and psychotic symptoms, based on which differential diagnoses of schizoaffective disorder (manic type), schizophrenia, and mania with psychotic symptoms (with chronic course) were made. The diagnosis of chronic mania was confirmed considering the predominance of fluctuating mood symptoms along with psychotic symptoms, lack of remission, and chronic course of illness. Antipsychotics were initially started for six weeks, to which the patient demonstrated a minimal response. A mood stabilizer was added to the regimen, leading to significant improvement, and the patient was discharged. According to existing literature, patients with chronic mania present with severe illness, the presence of psychotic symptoms, and socio-occupational impairment, which was also noticed in this case. The prevalence of chronic mania among patients with bipolar disorder is approximately 13-15%, which constitutes a significant proportion of known mental illnesses. Therefore, chronic mania should be added as a distinct clinical entity in the existing nosological systems.
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Affiliation(s)
- Surbhi Batra
- Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, IND
- Psychiatry, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Abhinav Anand
- Covid Care, Central Jail Hospital, Mandoli Prison, New Delhi, IND
| | - Anmol Singh
- Psychiatry, Medanta Institute of Neurosciences, Gurugram, IND
- Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, IND
| | - Shrestha Verma
- Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, IND
- Psychiatry, St. Stephen's Hospital, New Delhi, IND
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20
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Sujobert P, Largeaud L, Jamilloux Y, Heiblig M, Kosmider O. VEXAS: is it time to reshape the nosology of clonal hematopoiesis? Expert Rev Hematol 2023:1-5. [PMID: 37119011 DOI: 10.1080/17474086.2023.2209715] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
INTRODUCTION The recent description of VEXAS (for Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) challenges the nosological framework of myelodysplastic syndromes. AREAS COVERED Clonal expansion driven by somatic mutations in cancer genes has been largely described in healthy ageing individuals. Regarding hematopoiesis, the prevalence of clonal hematopoiesis has blurred the line between normal and pathological, especially for the definition of myelodysplastic syndromes. VEXAS syndrome further challenges the nosology as this clonal disease of hematopoiesis is also associated with dysplastic features and cytopenias. EXPERT OPINION In this perspective, we discuss whether VEXAS should be considered a genuine myelodysplastic syndrome, and propose a conceptual framework to refine the nosology, based on the distinction of clonal hematopoiesis of indeterminate potential (CHIP), clonal hematopoiesis of hematological significance and clonal hematopoiesis of other significance.
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Affiliation(s)
- Pierre Sujobert
- Hospices Civils de Lyon. Hôpital Lyon Sud, Service d'hématologie biologique, Lyon, France
- Université Claude Bernard Lyon 1, Faculté de médecine et de maïeutique Lyon Sud Charles Mérieux, Lymphoma Immunobiology Team, Pierre Bénite, France
| | - Laetitia Largeaud
- Université Claude Bernard Lyon 1, Faculté de médecine et de maïeutique Lyon Sud Charles Mérieux, Lymphoma Immunobiology Team, Pierre Bénite, France
| | - Yvan Jamilloux
- Lyon Immunopathology Federation (LIFE), Lyon University, Lyon, France
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de médecine interne, Lyon, France
| | - Maël Heiblig
- Université Claude Bernard Lyon 1, Faculté de médecine et de maïeutique Lyon Sud Charles Mérieux, Lymphoma Immunobiology Team, Pierre Bénite, France
- Hospices Civils de Lyon. Hôpital Lyon Sud, Service d'hématologie clinique, Lyon, France
| | - Olivier Kosmider
- AP-HP. Hôpital Cochin, Service d'hématologie biologique, Paris, France
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21
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Andreassen OA, Hindley GFL, Frei O, Smeland OB. New insights from the last decade of research in psychiatric genetics: discoveries, challenges and clinical implications. World Psychiatry 2023; 22:4-24. [PMID: 36640404 PMCID: PMC9840515 DOI: 10.1002/wps.21034] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [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] [Accepted: 10/07/2022] [Indexed: 01/15/2023] Open
Abstract
Psychiatric genetics has made substantial progress in the last decade, providing new insights into the genetic etiology of psychiatric disorders, and paving the way for precision psychiatry, in which individual genetic profiles may be used to personalize risk assessment and inform clinical decision-making. Long recognized to be heritable, recent evidence shows that psychiatric disorders are influenced by thousands of genetic variants acting together. Most of these variants are commonly occurring, meaning that every individual has a genetic risk to each psychiatric disorder, from low to high. A series of large-scale genetic studies have discovered an increasing number of common and rare genetic variants robustly associated with major psychiatric disorders. The most convincing biological interpretation of the genetic findings implicates altered synaptic function in autism spectrum disorder and schizophrenia. However, the mechanistic understanding is still incomplete. In line with their extensive clinical and epidemiological overlap, psychiatric disorders appear to exist on genetic continua and share a large degree of genetic risk with one another. This provides further support to the notion that current psychiatric diagnoses do not represent distinct pathogenic entities, which may inform ongoing attempts to reconceptualize psychiatric nosology. Psychiatric disorders also share genetic influences with a range of behavioral and somatic traits and diseases, including brain structures, cognitive function, immunological phenotypes and cardiovascular disease, suggesting shared genetic etiology of potential clinical importance. Current polygenic risk score tools, which predict individual genetic susceptibility to illness, do not yet provide clinically actionable information. However, their precision is likely to improve in the coming years, and they may eventually become part of clinical practice, stressing the need to educate clinicians and patients about their potential use and misuse. This review discusses key recent insights from psychiatric genetics and their possible clinical applications, and suggests future directions.
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Affiliation(s)
- Ole A Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Guy F L Hindley
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Oleksandr Frei
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Centre for Bioinformatics, Department of Informatics, University of Oslo, Oslo, Norway
| | - Olav B Smeland
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Nordgaard J, Madeira L, Shinn AK, Cermolacce M. Editorial: Psychiatric diagnoses: current state and methodological issues. Front Psychiatry 2023; 14:1194755. [PMID: 37124261 PMCID: PMC10133709 DOI: 10.3389/fpsyt.2023.1194755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Affiliation(s)
- Julie Nordgaard
- Mental Health Center Amager, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Julie Nordgaard
| | - Luis Madeira
- Department of Psychiatry, Institute of Preventive Medicine, University of Lisbon, Lisbon, Portugal
| | - Ann K. Shinn
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Michel Cermolacce
- Department of Psychiatry, APHM and Aix Marseille University, Marseilles, France
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23
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Abstract
Personalized case conceptualization is often regarded as a prerequisite for treatment success in psychotherapy for patients with comorbidity. This article presents Perceived Causal Networks, a novel method in which patients rate perceived causal relations among behavioral and emotional problems. First, 231 respondents screening positive for depression completed an online Perceived Causal Networks questionnaire. Median completion time (including repeat items to assess immediate test-retest reliability) was 22.7 minutes, and centrality measures showed excellent immediate test-retest reliability. Networks were highly idiosyncratic, but worrying and ruminating were the most central items for a third of respondents. Second, 50 psychotherapists rated the clinical utility of Perceived Causal Networks visualizations. Ninety-six percent rated the networks as clinically useful, and the information in the individual visualizations was judged to contain 47% of the information typically collected during a psychotherapy assessment phase. Future studies should individualize networks further and evaluate the validity of perceived causal relations.
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Affiliation(s)
- Lars Klintwall
- Stockholm University. Stockholm,
Sweden,Lars Klintwall, Stockholm University,
Frescati Hagväg 8, 112 42, Stockholm 106 91, Sweden.
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24
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Abstract
Background The explosion caused by the fusion of quantitative genetics and molecular genetics will transform behavioural genetic research in child and adolescent psychology and psychiatry. Methods Although the fallout has not yet settled, the goal of this paper is to predict the next 10 years of research in what could be called behavioural genomics. Results I focus on three research directions: the genetic architecture of psychopathology, causal modelling of gene-environment interplay, and the use of DNA as an early warning system. Conclusion Eventually, whole-genome sequencing will be available for all newborns, which means that behavioural genomics could potentially be applied ubiquitously in research and clinical practice.
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Affiliation(s)
- Robert Plomin
- King's College LondonInstitute of PsychiatryPsychology and NeuroscienceLondonUK
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25
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Jermy BS, Hagenaars S, Coleman JRI, Vassos E, Lewis CM. Risk factor profiles for depression following childbirth or a chronic disease diagnosis: case-control study. BJPsych Open 2022; 8:e182. [PMID: 36205003 PMCID: PMC9634597 DOI: 10.1192/bjo.2022.586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/23/2022] Open
Abstract
BACKGROUND Progress towards understanding the aetiology of major depression is compromised by its clinical heterogeneity. The variety of contexts underlying the development of a major depressive episode may contribute to such heterogeneity. AIMS To compare risk factor profiles for three subgroups of major depression according to episode context. METHOD Using self-report questionnaires and administrative records from the UK Biobank, we characterised three contextual subgroups of major depression: postpartum depression (3581 cases), depression following diagnosis of a chronic disease (409 cases) and a more typical (named heterogeneous) major depression phenotype excluding the two other contexts (34 699 cases). Controls with the same exposure were also defined. We tested each subgroup for association with the polygenic risk scores (PRS) for major depression and with other risk factors previously associated with major depression (bipolar disorder PRS, neuroticism, reported trauma in childhood and adulthood, socioeconomic status, family history of depression, education). RESULTS Major depression PRS was associated with all subgroups, but postpartum depression cases had higher PRS than heterogeneous major depression cases (OR = 1.06, 95% CI 1.02-1.10). Relative to heterogeneous depression, postpartum depression was more weakly associated with adulthood trauma and neuroticism. Depression following diagnosis of a chronic disease had weaker association with neuroticism and reported trauma in adulthood and childhood relative to heterogeneous depression. CONCLUSIONS The observed differences in risk factor profiles according to the context of a major depressive episode help provide insight into the heterogeneity of depression. Future studies dissecting such heterogeneity could help reveal more refined aetiological insights.
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Affiliation(s)
- Bradley S. Jermy
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
- Correspondence: Bradley Jermy.
| | - Saskia Hagenaars
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Jonathan R. I. Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Evangelos Vassos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Cathryn M. Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK; and Department of Medical & Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, UK
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26
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Lindsäter E, Svärdman F, Wallert J, Ivanova E, Söderholm A, Fondberg R, Nilsonne G, Cervenka S, Lekander M, Rück C. Exhaustion disorder: scoping review of research on a recently introduced stress-related diagnosis - ERRATUM. BJPsych Open 2022; 8:e176. [PMID: 36172805 PMCID: PMC9534901 DOI: 10.1192/bjo.2022.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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27
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Shah PJ, Boilson M, Rutherford M, Prior S, Johnston L, Maciver D, Forsyth K. Neurodevelopmental disorders and neurodiversity: definition of terms from Scotland's National Autism Implementation Team. Br J Psychiatry 2022; 221:577-579. [PMID: 35343409 DOI: 10.1192/bjp.2022.43] [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: 11/23/2022]
Abstract
Adults with neurodevelopmental disorders frequently present to, but fit uneasily into, adult mental health services. We offer definitions of important terms related to neurodevelopmental disorders through unifying research data, medical and other viewpoints. This may improve understanding, clinical practice and development of neurodevelopmental disorder pathways within adult mental health services.
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Affiliation(s)
- Premal J Shah
- General Adult Psychiatry, Royal Edinburgh Hospital, UK and School of Health Sciences, Queen Margaret University, Scotland, UK
| | - Marie Boilson
- General Adult Psychiatry, Queen Margaret Hospital, Scotland, UK and School of Health Sciences, Queen Margaret University Scotland, UK
| | | | - Susan Prior
- School of Health Sciences, Queen Margaret University, Scotland, UK
| | - Lorna Johnston
- School of Health Sciences, Queen Margaret University, Scotland, UK
| | - Donald Maciver
- School of Health Sciences, Queen Margaret University, Scotland, UK
| | - Kirsty Forsyth
- School of Health Sciences, Queen Margaret University, Scotland, UK
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28
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Lindsäter E, Svärdman F, Wallert J, Ivanova E, Söderholm A, Fondberg R, Nilsonne G, Cervenka S, Lekander M, Rück C. Exhaustion disorder: scoping review of research on a recently introduced stress-related diagnosis. BJPsych Open 2022; 8:e159. [PMID: 36458830 PMCID: PMC9438479 DOI: 10.1192/bjo.2022.559] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Symptoms related to chronic stress are prevalent and entail high societal costs, yet there is a lack of international consensus regarding diagnostics and treatment. A new stress-related diagnosis, exhaustion disorder, was introduced into the Swedish version of ICD-10 in 2005. Since then, use of the diagnosis has increased rapidly. AIMS To create the first comprehensive synthesis of research on exhaustion disorder to report on the current state of knowledge. Preregistration: Open Science Framework (http://www.w3.org/1999/xlink">osf.io), doi 10.17605/OSF.IO/VFDKW. METHOD A PRISMA-guided scoping review of all empirical studies of exhaustion disorder was conducted. Searches were run in the MEDLINE, PsycInfo and Web of Science databases. Data were systematically charted and thematically categorised based on primary area of investigation. RESULTS Eighty-nine included studies were sorted into six themes relating to lived experience of exhaustion disorder (n = 9), symptom presentation and course (n = 13), cognitive functioning (n = 10), biological measures (n = 24), symptom measurement scales (n = 4) and treatment (n = 29). Several studies indicated that individuals with exhaustion disorder experience a range of psychiatric and somatic symptoms beyond fatigue, but robust findings within most thematic categories were scarce. The limited number of studies, lack of replication of findings and methodological limitations (e.g. small samples and scarcity of specified primary outcomes) preclude firm conclusions about the diagnostic construct. CONCLUSIONS More research is needed to build a solid knowledge base for exhaustion disorder. International collaboration regarding the conceptualisation of chronic stress and fatigue is warranted to accelerate the growth of evidence.
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Affiliation(s)
- Elin Lindsäter
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm, Sweden; and Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Frank Svärdman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Health Care Services, Stockholm, Sweden
| | - John Wallert
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Health Care Services, Stockholm, Sweden
| | - Ekaterina Ivanova
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Health Care Services, Stockholm, Sweden
| | - Anna Söderholm
- Department of Psychology, Umeå Universitet, Umeå, Sweden
| | - Robin Fondberg
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Health Care Services, Stockholm, Sweden
| | - Gustav Nilsonne
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Simon Cervenka
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm, Sweden; and Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Mats Lekander
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Department of Psychology, Stockholm University, Sweden; and Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Health Care Services, Stockholm, Sweden
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29
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Castro-Calvo J, Flayelle M, Perales JC, Brand M, Potenza MN, Billieux J. Compulsive Sexual Behavior Disorder should not be classified by solely relying on component/symptomatic features •. J Behav Addict 2022; 11:210-215. [PMID: 35895452 PMCID: PMC9295252 DOI: 10.1556/2006.2022.00029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/14/2022] [Accepted: 04/15/2022] [Indexed: 01/02/2023] Open
Abstract
The paper by Sassover and Weinstein (2022) contributes to a timely and complex debate related to the classification of Compulsive Sexual Behavior Disorder (CSBD). The recent inclusion of CSBD as an impulse-control disorder in the ICD-11 has generated debate since a competitive view is that CSBD should rather be classified as an addictive disorder. Sassover and Weinstein (2022) reviewed existing evidence and concluded it does not support the conceptualization of CSBD as an addictive disorder. Although we agree regarding the relevance and timely nature of considering the classification of CSBD, we respectfully disagree with the position that relying on the components model of addiction (Griffiths, 2005) is the optimal approach for determining whether or not CSBD is an addictive disorder. In this commentary, we discuss potential pitfalls of relying on the components model to conceptualize CSBD as an addictive disorder and argue that considering a process-based approach is important for advancing this timely debate.
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Affiliation(s)
- Jesús Castro-Calvo
- Department of Personality, Assessment, and Psychological Treatments, University of Valencia, Spain
- Corresponding authors. E-mail: ,
| | - Maèva Flayelle
- Institute of Psychology, University of Lausanne (UNIL), Lausanne, Switzerland
| | - José C. Perales
- Department of Experimental Psychology, Mind, Brain and Behavior Research Center (CIMCYC), Universidad de Granada, Spain
| | - Matthias Brand
- General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Germany
| | - Marc N. Potenza
- Department of Psychiatry and the Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Department of Neuroscience and the Wu Tsai Institute, Yale University, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- The Connecticut Council on Problem Gambling, Wethersfield, CT 06109, USA
| | - Joël Billieux
- Institute of Psychology, University of Lausanne (UNIL), Lausanne, Switzerland
- Centre for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
- Corresponding authors. E-mail: ,
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30
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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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31
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Engmann B. On the origins of the concept of 'latent schizophrenia' in Russian psychiatry. Hist Psychiatry 2022; 33:230-235. [PMID: 34320852 DOI: 10.1177/0957154x211035328] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In the mid-twentieth century in the Soviet Union, latent schizophrenia became an important concept and a matter of research and also of punitive psychiatry. This article investigates precursor concepts in early Russian psychiatry of the nineteenth century, and examines whether - as claimed in recent literature - Russian and Soviet research on latent schizophrenia was mainly influenced by the work of Eugen Bleuler.
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Abstract
The "autism spectrum disorder" (ASD) construct and its current diagnostic criteria have led to the inclusion of increasingly heterogeneous and decreasingly atypical individuals under its definition. This broad category, based on the polymorphic clinical expression of common genetic variants underpinning the risk of autism, is likely beneficial for certain individuals. However, determining the boundaries between ASD and typical individuals, as well as those with other neurodevelopmental conditions, remains an issue of which the importance is growing with the increase in ASD prevalence. We identified four clinical contexts associated with a questionable, poorly justified, or unhelpful ASD diagnosis: (1) those in which diagnostic instruments raise uncertainties, (2) in the context of a subclinical presentation, (3) when early autistic signs tend to fade away during development, and (4) when comorbidities are prominent. We argue that in certain cases, a diagnosis of ASD may not be the most suitable, timely, or helpful medical act and provide recommendations for clinical practice when facing such situations.
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Affiliation(s)
- Pierre Defresne
- Center for Autism Spectrum Disorders, SUSA Foundation, 54521University of Mons, Belgium
| | - Laurent Mottron
- Faculty of Medicine, Psychiatry and Addictology Department, University of Montreal, Montreal, Quebec, Canada.,439501CIUSSS-Nord-de-l'Ile de Montréal, 12368Hospital Riviere-des-Prairies, Montreal, Quebec, Canada
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33
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Abstract
Perlson et al's editorial 'Envisioning a future for transgender and gender-diverse people beyond the DSM' heralds the arrival of the ICD-11's gender incongruence categories among conditions related to sexual health, brightening the spotlight on the re- (or rather de-)classification of gender-related disorders, which is a step in the right direction.
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Affiliation(s)
- Yulia Furlong
- Dr Yulia Furlong is a Senior Clinical Lecturer at the University of Western Australia, and Consultant Psychiatrist and the Head of Service for CAMHS Crisis Connect at Perth Children's Hospital. Dr Furlong was the Head of Service for the Paediatric Consultation Liaison and Gender Diversity Service at Perth Children's Hospital until January 2022
| | - Aleksandar Janca
- Prof. Aleksandar Janca is Emeritus Professor of Psychiatry and Director of the WHO Collaborating Centre at the University of Western Australia
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Abstract
Mental health research is at an important crossroads as the field seeks more reliable and valid phenotypes to study. Dimensional approaches to quantifying mental illness operate outside the confines of traditional categorical diagnoses, and they are gaining traction as a way to advance research on the causes and consequences of mental illness. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a leading dimensional research paradigm that synthesizes decades of data on the major dimensions of psychological disorders. In this article, we demonstrate how to use the HiTOP model to formulate and test research questions through a series of tutorials. To boost accessibility, data and annotated code for each tutorial are included at OSF (https://osf.io/8myzw). After presenting the tutorials, we outline how investigators can use these ideas and tools to generate new insights in their own substantive research programs.
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Affiliation(s)
| | - Miriam K. Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University
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35
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Sanchez-Garcia M, de la Rosa-Cáceres A, Díaz-Batanero C, Fernández-Calderón F, Lozano OM. Cocaine use disorder criteria in a clinical sample: an analysis using item response theory, factor and network analysis. Am J Drug Alcohol Abuse 2022; 48:284-292. [PMID: 35100067 DOI: 10.1080/00952990.2021.2012185] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The conceptualization of substance use disorders (SUDs) was modified in successive editions of the DSM. Dimensionality and inclusion/exclusion of several criteria was studied using various analytic approaches. OBJECTIVE The study aimed to deepen our knowledge of the interrelationships between the diagnostic criteria for cocaine use disorder (CUD), applying three different analytical techniques: factor analysis, Item Response Theory (IRT) models, and network analysis. METHODS 425 (85.4% male) outpatients were evaluated for CUD using the Substance Dependence Severity Scale. Confirmatory Factor Analysis, 2-parameter logistic model (IRT) and network analysis were applied to analyze the relationships between the diagnostic criteria. RESULTS The results show that "legal problems" criterion is not congruent with the CUD measure on three analyses. Also, network analysis suggests the usefulness of the "craving" criterion. The criterion "quit/control" is the one that presents the best centrality indices and expected influence, showing strong relationships with the criteria of "craving," "tolerance," "neglect roles" and "activities given up." CONCLUSIONS Network analysis appears to be a useful and complementary technique to factor analysis and IRT for understanding CUD. The "quit/control" criterion emerges as a central criterion to understand CUD.
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Affiliation(s)
- M Sanchez-Garcia
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain.,Research Center for Natural Resources, Health and The Environment, University of Huelva, Huelva, Spain
| | - A de la Rosa-Cáceres
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
| | - C Díaz-Batanero
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain.,Research Center for Natural Resources, Health and The Environment, University of Huelva, Huelva, Spain
| | - F Fernández-Calderón
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain.,Research Center for Natural Resources, Health and The Environment, University of Huelva, Huelva, Spain
| | - O M Lozano
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain.,Research Center for Natural Resources, Health and The Environment, University of Huelva, Huelva, Spain
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36
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Tyrer P, Mulder R, Newton-Howes G, Duggan C. Galenic syndromes: combinations of mental state and personality disorders too closely entwined to be separated. Br J Psychiatry 2022; 220:1-2. [PMID: 35067243 DOI: 10.1192/bjp.2021.220] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 11/23/2022]
Abstract
Many mental disorders are linked to personality, but this is rarely recognised in clinical practice. It is suggested here that when the links are very close, the two can be joined. Galenic syndromes are so named because Galen was the first physician to recognise the links between personality and disease.
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Affiliation(s)
- Peter Tyrer
- Division of Psychiatry, Imperial College London, UK; and Personality Disorder Services, Lincolnshire Partnership NHS Trust, UK
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, New Zealand
| | | | - Conor Duggan
- Institute of Mental Health, University of Nottingham, UK
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Gauld C, Espi P, Revol O, Fourneret P. Explanatory hypotheses of the ecology of new clinical presentations of Dissociative Identity Disorders in youth. Front Psychiatry 2022; 13:965593. [PMID: 36299545 PMCID: PMC9589448 DOI: 10.3389/fpsyt.2022.965593] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Dissociative Identity Disorders (DIDs) are controversial psychiatric conditions encountered in clinical practice and nosology. DID as described in the international classifications has little similarity with the clinical picture of "DID" met in current youth psychiatry. From this Perspective, we hypothesize that this current clinical presentation does not satisfy the categorical criteria of the international classifications. Based on the two terminological challenges related to the definition of DID (i.e., the notion of dissociative disorders and the different meanings of the term identity), we propose to differentiate two distinct entities from each other. The first is medical and listed in diagnostic criteria of international classifications; the second comes from popular culture and refers to the vast majority of clinical presentations received in daily clinical practice-presented under the term Dissociative Identity Conditions (DIC). Since the status of DIC is a hot topic in current clinical psychiatry, we aim to identify eight possible explanations that can be provided to support its occurrence: (1) impact of iatrogenicity; (2) factors of suggestibility and desire for social acceptability; (3) psychoanalytic explanations; (4) neuropsychological explanations; (5) socio-cognitive explanations; (6) emotional labeling; (7) narrative explanations; (8) and transient illnesses explanations. In conclusion, we sustain that DIC results from a narrative interpretation of medical discourse by popular culture, developing in patients presenting undeniable distress. Such a transient disease fits in an ecological niche, which echoes the values of society, persisting under the action of a need for narrative continuity of the self.
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Affiliation(s)
- Christophe Gauld
- Service de Psychopathologie de l'enfant et de l'adolescent, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France.,UMR CNRS 8590 IHPST, Université de la Sorbonne, Paris, France
| | - Pauline Espi
- Service de Psychopathologie de l'enfant et de l'adolescent, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Olivier Revol
- Service de Psychopathologie de l'enfant et de l'adolescent, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Pierre Fourneret
- Service de Psychopathologie de l'enfant et de l'adolescent, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France.,Laboratory of Social Neuroscience and Comparative Development, Institut des Sciences Cognitives, UMR5229, Université Lyon 1, Lyon, France
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Bell E, Malhi GS, Mannie Z, Boyce P, Bryant R, Inder M, Porter RJ. Novel insights into irritability: the relationship between subjective experience, age and mood. BJPsych Open 2021; 7:e198. [PMID: 34709149 PMCID: PMC8570102 DOI: 10.1192/bjo.2021.1033] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The relationship between irritability as a subjective experience and the behavioural indicators typically used to measure the construct are not known. Its links to mood, and contextual relationships, vary with age and are yet to be thoroughly examined. AIMS First, to interrogate the relationship between the subjective experience of irritability and mood, and that with its behavioural indicators. Second, to determine how these relationships vary with age and over time. METHOD This study examined data from a previous clinical trial of adolescents and young adults (N = 82) with bipolar disorder, who received a psychological intervention over 18 months. Participants completed a battery of questionnaires, which included assessments of irritability. Analyses of covariance were conducted to examine the interaction between mood symptoms, subjective measures of irritability, behavioural measures of irritability and age over time. RESULTS Subjective irritability scores differed significantly over time when controlling for manic, but not depressive, symptom scores. Further, subjective irritability significantly differed when controlling for behavioural measures of irritability (temper outbursts and argumentativeness). There were significant interactions between scores of depressive symptoms, temper outbursts and subjective irritability with age, wherein younger participants showed no correlation between depressive symptoms and temper outbursts. In addition, younger participants showed lower correlations between subjective irritability and both depressive and temper outburst scores, than older participants. CONCLUSIONS Subjective irritability is linked to mood morbidity and behavioural outbursts, and these relationships are contingent on age. Our novel findings suggest that subjective irritability should be assessed in greater detail in patients with mood disorders.
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Affiliation(s)
- Erica Bell
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Zola Mannie
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia; and NSW Health, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Philip Boyce
- Speciality of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Australia
| | - Maree Inder
- Department of Psychological Medicine, University of Otago, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, New Zealand
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McIntyre JS, Yager J, Everett A, Galanter CA, Lyness JM, Nininger J, Reus VI, Vergare M. The DSM-5 Clinical and Public Health Committee (CPHC): operations, mechanics, controversies and recommendations. Psychol Med 2021; 51:2493-2500. [PMID: 32840190 DOI: 10.1017/s0033291720001415] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND For DSM - 5, the American Psychiatric Association Board of Trustees established a robust vetting and review process that included two review committees that did not exist in the development of prior DSMs, the Scientific Review Committee (SRC) and the Clinical and Public Health Committee (CPHC). The CPHC was created as a body that could independently review the clinical and public health merits of various proposals that would fall outside of the strictly defined scientific process. METHODS This article describes the principles and issues which led to the creation of the CPHC, the composition and vetting of the committee, and the processes developed by the committee - including the use of external reviewers. RESULTS Outcomes of some of the more involved CPHC deliberations, specifically, decisions concerning elements of diagnoses for major depressive disorder, autism spectrum disorder, catatonia, and substance use disorders, are described. The Committee's extensive reviews and its recommendations regarding Personality Disorders are also discussed. CONCLUSIONS On the basis of our experiences, the CPHC membership unanimously believes that external review processes to evaluate and respond to Work Group proposals is essential for future DSM efforts. The Committee also recommends that separate SRC and CPHC committees be appointed to assess proposals for scientific merit and for clinical and public health utility and impact.
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Affiliation(s)
- John S McIntyre
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Joel Yager
- Department of Psychiatry, University of Colorado School of Medicine, Denver, CO, USA
| | - Anita Everett
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Cathryn A Galanter
- Department of Psychiatry, State University of New York Downstate, Kings County Hospital Center, New York, NY, USA
| | - Jeffrey M Lyness
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - James Nininger
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Victor I Reus
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Michael Vergare
- Department of Psychiatry and Human Behavior, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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Hoover-Fong J. Current state of the art in treatment of Mendelian disease: Skeletal dysplasias. Am J Med Genet A 2021; 185:3359-3368. [PMID: 34487414 DOI: 10.1002/ajmg.a.62468] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/23/2022]
Abstract
The current state of the art in treatment of Mendelian disease, specifically skeletal dysplasias, benefits tremendously from Dr. Victor McKusick's early delineation and standardization of the nomenclature surrounding these conditions. Through close observation and careful description of each dysplasia to flesh out the nosologic backbone of the genetic skeletal disorders, individuals with the same diagnosis were identified and grouped together for genetic interrogation. These efforts have resulted in the identification of the genetic etiology of nearly all recognized skeletal disorders. This, in turn, is leading to disease-specific treatment for many of the skeletal dysplasias in this new era of precision medicine. Furthermore, Dr. McKusick's natural history descriptions of many genetic skeletal disorders helped to establish the baseline disease state against which the effect of new treatment is compared.
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Affiliation(s)
- Julie Hoover-Fong
- Greenberg Center for Skeletal Dysplasias, Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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41
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Ineichen C, Baumann-Vogel H. Deconstructing Apathy in Parkinson's Disease: Challenges in Isolating Core Components of Apathy From Depression, Anxiety, and Fatigue. Front Neurol 2021; 12:720921. [PMID: 34512530 PMCID: PMC8427284 DOI: 10.3389/fneur.2021.720921] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/30/2021] [Indexed: 02/05/2023] Open
Abstract
Apathy, fatigue and depression are amongst the most debilitating non-motor syndromes of Parkinson's disease (PD). The aim of this study was to examine the prevalence of apathy, depression, anxiety and fatigue and whether these syndromes are separable in PD. A total of 337 patients were examined using the Unified Parkinson's Disease Rating Scale (UPDRS part III), the Apathy Evaluation Scale, the Hospital Anxiety and Depression Scale and the Fatigue Severity Scale. Using standard cutoff criteria, the prevalence rates of significant apathy, mild-to-severe depression, mild-to-severe anxiety and severe fatigue were 23.7, 13.4, 15.4, and 17.8%, respectively. Next, confirmatory factor analysis was employed of items from these three clinical scales. A priori hypothesis testing including four different factors (reduced motivation/interest, physical fatigue, reduced pleasure, anxiety) was performed. The factor analysis revealed strong fit statistics for the model with χ2 (57, N = 377) = 58.9, p = 0.41, CMIN/DF = 1,034, NFI = 0.977, CFI = 0.999, IFI = 0.999, RFI = 0.968, and TLI = 0.999. The RMSEA was 0.01, and the standardized RMR was 0.027. These results support the hypothesis that apathy, fatigue, depression and anxiety represent prevalent syndromes that can be separated in Parkinson's disease and that apathy is not just a subcomponent of depression or fatigue. The results of this study may contribute to a clearer diagnostic process for apathy, fatigue and depression and may aid in patient care.
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Affiliation(s)
- Christian Ineichen
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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42
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Blom JD, Sharpless BA. Life, death, genomics and psychiatry's struggle with esoteric disorders. Per Med 2021; 18:417-421. [PMID: 34431327 DOI: 10.2217/pme-2021-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Jan Dirk Blom
- Outpatient Clinic for Uncommon Psychiatric Syndromes, Parnassia Psychiatric Institute, The Hague, The Netherlands.,Institute of Psychology, Leiden University, Leiden, The Netherlands.,Department of Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Brian A Sharpless
- Department of Psychology, St. Mary's College of Maryland, St. Mary's City, MD 20686, USA.,Department of Psychology, Goldsmiths, University of London, London, UK
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43
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Martin EA, Jonas KG, Lian W, Foti D, Donaldson KR, Bromet EJ, Kotov R. Predicting Long-Term Outcomes in First-Admission Psychosis: Does the Hierarchical Taxonomy of Psychopathology Aid DSM in Prognostication? Schizophr Bull 2021; 47:1331-1341. [PMID: 33890112 PMCID: PMC8379532 DOI: 10.1093/schbul/sbab043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/14/2022]
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical, dimensional model of psychological symptoms and functioning. Its goals are to augment the use and address the limitations of traditional diagnoses, such as arbitrary thresholds of severity, within-disorder heterogeneity, and low reliability. HiTOP has made inroads to addressing these problems, but its prognostic validity is uncertain. The present study sought to test the prediction of long-term outcomes in psychotic disorders was improved when the HiTOP dimensional approach was considered along with traditional (ie, DSM) diagnoses. We analyzed data from the Suffolk County Mental Health Project (N = 316), an epidemiologic study of a first-admission psychosis cohort followed for 20 years. We compared 5 diagnostic groups (schizophrenia/schizoaffective, bipolar disorder with psychosis, major depressive disorder with psychosis, substance-induced psychosis, and other psychoses) and 5 dimensions derived from the HiTOP thought disorder spectrum (reality distortion, disorganization, inexpressivity, avolition, and functional impairment). Both nosologies predicted a significant amount of variance in most outcomes. However, except for cognitive functioning, HiTOP showed consistently greater predictive power across outcomes-it explained 1.7-fold more variance than diagnoses in psychiatric and physical health outcomes, 2.1-fold more variance in community functioning, and 3.4-fold more variance in neural responses. Even when controlling for diagnosis, HiTOP dimensions incrementally predicted almost all outcomes. These findings support a shift away from the exclusive use of categorical diagnoses and toward the incorporation of HiTOP dimensions for better prognostication and linkage with neurobiology.
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Affiliation(s)
- Elizabeth A Martin
- Department of Psychological Science, University of California, Irvine, Irvine, CA
| | | | - Wenxuan Lian
- Department of Materials Science and Engineering and Department of Applied Math and Statistics, Stony Brook University, Stony Brook, NY
| | - Dan Foti
- Department of Psychological Sciences, Purdue University, West Lafayette, IN
| | | | - Evelyn J Bromet
- Department of Psychiatry, Stony Brook University, Stony Brook, NY
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY
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Abstract
OBJECTIVE To study the features of psychopatological structure of endogenous depression in young women and to identify correlations between various clinical types of depression and their nosological affilation. MATERIAL AND METHODS The results of clinical/psychopathological examination of 107 female patients, aged 16 to 25 years, with endogenous depression with one of the following ICD-10 diagnosis: (F34.0; F31.3-F31.5; F21.3-F.21.4+F31.3-F31.5; F60.X+F31.3-F31.5) were analyzed. RESULTS Several types of endogenous depression were identified: 1) hysterical depression with hysterical-conversions, and also the phenomena of delusional fantasies; 2) dysmorphic depression with predominance of over-valued ideas of physical disability, self-inferiority and eating disorder; 3) depersonalization depression with depersonalization-derealization symptoms; 4) psychopath-like depression with exaggerated behavior, opposition and impulsivity; 5) existential depression with a feeling of losing the life meaning and often pessimistic worldview; 6) psychasthenic depression with the low self-esteem and exaggerated introspection combined with obsessive-phobic disorder; 7) anxious-melancholic depression with anxiety, melancholy and ideas of self-accusation and self-inferiority; 8) depression with symptoms of adolescent asthenic insolvency with difficulties of understanding information, increasing intellectual exhaustion. We revealed differences in motives for committing non-suicidal self-harm behavior and suicidal behavior in typological variants of depressions. CONCLUSION Hysteroform and psychopathic depressions prevail in personality disorders, while psychosthenic-like, anxious-melancholic and existential depressions are more frequent in affective disorders. Depersonalization depressions are more common in schizotypal disorder. When comparing the types of depressions in boys as reported in previous research with those in girls, the prevalence of hysteroform and anxious-melancholic variants in girls is revealed.
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45
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Aberer W. Hereditary angioedema: An orphan but an original disease? J Allergy Clin Immunol 2021; 148:994-995. [PMID: 34364956 DOI: 10.1016/j.jaci.2021.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/28/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Werner Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria.
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46
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Aftab A. Scepticism of the gentle variety: interview with Derek Bolton, PhD. Int Rev Psychiatry 2021; 33:458-462. [PMID: 33153334 DOI: 10.1080/09540261.2020.1800600] [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: 10/23/2022]
Abstract
This interview with Derek Bolton, PhD, goes into a discussion of his philosophical work on the diagnosis and definition of mental disorder, the basis of the standards or norms by which we judge that a person has a mental disorder, and the validity of the distinction between abnormal and normal mental functioning. Bolton argues that the notion that emerges from a conceptual analysis of psychiatry's diagnostic manuals is not a naturalist notion of disorder, but one that is focussed on harm and suffering, and in which the personal, the social and the biological cannot be clearly distinguished. The implications of this thinking with regards to the relationship between the medical model and the psychological approaches are also discussed. His most recent philosophical work reconceptualizes the biopsychosocial model as a philosophical theory of biopsychosocial causal interactions and he argues that there are causal regulatory functions within the psychological domain, and this is so independent of whether they can be captured by a physicochemical description of brain processes.
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Affiliation(s)
- Awais Aftab
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA.,Northcoast Behavioral Healthcare (Ohio Department of Mental Health and Addiction Services), Northfield, OH, USA
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47
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Abstract
This interview with Peter Zachar, PhD, discusses his 2014 book 'A Metaphysics of Psychopathology', and explores his application of the philosophy of scientifically-inspired pragmatism to psychiatric classification, his critique of essentialistic thinking in psychiatry, and his notion of the imperfect community model with regards to psychiatric disorders. The imperfect community is a non-essentialist idea, namely, that the various members of the class of psychiatric disorders have many things in common, but there is no one thing (an essence) that they all have in common that distinguishes them as a group from non-disorders. The resulting domain is, however, not random or arbitrary - new constructs have been introduced for reasons that reflect our scientific goals and pragmatic interests. Zachar is sceptical about the possibility of a single correct and privileged psychiatric classification, but he recognises that the ways in which psychiatric symptoms empirically cluster together places constraints on psychiatric classification that, for instance, don't apply to organising libraries. Classifications are contingent on multiple factors, including our scientific knowledge and goals. Epistemic and evaluative commitments, once identified, work together in a non-arbitrary way to constrain what counts as a good solution to the question of classification.
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Affiliation(s)
- Awais Aftab
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA.,Northcoast Behavioral Healthcare (Ohio Department of Mental Health and Addiction Services), Northfield, OH, USA
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48
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Abstract
This article provides a conceptual overview of the medical model and its application to psychiatry, understanding the medical model in psychiatry as a biopsychosocial model. The article discusses basic concepts relevant to the medical model (illness, disease, disorder, condition, etc.), the nature of medical knowledge and diagnostic construct, medical classifications in psychiatry, and the medical model within multidisciplinary practice. Salient criticisms of the medical model are discussed and addressed at relevant points. It is recognized that concepts such as disease and illness lack uncontested definitions and are not free from value judgements even in general medicine. Diagnostic constructs used in psychiatry are often descriptive heterogenous categories which can nonetheless offer clinical utility. The medical model co-exists with non-medical approaches and perspectives, and psychiatrists work in an interdisciplinary context with other models and professionals. Criticism of the medical model in psychiatry often fail to recognize the continuities between psychiatry and the rest of medicine, and the persistence of these controversies may be a result of fundamental disagreement over values.
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Affiliation(s)
- Ahmed Samei Huda
- Tameside and Glossop EIT, Pennine Care NHS Foundation Trust, Pennine Care Trust HQ, Ashton-under-Lyne, UK
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49
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Pietrzak RH, Javier FG, Krystal JH, Southwick SM. Subthreshold post-traumatic stress disorder as a risk factor for post-traumatic stress disorder: results from a sample of USA veterans. Br J Psychiatry 2021; 219:456-459. [PMID: 35048836 DOI: 10.1192/bjp.2021.17] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Subthreshold post-traumatic stress disorder (PTSD) is more prevalent than PTSD, yet its role as a potential risk factor for PTSD is unknown. To address this gap, we analysed data from a 7-year, prospective national cohort of USA veterans. Of veterans with subthreshold PTSD at wave 1, 34.3% developed PTSD compared with 7.6% of trauma-exposed veterans without subthreshold PTSD (relative risk ratio 6.4). Among veterans with subthreshold PTSD, specific PTSD symptoms, greater age, cognitive difficulties, lower dispositional optimism and new-onset traumas predicted incident PTSD. Results suggest that preventive interventions targeting subthreshold PTSD and associated factors may help mitigate risk for PTSD in USA veterans.
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Affiliation(s)
- Robert H Pietrzak
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, Connecticut, USA; and Department of Psychiatry, Yale School of Medicine, Connecticut, USA
| | - Frances G Javier
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, Connecticut, USA; and Department of Psychiatry, Yale School of Medicine, Connecticut, USA
| | - John H Krystal
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, Connecticut, USA; and Department of Psychiatry, Yale School of Medicine, Connecticut, USA
| | - Steven M Southwick
- US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, Connecticut, USA; and Department of Psychiatry, Yale School of Medicine, Connecticut, USA
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50
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Abstract
Background The detection of neural autoantibodies in patients with cognitive decline is an increasingly frequent phenomenon in memory clinics, and demanding as it does a specific diagnostic approach and therapeutic management, it deserves greater attention. It is this review’s aim to present the latest nosology of neural autoantibody-associated dementia. Methods A specific literature research via PubMed was conducted to describe the nosology of neural autoantibody-associated dementia. Results An autoimmune dementia comprises with an early onset, atypical clinical presentation and rapid progression in conjunction with neural antibodies, signs of inflammation in the cerebrospinal fluid, and a non-neurodegenerative pattern in neuroimaging. An autoimmune dementia is probably present if the patient responds to immunotherapy. Atypical dementia involving neural autoantibodies with mostly N-methyl-D-aspartate receptor antibodies might not fulfill all the autoimmune-dementia criteria, thus it may constitute an independent disease entity. Finally, a neurodegenerative dementia such as the frontotemporal type also coincides with neural autoantibodies such as the subunit ionotropic glutamate receptors 3 of amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antibodies, dementia with Lewy bodies with myelin oligodendrocytic protein, myelin basic protein antibodies, or Creutzfeldt-Jakob disease with Zic4 or voltage gated potassium channel antibodies. These dementia entities may well overlap in their clinical features and biomarkers, i.e., their neural autoantibodies or neuroimaging patterns. Conclusion There are three main forms of neural autoantibody-associated dementia we can distinguish that might also share certain features in their clinical and laboratory presentation. More research is urgently necessary to improve the diagnosis and therapy of these patients, as the progression of their dementia might thus be improved or even reversed.
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Affiliation(s)
- Niels Hansen
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
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