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Zheng K, Yu S, Chen L, Dang L, Chen B. BPI-GNN: Interpretable brain network-based psychiatric diagnosis and subtyping. Neuroimage 2024; 292:120594. [PMID: 38569980 DOI: 10.1016/j.neuroimage.2024.120594] [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: 11/03/2023] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/05/2024] Open
Abstract
Converging evidence increasingly suggests that psychiatric disorders, such as major depressive disorder (MDD) and autism spectrum disorder (ASD), are not unitary diseases, but rather heterogeneous syndromes that involve diverse, co-occurring symptoms and divergent responses to treatment. This clinical heterogeneity has hindered the progress of precision diagnosis and treatment effectiveness in psychiatric disorders. In this study, we propose BPI-GNN, a new interpretable graph neural network (GNN) framework for analyzing functional magnetic resonance images (fMRI), by leveraging the famed prototype learning. In addition, we introduce a novel generation process of prototype subgraph to discover essential edges of distinct prototypes and employ total correlation (TC) to ensure the independence of distinct prototype subgraph patterns. BPI-GNN can effectively discriminate psychiatric patients and healthy controls (HC), and identify biological meaningful subtypes of psychiatric disorders. We evaluate the performance of BPI-GNN against 11 popular brain network classification methods on three psychiatric datasets and observe that our BPI-GNN always achieves the highest diagnosis accuracy. More importantly, we examine differences in clinical symptom profiles and gene expression profiles among identified subtypes and observe that our identified brain-based subtypes have the clinical relevance. It also discovers the subtype biomarkers that align with current neuro-scientific knowledge.
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Affiliation(s)
- Kaizhong Zheng
- National Key Laboratory of Human-Machine Hybrid Augmented Intelligence, National Engineering Research Center for Visual Information and Applications, and Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, China.
| | - Shujian Yu
- Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Machine Learning Group, UiT - Arctic University of Norway, Tromsø, Norway.
| | - Liangjun Chen
- National Key Laboratory of Human-Machine Hybrid Augmented Intelligence, National Engineering Research Center for Visual Information and Applications, and Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, China.
| | - Lujuan Dang
- National Key Laboratory of Human-Machine Hybrid Augmented Intelligence, National Engineering Research Center for Visual Information and Applications, and Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, China.
| | - Badong Chen
- National Key Laboratory of Human-Machine Hybrid Augmented Intelligence, National Engineering Research Center for Visual Information and Applications, and Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University, Xi'an, China.
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Thomsen MK, Jørgensen MD, Pedersen L, Erichsen R, Sørensen HT, Mikkelsen EM. Mental disorders, participation, and trajectories in the Danish colorectal cancer programme: a population-based cohort study. Lancet Psychiatry 2023; 10:518-527. [PMID: 37353263 DOI: 10.1016/s2215-0366(23)00179-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND People with mental disorders exhibit increased mortality due to colorectal cancer, despite having a similar incidence to the general population. We aimed to evaluate the extent to which people with mental disorders participate in organised colorectal cancer screening. METHODS We conducted a population-based cohort study of all Danish residents aged 50-74 years who were invited to undergo biennial faecal immunochemical testing between March 1, 2014, and Sept 30, 2018. We used national registry data from all first-time invitees. The primary endpoint was participation within 90 days of invitation. We calculated the proportion who participated and assessed their screening results and adherence to and completeness of follow-up colonoscopy according to their history of mental disorders, classified as none, mild or moderate, or severe. We computed crude and adjusted participation differences in percentage points and participation ratios using the pseudo-observations method. FINDINGS Of 2 036 704 people who were invited, we included 2 036 352 in the final cohort, of whom 1 008 045 (49·5%) were men and 1 028 307 (50·5%) were women, with a mean age of 60·7 years (SD 8·3, range 49-78). Data on ethnicity were not collected. Compared with people with no mental disorders, the adjusted analysis showed lower participation among people with mild or moderate mental disorders (men: participation difference -4·4 percentage points [95% CI -4·7 to -4·1]; women: -3·8 percentage points [-4·1 to -3·6]) and severe mental disorders (men: participation difference -13·8 percentage points [-14·3 to -13·3]; women: -15·4 percentage points [-15·8 to -14·9]). People with mental disorders had a higher proportion of positive faecal immunochemical test results, lower adherence to colonoscopy, and more incomplete colonoscopies than people without mental disorders. INTERPRETATION People with mental disorders were less likely to participate in colorectal cancer screening than those without these disorders. Patients with mental disorders could benefit from support or encouragement from their general practitioner or mental health-care facility to participate in cancer screening. Potential interventions should consider type of mental disorder, as needs might differ. FUNDING Danish Cancer Society, Danish Health Foundation.
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Affiliation(s)
- Mette Kielsholm Thomsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; CASTLE - Cancer Survivorship and Treatment Late Effects, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marie Dahl Jørgensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Surgery, Randers Regional Hospital, Randers, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
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Yang D, Qiu B, Jiang J, Xia Y, Li L, Li Y, Luo L, Liu X, Meng J. Development of inferiority-compensation scale among high school students. BMC Med Educ 2023; 23:23. [PMID: 36635748 PMCID: PMC9837908 DOI: 10.1186/s12909-022-03979-3] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
An increasing number of high school students are inflicted by different degrees of mental disorders in learning, such as moodiness, learning difficulties, test anxiety, difficulty coping with frustration, etc., which are one of the factors leading to the inferiority of students. In the present study, the initial scale of inferiority compensation for high school students was developed through literature searching, expert evaluation, interviews, and an open scale. 1187 high school students were tested in different periods, after deleting an invalid 83 scales, including 461 copies of valid scale of exploratory factor analysis in the first stage and 643 copies of valid scale of confirmatory factor analysis in the second stage. The results showed that the inferiority compensation scale for high school students consisted of two sub-scale: self-compensation and others-compensation, ach two were composed of five dimensions including academic performance, physical fitness, social communication, appearance, and self-esteem. Confirmatory factor analysis showed that the total scale and the two sub-scale all had good structural validity (RMSEA≤0.08; CFI&IFI ≥ 0.9), and the combined reliability and values (such as the correlation coefficient of each dimension) of the two sub-scale were within the ideal range. With good reliability and validity (Cronbacα&KMO ≥ 0.90), and meeting the requirements of psychometrics, the scale can be used in the relevant research and practice of inferiority compensation for high school students.
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Affiliation(s)
- Di Yang
- Key Laboratory of Applied Psychology, Chongqing Normal University, Chongqing, China
- Research Center for Brain and Cognitive Science, Chongqing Normal University, Chongqing, 401331, China
| | - Baiyang Qiu
- Chongqing Youth Vocational & Technical College, Chongqing Youth Vocational & Technical College, Chongqing, China
| | - Jin Jiang
- Key Laboratory of Applied Psychology, Chongqing Normal University, Chongqing, China
- Research Center for Brain and Cognitive Science, Chongqing Normal University, Chongqing, 401331, China
| | - Youkui Xia
- Key Laboratory of Applied Psychology, Chongqing Normal University, Chongqing, China
- Research Center for Brain and Cognitive Science, Chongqing Normal University, Chongqing, 401331, China
| | - Lingxiao Li
- Key Laboratory of Applied Psychology, Chongqing Normal University, Chongqing, China
- Research Center for Brain and Cognitive Science, Chongqing Normal University, Chongqing, 401331, China
| | - Yanting Li
- Key Laboratory of Applied Psychology, Chongqing Normal University, Chongqing, China
- Research Center for Brain and Cognitive Science, Chongqing Normal University, Chongqing, 401331, China
| | - Longli Luo
- Key Laboratory of Applied Psychology, Chongqing Normal University, Chongqing, China
- Research Center for Brain and Cognitive Science, Chongqing Normal University, Chongqing, 401331, China
| | - Xiaocui Liu
- Key Laboratory of Applied Psychology, Chongqing Normal University, Chongqing, China
- Research Center for Brain and Cognitive Science, Chongqing Normal University, Chongqing, 401331, China
| | - Jing Meng
- Key Laboratory of Applied Psychology, Chongqing Normal University, Chongqing, China.
- Research Center for Brain and Cognitive Science, Chongqing Normal University, Chongqing, 401331, China.
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Radhakrishnan L, Leeb RT, Bitsko RH, Carey K, Gates A, Holland KM, Hartnett KP, Kite-Powell A, DeVies J, Smith AR, van Santen KL, Crossen S, Sheppard M, Wotiz S, Lane RI, Njai R, Johnson AG, Winn A, Kirking HL, Rodgers L, Thomas CW, Soetebier K, Adjemian J, Anderson KN. Pediatric Emergency Department Visits Associated with Mental Health Conditions Before and During the COVID-19 Pandemic - United States, January 2019-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:319-324. [PMID: 35202358 DOI: 10.15585/mmwr.mm7108e2] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In 2021, a national emergency* for children's mental health was declared by several pediatric health organizations, and the U.S. Surgeon General released an advisory† on mental health among youths. These actions resulted from ongoing concerns about children's mental health in the United States, which was exacerbated by the COVID-19 pandemic (1,2). During March-October 2020, among all emergency department (ED) visits, the proportion of mental health-related visits increased by 24% among U.S. children aged 5-11 years and 31% among adolescents aged 12-17 years, compared with 2019 (2). CDC examined changes in U.S. pediatric ED visits for overall mental health conditions (MHCs) and ED visits associated with specific MHCs (depression; anxiety; disruptive behavioral and impulse-control disorders; attention-deficit/hyperactivity disorder; trauma and stressor-related disorders; bipolar disorders; eating disorders; tic disorders; and obsessive-compulsive disorders [OCD]) during 2019 through January 2022 among children and adolescents aged 0-17 years, overall and by sex and age. After declines in weekly visits associated with MHCs among those aged 0-17 years during 2020, weekly numbers of ED visits for MHCs overall and for specific MHCs varied by age and sex during 2021 and January 2022, when compared with corresponding weeks in 2019. Among adolescent females aged 12-17 years, weekly visits increased for two of nine MHCs during 2020 (eating disorders and tic disorders), for four of nine MHCs during 2021 (depression, eating disorders, tic disorders, and OCD), and for five of nine MHCs during January 2022 (anxiety, trauma and stressor-related disorders, eating disorders, tic disorders, and OCD), and overall MHC visits during January 2022, compared with 2019. Early identification and expanded evidence-based prevention and intervention strategies are critical to improving children's and adolescents' mental health (1-3), especially among adolescent females, who might have increased need.
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Su TP, Chen MH, Tu PC. Using big data of genetics, health claims, and brain imaging to challenge the categorical classification in mental illness. J Chin Med Assoc 2022; 85:139-144. [PMID: 34861668 DOI: 10.1097/jcma.0000000000000675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Psychiatric disorders in first-degree relatives (FDRs) often differ from the index patient's diagnosis, suggesting that there is genetic contribution to psychiatric disorders in which related cases do not all map to the same diagnosis as the index case. Our aim is to look for psychiatric comorbidities across major mental illnesses using three approaches, genetics, clinical diagnosis, and brain imaging to address common associations and pathology among mental illnesses. Genome-wide association studies from the Psychiatric Genomics Consortium showed single gene polymorphisms are common across 5 major psychiatric disorders, including schizophrenia (SZ), bipolar disorder (BD), major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD). Clinically, results of Taiwan's nationwide population studies showed that other major psychiatric disorders were more likely to coaggregate in families with an index case of an individual with a psychiatric disorder, compared to control families. Finally, resting functional connectivity (FC) magnetic resonance imaging (MRI) and whole-brain connectomic analysis of SZ, BD I, BD II, MDD, and healthy controls revealed that the four groups of patients shared similar patterns of abnormal neural substrate in the brain that differed from controls. In conclusion, using big data from genetics, administrative health claims, and brain imaging, we identified concordance, indicating dimensional coherence of genetic heritability, clinical mutual associations, and common neurobiological substrates across major psychiatric disorders. These results will challenge the current diagnostic classification system and possibly move psychiatry beyond descriptive syndromes towards a nosology informed by disease cause.
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Affiliation(s)
- Tung-Ping Su
- Department of Psychiatry, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Brain Science Institute, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Pei-Chi Tu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Philosophy of Mind and Cognition, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Cao H, Wang J, Baranova A, Zhang F. Classifying major mental disorders genetically. Prog Neuropsychopharmacol Biol Psychiatry 2022; 112:110410. [PMID: 34339760 DOI: 10.1016/j.pnpbp.2021.110410] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 03/16/2021] [Revised: 06/24/2021] [Accepted: 07/26/2021] [Indexed: 01/09/2023]
Abstract
Typically, mental disorders are defined and classified based on clinical symptoms and syndromes. Although clinically useful, current diagnostic systems for psychiatry cause concerns due to the lack of biological mechanisms. Deciphering the relationships among psychiatric traits according to their genetic basis may facilitate understanding the biological mechanisms of psychiatric disorders. Ten mental disorders were classified by genomic structural equation modeling (SEM), which leverages summary results of genome-wide association studies. Attention-deficit/hyperactivity disorder (ADHD), anorexia nervosa (AN), anxiety disorder (ANX), autism spectrum disorder (ASD), bipolar disorder (BD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), schizophrenia (SZ), and Tourette syndrome (TS) were included. The analysis indicates that they are genetically inter-correlated with one another and can be separated based on their general psychopathology. Most disorders have a close partner, forming pairs of traits; only TS is a relatively distinctive condition. At a higher level, MDD, ANX, ADHD, ASD, and PTSD cluster together, while OCD, AN, and TS cluster together. Together, the ten traits constitute a hierarchical classificatory system. This study allows inference of genetically determined classification of the ten mental disorders, which may biologically inform the current diagnostic framework and treatment regimens for mental disorders.
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Affiliation(s)
- Hongbao Cao
- School of Systems Biology, George Mason University (GMU), Fairfax, VA 22030, USA
| | - Jun Wang
- Department of Clinical Psychology, The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, Jiangsu Province 214151, China
| | - Ancha Baranova
- School of Systems Biology, George Mason University (GMU), Fairfax, VA 22030, USA; Research Centre for Medical Genetics, Moscow 115478, Russia
| | - Fuquan Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu Province 210029, China.
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Wiese W, Friston KJ. AI ethics in computational psychiatry: From the neuroscience of consciousness to the ethics of consciousness. Behav Brain Res 2021; 420:113704. [PMID: 34871706 PMCID: PMC9125160 DOI: 10.1016/j.bbr.2021.113704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022]
Abstract
Methods used in artificial intelligence (AI) overlap with methods used in computational psychiatry (CP). Hence, considerations from AI ethics are also relevant to ethical discussions of CP. Ethical issues include, among others, fairness and data ownership and protection. Apart from this, morally relevant issues also include potential transformative effects of applications of AI—for instance, with respect to how we conceive of autonomy and privacy. Similarly, successful applications of CP may have transformative effects on how we categorise and classify mental disorders and mental health. Since many mental disorders go along with disturbed conscious experiences, it is desirable that successful applications of CP improve our understanding of disorders involving disruptions in conscious experience. Here, we discuss prospects and pitfalls of transformative effects that CP may have on our understanding of mental disorders. In particular, we examine the concern that even successful applications of CP may fail to take all aspects of disordered conscious experiences into account. Considerations from AI ethics are also relevant to the ethics of computational psychiatry. Ethical issues include, among others, fairness and data ownership and protection. They also include potential transformative effects. Computational psychiatry may transform conceptions of mental disorders and health. Disordered conscious experiences may pose a particular challenge.
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Affiliation(s)
- Wanja Wiese
- Institute of Philosophy II, Ruhr University Bochum, Universitätsstraße 150, 44780 Bochum, Germany.
| | - Karl J Friston
- Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London WC1N 3AR, UK
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Chan SKW, Lee KKW, Chan VHY, Pang HH, Wong CSM, Hui CLM, Chang WC, Lee EHM, Chan WC, Cheung EFC, Chiu HFK, Chiang TP, Lam M, Lau JTF, Ng RMK, Hung SF, Lam LCW, Chen EYH. The 12-month prevalence of psychotic experiences and their association with clinical outcomes in Hong Kong: an epidemiological and a 2-year follow up studies. Psychol Med 2021; 51:2501-2508. [PMID: 32466813 DOI: 10.1017/s0033291720001452] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The relationship between the subtypes of psychotic experiences (PEs) and common mental health symptoms remains unclear. The current study aims to establish the 12-month prevalence of PEs in a representative sample of community-dwelling Chinese population in Hong Kong and explore the relationship of types of PEs and common mental health symptoms. METHOD This is a population-based two-phase household survey of Chinese population in Hong Kong aged 16-75 (N = 5719) conducted between 2010 and 2013 and a 2-year follow-up study of PEs positive subjects (N = 152). PEs were measured with Psychosis Screening Questionnaire (PSQ) and subjects who endorsed any item on the PSQ without a clinical diagnosis of psychotic disorder were considered as PE-positive. Types of PEs were characterized using a number of PEs (single v. multiple) and latent class analysis. All PE-positive subjects were assessed with common mental health symptoms and suicidal ideations at baseline and 2-year follow-up. PE status was also assessed at 2-year follow-up. RESULTS The 12-month prevalence of PEs in Hong Kong was 2.7% with 21.1% had multiple PEs. Three latent classes of PEs were identified: hallucination, paranoia and mixed. Multiple PEs and hallucination latent class of PEs were associated with higher levels of common mental health symptoms. PE persistent rate at 2-year follow-up was 15.1%. Multiple PEs was associated with poorer mental health at 2-year follow-up. CONCLUSIONS Results highlighted the transient and heterogeneous nature of PEs, and that multiple PEs and hallucination subtype of PEs may be specific indices of poorer common mental health.
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Affiliation(s)
- Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
| | | | - Veronica Hei Yan Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Herbert H Pang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Corine Sau Man Wong
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | | | | | | | | | - Joseph Tak Fai Lau
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong
| | | | - Se Fong Hung
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | | | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
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Abstract
ABSTRACT After a long and torturous path, an elusive quest for structure and order may have misled the American Psychiatric Association to overexpand the scope of its Diagnostic and Statistical Manual (DSM) codification of mental disorders. The DSM and guidelines came to represent American psychiatry to the world. Although important for epidemiological and statistical research, in volume and complexity, the DSM challenges clinicians. The DSM effort at categorization must be reconceived to acknowledge modern biological realities. Molecular and other selective biological sciences no longer dominate biology as they did at the time of DSM's initial conception. Today, a Darwinian-Hippocratic combined biology leads psychiatry to address individuals and populations irretrievably and uniquely interdependent with environments. Unfortunately, the DSM, as currently conceived, fails to support this emerging 21st century biological grounding for psychiatry.
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Affiliation(s)
- Robert E Becker
- Drug Design and Development Section, Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, Baltimore, Maryland; and Aristea Translational Medicine Corp, Park City, Utah
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Abstract
The question of 'what is a mental disorder?' is central to the philosophy of psychiatry, and has crucial practical implications for psychiatric nosology. Rather than approaching the problem in terms of abstractions, we review a series of exemplars - real-world examples of problematic cases that emerged during work on and immediately after DSM-5, with the aim of developing practical guidelines for addressing future proposals. We consider cases where (1) there is harm but no clear dysfunction, (2) there is dysfunction but no clear harm, and (3) there is possible dysfunction and/or harm, but this is controversial for various reasons. We found no specific criteria to determine whether future proposals for new entities should be accepted or rejected; any such proposal will need to be assessed on its particular merits, using practical judgment. Nevertheless, several suggestions for the field emerged. First, while harm is useful for defining mental disorder, some proposed entities may require careful consideration of individual v. societal harm, as well as of societal accommodation. Second, while dysfunction is useful for defining mental disorder, the field would benefit from more sharply defined indicators of dysfunction. Third, it would be useful to incorporate evidence of diagnostic validity and clinical utility into the definition of mental disorder, and to further clarify the type and extent of data needed to support such judgments.
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Affiliation(s)
- Dan J. Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Andrea C. Palk
- Department of Philosophy, Stellenbosch University, Stellenbosch, South Africa
| | - Kenneth S. Kendler
- Virginia Institute of Psychiatric and Behavioral Genetics and Departments of Psychiatry, and Human and Molecular Genetics, School of Medicine/Virginia Commonwealth University, VA, USA
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Yager J. Can Trans-Syndromal Prototypes ("Types") Improve Depiction of Complex Psychiatric Cases?: An Alternative Way to Consider Concordant Comorbid Psychiatric Disorders and Their Contexts as Coherent Units for Research, Assessment, and Treatment Planning. J Nerv Ment Dis 2021; 209:1-8. [PMID: 33141784 DOI: 10.1097/nmd.0000000000001261] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS In many psychiatric settings, patients with complex cases are the rule rather than the exception. These cases are characterized by multidiagnostic conditions, often complicated with distressed social contexts, for which few if any evidence-based practice guidelines exist. The aim of this hypothesis-generating article is to consider whether and how these cases might comprise trans-syndromal prototypes ("types"), coherent units that could serve as the basis for further study, assessment, and treatment planning. METHODS For context, psychiatric and medical visit diagnoses and problem lists noted among principle visit diagnoses and "snapshot" portions of electronic medical records were tabulated for 293 psychiatric outpatients seen consecutively during a 1-week period at a university psychiatric clinic. By considering resulting comorbidity patterns in these records from the perspectives of clinicians caring for these patients, several commonly encountered diagnostic-problem sets emerged as candidate types. RESULTS Of 293 patients, only 18% had a single diagnosis, 43% had two, 29% had three, and 7% had four or more noted. Occurring in assorted combinations, specific diagnostic areas noted included depressive disorders (68%, the large majority major depressive disorder recurrent), anxiety disorders (60%, the large majority generalized anxiety disorder, with or without panic disorder and/or social anxiety disorder), posttraumatic stress disorder (22%), attention deficit hyperactivity disorder (ADHD) (17%), alcohol and substance abuse disorders (16%), personality disorders (11%), and bipolar disorders (18%). Several illustrative candidate types emerging from this population are described including major anxious depressive disorder, anxiety disorder secondary to ADHD, complex emotional instability disorder, multi-impulsive eating disorder, substance-dependent impoverished personality disorder, painful mood disorder, and complex personal and cultural trauma disorder. Other potential types are identified as well. CONCLUSIONS AND IMPLICATIONS The types described here are but a small selection, because other settings including community mental health centers, private practices, public and private hospitals, and forensic facilities see a variety of other types as well. The study of types might provide important findings about pathogenesis, course, outcome, and treatment to augment information obtained from examination of individual diagnostic components.
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Affiliation(s)
- Joel Yager
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
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Zugai JS. Use of the DSM in undergraduate mental health nursing education: Friend or foe? A contemporary issue. Nurse Educ Today 2020; 93:104526. [PMID: 32653536 DOI: 10.1016/j.nedt.2020.104526] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 05/10/2020] [Accepted: 06/30/2020] [Indexed: 06/11/2023]
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Moore TM, Kaczkurkin AN, Durham EL, Jeong HJ, McDowell MG, Dupont RM, Applegate B, Tackett JL, Cardenas-Iniguez C, Kardan O, Akcelik GN, Stier AJ, Rosenberg MD, Hedeker D, Berman MG, Lahey BB. Criterion validity and relationships between alternative hierarchical dimensional models of general and specific psychopathology. J Abnorm Psychol 2020; 129:677-688. [PMID: 32672986 PMCID: PMC7541771 DOI: 10.1037/abn0000601] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
[Correction Notice: An Erratum for this article was reported in Vol 129(7) of Journal of Abnormal Psychology (see record 2020-72912-001). In the article (http://dx.doi.org/10.1037/abn0000601), an acknowledgment is missing from the author note. The missing acknowledgement is included in the erratum.] Psychopathology can be viewed as a hierarchy of correlated dimensions. Many studies have supported this conceptualization, but they have used alternative statistical models with differing interpretations. In bifactor models, every symptom loads on both the general factor and 1 specific factor (e.g., internalizing), which partitions the total explained variance in each symptom between these orthogonal factors. In second-order models, symptoms load on one of several correlated lower-order factors. These lower-order factors load on a second-order general factor, which is defined by the variance shared by the lower-order factors. Thus, the factors in second-order models are not orthogonal. Choosing between these valid statistical models depends on the hypothesis being tested. Because bifactor models define orthogonal phenotypes with distinct sources of variance, they are optimal for studies of shared and unique associations of the dimensions of psychopathology with external variables putatively relevant to etiology and mechanisms. Concerns have been raised, however, about the reliability of the orthogonal specific factors in bifactor models. We evaluated this concern using parent symptom ratings of 9-10 year olds in the ABCD Study. Psychometric indices indicated that all factors in both bifactor and second-order models exhibited at least adequate construct reliability and estimated replicability. The factors defined in bifactor and second-order models were highly to moderately correlated across models, but have different interpretations. All factors in both models demonstrated significant associations with external criterion variables of theoretical and clinical importance, but the interpretation of such associations in second-order models was ambiguous due to shared variance among factors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Tyler M Moore
- Department of Psychiatry, University of Pennsylvania
| | | | | | | | | | | | - Brooks Applegate
- Department of Educational Leadership, Research and Technology, Western Michigan University
| | | | | | - Omid Kardan
- Departments of Psychology and Public Health Sciences, University of Chicago
| | - Gaby N Akcelik
- Departments of Psychology and Public Health Sciences, University of Chicago
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Chen R, Lee K, Herskovits EH. Computational framework for detection of subtypes of neuropsychiatric disorders based on DTI-derived anatomical connectivity. Neuroradiol J 2020; 33:393-399. [PMID: 32894990 PMCID: PMC7482041 DOI: 10.1177/1971400920950694] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Many brain disorders - such as Alzheimer's disease, Parkinson's disease, schizophrenia and autism - are heterogeneous, that is, they may have several subtypes. Traditionally, clinicians have identified subtypes, such as subtypes of psychosis, using clinical criteria. Neuroimaging has the potential to detect subtypes based on objective biomarker-based criteria; however, there are no studies that evaluate the application of combining unsupervised machine learning and anatomical connectivity analysis to accomplish this goal. We propose a computational framework to detect subtypes based on anatomical connectivity computed from diffusion tensor imaging data, in a data-driven and fully automated way. The proposed method exhibits excellent performance on simulated data. We also applied this approach to a real-world dataset: the Nathan Kline Institute data set. The Nathan Kline Institute study consists of 137 normal adult subjects (mean age 41 years (standard deviation 18), male/female 85/52). We examined the association between detected subtypes and the impulsive behavior scale. We found that a subtype characterized by lower connectivity scores was associated with a higher positive urgency score; positive urgency is a vulnerability marker for drug addiction. The top-ranked connections characterizing subtypes involve several brain regions, including the anterior cingulate gyrus, median cingulate gyrus, thalamus, superior frontal gyrus (medial), middle frontal gyrus (orbital part), inferior frontal gyrus (triangular part), superior frontal gyrus, precuneus and putamen. The proposed framework is extendable, and can be used to detect subtypes from other features, including clinical and genomic biomarkers.
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Affiliation(s)
- Rong Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, USA
| | - Kyunghun Lee
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, USA
| | - Edward H Herskovits
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, USA
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Pajević I, Žigić N, Bećirović E, Pajević A. Psychological Disorders in Childhood and Adolescent Age - New Classifications. Psychiatr Danub 2020; 32:311-315. [PMID: 33030445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The eleventh revision of the International Classification of Diseases (ICD-11) is planned to be published in 2018. So called, "beta version" of the chapter of mental and behavioral disorders (ICD-11) is already available and it is considered that there will be no significant deviations in the final version. The DSM-5 was released in 2013. Changes related to mental disorders in child and adolescent psychiatry have been made in both of these classifications. To identify changes in the classifications of mental disorders in childhood and adolescent age in beta version of ICD-11 and DSM-5. METHODS Review of mental disorders in childhood and adolescent age and their classification in ICD-11 and DSM-5. RESULTS For disorders that are classified as "mental retardation" in ICD-10, a new term "intellectual development disorders" has been introduced in ICD-11, ie "intellectual disabilities" in DSM-5. Hyperactivity disorders and attention deficit is a separate entity in relation to ICD-10, in which it is classified as a hyperkinetic disorder. Asperger's syndrome, which is isolated from autism spectrum disorders in DSM-5, does not appear under that name in ICD-11 either. Elimination disorders are in a separate block MKB-11 and DSM-5. Speech and language disorders are classified as communication disorders in the DSM-5 classification. Selective mutism and anxiety separation disorder in childhood are in the block of anxiety and fear-related disorders in ICD-11, and among anxiety disorders in DSM-5, respectively. Reactive emotional disorder and disinhibited attachment disorder of childhood are classified as stress-related disorders in ICD-11 and DSM-5. CONCLUSIONS The new classifications (ICD-11 and DSM-5) classify mental disorders in child and adolescent psychiatry somewhat differently from their antecedents. New entities have also been formed.
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Affiliation(s)
- Izet Pajević
- Department of Psychiatry, University Clinical Center Tuzla, Ul. Rate Dugonjića bb, 75000 Tuzla, Bosnia and Herzegovina,
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16
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Abstract
Categorising mental disorders for purposes of diagnosis, research and practice has historically been justified on philosophical terms as a pragmatic activity; categories which have been subject to wide-ranging philosophical critique have been defended on the grounds that they serve as heuristic devices providing loose representations of shared experiences, not labels for real structures. In acknowledgement of this, there has been increasing recognition that subclassifying multiple discrete forms of persistent depression moves too far away from the notion of a heuristic and that attempts to create more precise categories become less clinically useful. Hence the most recent Diagnostic and Statistical Manual of Mental Disorders (V.5) and International Classification of Diseases (V.11) both group persistent forms of depression together. However, the UK National Institute for Health and Care Excellence has delineated certain subclassifications of persistent depression in its new guideline, which grossly distorts the phenomenology of depression. This approach commits a fundamental philosophical error in conflating absence of knowledge with knowledge of absence. In this sense, the new guideline appears to be engaging in an activity akin to the digital game Minecraft, in which the craft of building structures from units of construction is largely divorced from the laws of physics. The risk of ignoring these philosophical errors and making false claims about scientific plausibility is that the guideline recommendations inevitably represent a highly distorted phenomenology of depression and will be of very little value to patients or practitioners looking for guidance on best possible treatment options.
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Affiliation(s)
- Susan McPherson
- Health and Social Care, University of Essex, Colchester CO4 3SQ, UK
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Dias de Castro Bins H, Dotta Panichi RM, Vernet Taborda JG, Arzeno Ferrão Y. Childhood trauma, psychiatric disorders, and criminality in women: Associations with serum levels of brain-derived neurotrophic factor. Int J Law Psychiatry 2020; 71:101574. [PMID: 32768114 DOI: 10.1016/j.ijlp.2020.101574] [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] [Received: 02/26/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
Psychiatric disorders and childhood trauma are highly prevalent in female inmates. Brain-derived neurotrophic factor (BDNF) plays a number of roles in neuronal survival, structure, and function. Data in the literature suggest that it is a neurobiological substrate that moderates the impact of childhood adversities on the late expression of psychiatric disorders. The aim of this study was to determine whether five childhood trauma subtypes-physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect-are associated with adult psychiatric disorders, BDNF levels, and criminality among incarcerated women. This was a cross-sectional study involving a consecutive sample of 110 women, divided into three groups of women (forensic - mentally ill who committed crimes, clinical psychiatric inpatients and healthy controls). The Childhood Trauma Questionnaire and the Mini-International Neuropsychiatric Interview-Plus were applied in the whole sample, and BDNF levels were measured in a sub-sample of 54 women. The rates of mental illness and childhood trauma were high in the forensic group. Emotional abuse was higher in the clinical and forensic groups than in the healthy control group. Lower BDNF levels were associated with emotional abuse in the forensic group as well as with sexual abuse in the healthy control group. After multinomial logistic regression, lower levels of BDNF, higher levels of emotional abuse and the presence of familial offense were considered factors related to clinical psychiatric group. The results of this study underscore the idea that BDNF may be an important factor related to the development of diseases and criminality in women who are victims of childhood trauma, becoming a possible biological marker.
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Affiliation(s)
- Helena Dias de Castro Bins
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (Federal University of Health Sciences of Porto Alegre), Porto Alegre, Brazil.
| | - Renata Maria Dotta Panichi
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (Federal University of Health Sciences of Porto Alegre), Porto Alegre, Brazil
| | - José Geraldo Vernet Taborda
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (Federal University of Health Sciences of Porto Alegre), Porto Alegre, Brazil
| | - Ygor Arzeno Ferrão
- Department of Clinical Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (Federal University of Health Sciences of Porto Alegre), Porto Alegre, Brazil
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Abstract
Taxometric procedures have been used extensively to investigate whether individual differences in personality and psychopathology are latently dimensional or categorical ('taxonic'). We report the first meta-analysis of taxometric research, examining 317 findings drawn from 183 articles that employed an index of the comparative fit of observed data to dimensional and taxonic data simulations. Findings supporting dimensional models outnumbered those supporting taxonic models five to one. There were systematic differences among 17 construct domains in support for the two models, but psychopathology was no more likely to generate taxonic findings than normal variation (i.e. individual differences in personality, response styles, gender, and sexuality). No content domain showed aggregate support for the taxonic model. Six variables - alcohol use disorder, intermittent explosive disorder, problem gambling, autism, suicide risk, and pedophilia - emerged as the most plausible taxon candidates based on a preponderance of independently replicated findings. We also compared the 317 meta-analyzed findings to 185 additional taxometric findings from 96 articles that did not employ the comparative fit index. Studies that used the index were 4.88 times more likely to generate dimensional findings than those that did not after controlling for construct domain, implying that many taxonic findings obtained before the popularization of simulation-based techniques are spurious. The meta-analytic findings support the conclusion that the great majority of psychological differences between people are latently continuous, and that psychopathology is no exception.
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Affiliation(s)
- Nick Haslam
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Melanie J McGrath
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Peter Kuppens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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Zima BT, Gay JC, Rodean J, Doupnik SK, Rockhill C, Davidson A, Hall M. Classification System for International Classification of Diseases, Ninth Revision, Clinical Modification and Tenth Revision Pediatric Mental Health Disorders. JAMA Pediatr 2020; 174:620-622. [PMID: 32202603 PMCID: PMC7091372 DOI: 10.1001/jamapediatrics.2020.0037] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/28/2019] [Indexed: 11/14/2022]
Affiliation(s)
- Bonnie T. Zima
- UCLA Center for Health Services & Society, UCLA-Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles
| | - James C. Gay
- Monroe Carell Jr Children’s Hospital at Vanderbilt, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Carol Rockhill
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle
| | | | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
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Abstract
AbstractObjectiveThe present study examined the prevalence of DSM IV axis I disorders and DSM IV personality disorders among sexual offenders in Forensic State Hospitals in Germany.MethodCurrent and lifetime prevalence rates of mental disorders were investigated based on clinical structured interviews among sexual offenders (n = 55). Additionally, subgroups were analyzed on the basis of diagnostic research criteria, with 30 sexual offenders classified as paraphiliacs and 25 sexual offenders as having an impulse control disorder (without paraphilia).ResultsAnxiety disorders, mood disorders, and substance use disorders were common among sexual offenders, as were cluster B and cluster C personality disorders. While social phobia was most common among paraphilic sexual offenders, major depression was most prevalent in impulse control disordered sexual offenders.ConclusionThe results replicate recent findings of high psychiatric morbidity in sexual offenders placed in forensic facilities. Furthermore, differential patterns of co-morbid mental disorders were found in paraphiliacs and impulse control disordered sexual offenders. With regard to an effective therapy and relapse prevention co-morbid mental disorders should be a greater focus in the assessment of subgroups of sexual offenders.
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Affiliation(s)
- Anja Leue
- Central Institute of Mental Health, Mannheim, J5, 68159 Mannheim, Germany.
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21
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Abstract
AbstractBody dysmorphic disorder (BDD) is currently classified as a somatoform disorder in DSM-IV, but has been long noted to have some important similarities with obsessive—compulsive disorder (OCD). In addition, BDD and OCD have been often reported to be comorbid with each other. In the present study, we compared demographic characteristics, clinical features and psychiatric comorbidity in patients with OCD, BDD or comorbid BDD—OCD (34 subjects with BDD, 79 with OCD and 24 with BDD—OCD). We also compared the pattern of body dysmorphic concerns and associated behaviors in BDD patients with or without OCD comorbidity. In our sample, BDD and OCD groups showed similar sex ratio. Both groups with BDD and BDD—OCD were significantly younger, and experienced the onset of their disorder at a significantly younger age than subjects with OCD. The two BDD groups were also less likely to be married, and more likely to be unemployed and to have achieved lower level degree, than OCD subjects even when controlling for age. The three groups were significantly different in the presence of comorbid bulimia, alcohol-related and substance-use disorders, BDD—OCD patients showing the highest rate and OCD the lowest. BDD—OCD reported more comorbid bipolar II disorder and social phobia than in the other two groups, while generalized anxiety disorder was observed more frequently in OCD patients. Patients with BDD and BDD—OCD were similar as regards the presence of repetitive BDD-related behaviors, such as mirror-checking or camouflaging. Both groups also did show a similar pattern of distribution as regards the localization of the supposed physical defects in specific areas of the body. The only significant difference concerned the localization in the face, that was more frequent in the BDD group. Our results do not contradict the proposed possible conceptualization of BDD as an OCD spectrum disorder. However, BDD does not appear to be a simple clinical variant of OCD and it seems to be also related to social phobia, mood, eating and impulse control disorders. The co-presence of BDD and OCD features appears to possibly individuate a particularly severe form of the syndrome, with a greater load of psychopathology and functional impairment and a more frequent occurrence of other comorbid mental disorders.
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Affiliation(s)
- Franco Frare
- Department of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy
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22
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Tiganov AS, Savenko YS. The necessity of developing a two-stage qualification in ICD-11. Psychiatriki 2020; 31:172-176. [PMID: 32840221 DOI: 10.22365/jpsych.2020.312.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In the International Classification of Diseases, 10th Revision (ICD-10) two opposing principles are combined and mixed: atheoreticity that is necessary for the natural classification and commitment to nosology. Implementation of these principles requires a two-stage qualification. The first stage should be narrative detailed syndromological qualifications with identification of psychotic level of disorders. As for the second stage, the qualification should be nosological, based on complete clinical analysis, which is far from being possible to realize at once. ICD-10, specifically brought to nosological certainty, may remain the natural foundation for nosological qualification. Implementation of the syndromic qualification at the first stage will allow to consider nosological features of each syndrome at the second stage and to expand the list of criteria in different clusters. Such a suggestion opens the prospect for subsequent revisions of the ICD and allows to direct our efforts and those of practitioners to the unified channel, where the statistical goals would not be implemented at the expense of the research ones.
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Affiliation(s)
- A S Tiganov
- The Mental Health Research Center of the Russian Academy of Sciences
| | - Yu S Savenko
- Independent Psychiatric Association of Russia, Russia
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23
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Ouliaris C. Considering context: lessons from global mental health. Australas Psychiatry 2020; 28:210-212. [PMID: 31867984 DOI: 10.1177/1039856219889318] [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: 11/15/2022]
Abstract
OBJECTIVE The development of international mental health has been characterised by the globalisation of Western psychiatric nosology that is arguably ill-suited to developing countries. This piece highlights the limitations of our current classification systems and explores how we may seek to overcome these limitations by considering the context in which symptoms present. CONCLUSION In developing a global model of psychiatric illnesses, it is important to emphasise contextual value judgements. Doing so welcomes integration of traditional models of care and encourages partnership across nations.
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Affiliation(s)
- Nicolas Garel
- From the Department of Psychiatry, McGill University (Garel, Joober); and the Douglas Mental Health University Institute, (Joober) Montreal, Que, Canada
| | - Ridha Joober
- From the Department of Psychiatry, McGill University (Garel, Joober); and the Douglas Mental Health University Institute, (Joober) Montreal, Que, Canada
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25
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Helle AC, Trull TJ, Watts AL, McDowell Y, Sher KJ. Psychiatric Comorbidity as a Function of Severity: DSM-5 Alcohol Use Disorder and HiTOP Classification of Mental Disorders. Alcohol Clin Exp Res 2020; 44:632-644. [PMID: 32125715 PMCID: PMC7117865 DOI: 10.1111/acer.14284] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/26/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Understanding the comorbidity of alcohol use disorder (AUD) and other psychiatric diagnoses has been a long-standing interest of researchers and mental health professionals. Comorbidity is often examined via the diagnostic co-occurrence of discrete, categorical diagnoses, which is incongruent with increasingly supported dimensional approaches of psychiatric classification and diagnosis, and for AUD more specifically. The present study examined associations between DSM-5 AUD and psychiatric symptoms of other DSM-IV and DSM-5 disorders categorically, and dimensionally organized according to the Hierarchical Taxonomy of Psychopathology (HiTOP) spectra (e.g., Internalizing, Disinhibited Externalizing). METHODS The comorbidity of AUD with other psychological disorders was examined in 2 independent nationally representative samples of past-year drinkers via an initial examination in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) Wave 2 and replicated in NESARC-III. RESULTS Analyses focusing on psychopathology symptom counts organized by spectra demonstrated that greater AUD severity was associated with a higher number of symptoms across HiTOP spectra. Traditional categorical analyses also demonstrated increasing prevalence as a monotonic function of DSM-5 AUD severity gradients. CONCLUSIONS This study indicates that AUD and other psychiatric disorder comorbidity implies increased presence of multiple forms of psychopathology with a corresponding increased number of symptoms across hierarchical spectra. Greater AUD severity increases the likelihood of other psychopathology and, when present, "more severe" presentations. That is, on average, a given disorder (e.g., depression) is more severe when copresenting with an AUD, and increases in severity along with the AUD.
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Affiliation(s)
- Ashley C Helle
- From the, Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
| | - Timothy J Trull
- From the, Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
| | - Ashley L Watts
- From the, Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
| | - Yoanna McDowell
- From the, Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
| | - Kenneth J Sher
- From the, Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
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Mullins-Sweatt SN, Hopwood CJ, Chmielewski M, Meyer NA, Min J, Helle AC, Walgren MD. Treatment of personality pathology through the lens of the hierarchical taxonomy of psychopathology: Developing a research agenda. Personal Ment Health 2020; 14:123-141. [PMID: 31364820 PMCID: PMC7053295 DOI: 10.1002/pmh.1464] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 12/19/2022]
Abstract
Despite the emphasis on evidence-based treatment for psychological disorders, to date, there has been limited research examining treatment for nine of the 10 categorical personality disorders in DSM-5 Section 2. This is perhaps not surprising given the complex heterogeneity and co-morbidity within personality pathology. The hierarchical taxonomy of psychopathology (HiTOP) was proposed to address limitations within the traditional categorical model of the diagnostic system. Within this system are five spectra: detachment, antagonistic externalizing, disinhibited externalizing, thought disorder and internalizing. These foundational personality traits potentially have direct and specific treatment implications. The purpose of this paper is to highlight potential psychotherapeutic and pharmacological treatment recommendations within the personality spectra. Additionally, we outline the advantages of considering the personality science found within dimensional models of psychopathology in clinical assessment and intervention to aid in treatment planning. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | - Neil A Meyer
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Jiwon Min
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Ashley C Helle
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Maggie D Walgren
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
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Waszczuk MA, Eaton NR, Krueger RF, Shackman AJ, Waldman ID, Zald DH, Lahey BB, Patrick CJ, Conway CC, Ormel J, Hyman SE, Fried EI, Forbes MK, Docherty AR, Althoff RR, Bach B, Chmielewski M, DeYoung CG, Forbush KT, Hallquist M, Hopwood CJ, Ivanova MY, Jonas KG, Latzman RD, Markon KE, Mullins-Sweatt SN, Pincus AL, Reininghaus U, South SC, Tackett JL, Watson D, Wright AGC, Kotov R. Redefining phenotypes to advance psychiatric genetics: Implications from hierarchical taxonomy of psychopathology. J Abnorm Psychol 2020; 129:143-161. [PMID: 31804095 PMCID: PMC6980897 DOI: 10.1037/abn0000486] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Genetic discovery in psychiatry and clinical psychology is hindered by suboptimal phenotypic definitions. We argue that the hierarchical, dimensional, and data-driven classification system proposed by the Hierarchical Taxonomy of Psychopathology (HiTOP) consortium provides a more effective approach to identifying genes that underlie mental disorders, and to studying psychiatric etiology, than current diagnostic categories. Specifically, genes are expected to operate at different levels of the HiTOP hierarchy, with some highly pleiotropic genes influencing higher order psychopathology (e.g., the general factor), whereas other genes conferring more specific risk for individual spectra (e.g., internalizing), subfactors (e.g., fear disorders), or narrow symptoms (e.g., mood instability). We propose that the HiTOP model aligns well with the current understanding of the higher order genetic structure of psychopathology that has emerged from a large body of family and twin studies. We also discuss the convergence between the HiTOP model and findings from recent molecular studies of psychopathology indicating broad genetic pleiotropy, such as cross-disorder SNP-based shared genetic covariance and polygenic risk scores, and we highlight molecular genetic studies that have successfully redefined phenotypes to enhance precision and statistical power. Finally, we suggest how to integrate a HiTOP approach into future molecular genetic research, including quantitative and hierarchical assessment tools for future data-collection and recommendations concerning phenotypic analyses. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bo Bach
- Centre of Excellence on Personality Disorder
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Guilera G, Pino O, Barrios M, Rojo E, Vieta E, Gómez-Benito J. Towards an ICF Core Set for functioning assessment in severe mental disorders: Commonalities in bipolar disorder, depression and schizophrenia. Psicothema 2020; 32:7-14. [PMID: 31954410 DOI: 10.7334/psicothema2019.186] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The International Classification of Functioning, Disability and Health (ICF) offers an internationally accepted standard for describing and assessing functioning and disability in any health condition. A specific list of ICF categories, an ICF Core Set (CS), has been developed for bipolar disorder, depression and schizophrenia. The aim of this study was to determine commonalities in the ICF-CSs for these three disorders, and to identify relevant categories for the development of tentative ICF-CSs for severe mental disorders in general. METHODS The ICF categories of all three mental health conditions were examined and compared. RESULTS Comparison of the Comprehensive ICF-CSs for the three mental health conditions revealed a set of 34 common categories (i.e., 10 from the Body functions component, 14 from the Activities and participation component, and 10 Environmental factors ). These categories formed the proposed Comprehensive ICF-CS for severe mental disorders. A total of 11 categories were common to the Brief ICF-CSs of the three mental health conditions, and these formed the Brief ICF-CS for severe mental disorders (i.e., 3 from the Body functions component, 6 from the Activities and participation component, and 2 Environmental factors ). All the categories included refer to key aspects of functioning for severe mental disorders. CONCLUSIONS The proposed ICF-CSs for severe mental disorders may be applicable across a number of psychotic and affective disorders and they should prove useful for mental health services whose care remit covers a range of conditions.
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Stein DJ, Szatmari P, Gaebel W, Berk M, Vieta E, Maj M, de Vries YA, Roest AM, de Jonge P, Maercker A, Brewin CR, Pike KM, Grilo CM, Fineberg NA, Briken P, Cohen-Kettenis PT, Reed GM. Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Med 2020; 18:21. [PMID: 31983345 PMCID: PMC6983973 DOI: 10.1186/s12916-020-1495-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/09/2020] [Indexed: 12/16/2022] Open
Abstract
An update of the chapter on Mental, Behavioral and Neurodevelopmental Disorders in the International Classification of Diseases and Related Health Problems (ICD) is of great interest around the world. The recent approval of the 11th Revision of the ICD (ICD-11) by the World Health Organization (WHO) raises broad questions about the status of nosology of mental disorders as a whole as well as more focused questions regarding changes to the diagnostic guidelines for specific conditions and the implications of these changes for practice and research. This Forum brings together a broad range of experts to reflect on key changes and controversies in the ICD-11 classification of mental disorders. Taken together, there is consensus that the WHO's focus on global applicability and clinical utility in developing the diagnostic guidelines for this chapter will maximize the likelihood that it will be adopted by mental health professionals and administrators. This focus is also expected to enhance the application of the guidelines in non-specialist settings and their usefulness for scaling up evidence-based interventions. The new mental disorders classification in ICD-11 and its accompanying diagnostic guidelines therefore represent an important, albeit iterative, advance for the field.
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Affiliation(s)
- Dan J. Stein
- SA Medical Research Council Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Berk
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, Parkville, Australia
- Florey Institute for Neuroscience and Mental Health, Parkville, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Eduard Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia Spain
| | - Mario Maj
- Department of Psychiatry, University of Campania ‘L. Vanvitelli’, Naples, Italy
| | - Ymkje Anna de Vries
- Department of Developmental Psychology, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Annelieke M. Roest
- Department of Developmental Psychology, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Peter de Jonge
- Department of Developmental Psychology, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Andreas Maercker
- Department of Psychology – Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | - Chris R. Brewin
- Research Deparment of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Kathleen M. Pike
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Naomi A. Fineberg
- Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Welwyn Garden City, UK
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Geoffrey M. Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY USA
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Leoutsakos JMS, Wise EA, Lyketsos CG, Smith GS. Trajectories of neuropsychiatric symptoms over time in healthy volunteers and risk of MCI and dementia. Int J Geriatr Psychiatry 2019; 34:1865-1873. [PMID: 31452260 PMCID: PMC6854285 DOI: 10.1002/gps.5203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Received: 04/29/2019] [Accepted: 08/06/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To identify subtypes of neuropsychiatric symptom (NPS) course among cognitively normal individuals and to assess the association between these subtypes and hazard of later mild cognitive impairment (MCI) or dementia diagnosis. METHODS We modeled neuropsychiatric inventory questionnaire (NPI-Q) scores from 4184 volunteers over approximately 4 years using growth mixture models, generating latent classes of trajectory. We then fit Cox proportional hazard models to determine if membership in trajectory classes was associated with increased hazard of diagnosis of MCI or dementia. RESULTS We identified four trajectory classes: the majority of the sample (65%) would be expected to belong to a class with consistently low or zero NPS. The next most prevalent class, (16%) showed a decrease over time in NPI-Q total score but, compared with the majority class had an almost threefold increase in hazard of MCI or dementia (HR: 2.92; 95% CI: 1.82-4.68). Another class (14%) showed an increase in NPS over time and was also associated with greater hazard of MCI or dementia (HR: 3.96; CI: 2.61-6.03). The smallest class (5%) had high and fluctuating NPI-Q total scores and had the greatest hazard (HR: 4.57; CI: 2.72-7.63). CONCLUSION We have demonstrated that it is possible to identify meaningful groups of NPS trajectories and that trajectory of NPS can convey information beyond a single cross-sectional measure. While even those whose NPS improved were at increased hazard of MCI or dementia, hazard increased as a function of the severity of the NPS trajectory.
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Affiliation(s)
- Jeannie-Marie S Leoutsakos
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Elizabeth A Wise
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Constantine G Lyketsos
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Gwenn S Smith
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
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Kar SK, Roy P, Singh J, Tripathi A, Dalal PK. Clinical profile and correlates of hospital stay in patients with severe mental illness. Asian J Psychiatr 2019; 45:41-43. [PMID: 31493623 DOI: 10.1016/j.ajp.2019.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, U.P, India.
| | - Pritha Roy
- Department of Geriatric Mental Health, King George's Medical University, Lucknow, U.P, India.
| | - Jai Singh
- Department of Psychiatry, King George's Medical University, Lucknow, U.P, India.
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, U.P, India.
| | - Pronob Kumar Dalal
- Department of Psychiatry, King George's Medical University, Lucknow, U.P, India.
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Abstract
This article examines the revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and its claim of incorporating a "greater cultural sensitivity." The analysis reveals that the manual conveys mixed messages as it explicitly addresses the critique of being ethnocentric and having a static notion of culture yet continues in a similar fashion when culture is applied in diagnostic criteria. The analysis also relates to current trends in psychiatric nosology that emphasize neurobiology and decontextualize distress and points to how the DSM-5 risks serving as an ethnic dividing line in psychiatry by making sociocultural context relevant only for some patients.
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Affiliation(s)
- Anna Bredström
- Institute for Research on Migration, Ethnicity and Society (REMESO/ISV), Linköping University, SE-601 74, Norrköping, Sweden.
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Abstract
BACKGROUND The co-occurrence of internalizing disorders is a common form of psychiatric comorbidity, raising questions about the boundaries between these diagnostic categories. We employ network psychometrics in order to: (a) determine whether internalizing symptoms cluster in a manner reflecting DSM diagnostic criteria, (b) gauge how distinct these diagnostic clusters are and (c) examine whether this network structure changes from childhood to early and then late adolescence. METHOD Symptom-level data were obtained for service users in publicly funded mental health services in England between 2011 and 2015 (N = 37,162). A symptom network (i.e. Gaussian graphical model) was estimated, and a community detection algorithm was used to explore the clustering of symptoms. RESULTS The estimated network was densely connected and characterized by a multitude of weak associations between symptoms. Six communities of symptoms were identified; however, they were weakly demarcated. Two of these communities corresponded to social phobia and panic disorder, and four did not clearly correspond with DSM diagnostic categories. The network structure was largely consistent by sex and across three age groups (8-11, 12-14 and 15-18 years). Symptom connectivity in the two older age groups was significantly greater compared to the youngest group and there were differences in centrality across the age groups, highlighting the age-specific relevance of certain symptoms. CONCLUSIONS These findings clearly demonstrate the interconnected nature of internalizing symptoms, challenging the view that such pathology takes the form of distinct disorders.
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Affiliation(s)
- Eoin McElroy
- Institute of Psychology, Health and SocietyUniversity of LiverpoolLiverpoolUK
| | - Praveetha Patalay
- Institute of Psychology, Health and SocietyUniversity of LiverpoolLiverpoolUK
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Schwartz ZH. Psychiatric Skepticism in Medical Education: Why We Need Philosophy. Acad Psychiatry 2019; 43:461-463. [PMID: 30891684 DOI: 10.1007/s40596-019-01049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/24/2019] [Indexed: 06/09/2023]
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Maclean MJ, Sims SA, O'Donnell M. Role of pre-existing adversity and child maltreatment on mental health outcomes for children involved in child protection: population-based data linkage study. BMJ Open 2019; 9:e029675. [PMID: 31362970 PMCID: PMC6678009 DOI: 10.1136/bmjopen-2019-029675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine mental health outcomes for children with a history of child protection system involvement, accounting for pre-existing adversity, and to examine variation in risk across diagnostic groupings and child protection subgroups. DESIGN A longitudinal, population-based record-linkage study. PARTICIPANTS All children in Western Australia (WA) with birth records between 1990 and 2009. OUTCOME MEASURES Mental health diagnoses, mental health contacts and any mental health event ascertained from International Classification of Diseases codes within WA's Hospital Morbidity Data Collection and Mental Health Information System from birth until 2013. RESULTS Compared with children without child protection contact, children with substantiated maltreatment had higher prevalence of mental health events (37.4% vs 5.9%) and diagnoses (20% vs 3.6%). After adjusting for background risks, all maltreatment types were associated with an almost twofold to almost threefold increased hazard for mental health events. Multivariate analysis also showed mental health events were elevated across all child protection groups, ranging from HR: 3.54 (95% CI 3.28 to 3.82) for children who had entered care to HR: 2.31 (95% CI 2.18 to 2.46) for unsubstantiated allegations. Maternal mental health, aboriginality, young maternal age and living in socially disadvantaged neighbourhoods were all associated with an increased likelihood of mental health events. The increase varied across diagnostic categories, with particularly increased risk for personality disorder, and frequent comorbidity of mental health and substance abuse disorders. CONCLUSIONS Young people who have been involved in the child protection system are at increased risk for mental health events and diagnoses. These findings emphasise the importance of services and supports to improve mental health outcomes in this vulnerable population. Adversities in childhood along with genetic or environmental vulnerabilities resulting from maternal mental health issues also contribute to young people's mental health outcomes, suggesting a role for broader social supports and early intervention services in addition to targeted mental health programmes.
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Affiliation(s)
- Miriam Jennifer Maclean
- Linked Analytics and Social Policy, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Scott Anthony Sims
- Linked Analytics and Social Policy, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Melissa O'Donnell
- Linked Analytics and Social Policy, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Centre for Child Health Research, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
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Abstract
BACKGROUND A taxonomy of the objects of study, theory, assessment, and intervention is critical to the development of all clinical sciences. Clinical psychology has been conceptually and administratively dominated by the taxonomy of an adjacent discipline - psychiatry's Diagnostic and statistical manual of mental disorders (DSM). Many have called for a 'paradigm shift' away from a medical nosology of diseases toward clinical psychology's own taxonomy of clinical psychological problems (CPPs), without being able to specify what is to be listed and classified. MAIN TEXT An examination of DSM's problems for clinical psychology, especially its lack of clinical utility, and a search for the essence of CPPs in what clinical psychologists actually do, leads to the proposal that: The critical psychological-level phenomenon underlying CPPs is the occurrence of 'problem-maintaining circles' (PMCs) of causally related cognitions, emotions, behaviours, and/or stimuli. This concept provides an empirically-derived, theory-based, treatment-relevant, categorical, essentialist, parsimonious, and nonstigmatizing definition of CPPs. It distinguishes psychological problems in which PMCs have not (yet?) formed, and which may respond to 'counseling', clinical psychological problems in which active PMCs require clinical intervention, and psychopathological problems which are unlikely to be 'cured' by PMC-breaking alone. CONCLUSION A subsequent classification and coding system of PMCs is proposed, and expected benefits to research, communication, and the quality of case formulation in clinical psychology are described, reliant upon a development effort of some meaningful fraction of that which has been devoted to the DSM.
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Affiliation(s)
- Gary M Bakker
- School of Medicine, University of Tasmania, Locked Bag 1377, Launceston, Tasmania, 7250, Australia.
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Abstract
Few conditions have sparked as much controversy as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Professional consensus has long suggested that the condition should be classified as psychiatric, while patients and advocacy groups have insisted it is a serious biological disease that requires medical care and research to develop it. This longstanding debate shifted in 2015, when U.S. governmental health authorities fully embraced medical classification and management. Given that some globally respected health authorities now insist that ME/CFS is a serious biological disease, this paper asks whether it can be ethical for the U.K. practice guideline now in development to characterize the condition as a mental health disorder. Following a brief history of ME/CFS controversy, I offer three arguments to show that it would be unethical for the U.K. to now characterize ME/CFS as a mental health condition, considering the relevance of that conclusion for ME/CFS guidelines elsewhere and for other contested conditions.
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Affiliation(s)
- Diane O'Leary
- Rotman Institute of Philosophy, Western University, London, Ontario, Canada
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Feczko E, Miranda-Dominguez O, Marr M, Graham AM, Nigg JT, Fair DA. The Heterogeneity Problem: Approaches to Identify Psychiatric Subtypes. Trends Cogn Sci 2019; 23:584-601. [PMID: 31153774 PMCID: PMC6821457 DOI: 10.1016/j.tics.2019.03.009] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [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: 07/31/2018] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 12/12/2022]
Abstract
The imprecise nature of psychiatric nosology restricts progress towards characterizing and treating mental health disorders. One issue is the 'heterogeneity problem': different causal mechanisms may relate to the same disorder, and multiple outcomes of interest can occur within one individual. Our review tackles this heterogeneity problem, providing considerations, concepts, and approaches for investigators examining human cognition and mental health. We highlight the difficulty of pure dimensional approaches due to 'the curse of dimensionality'. Computationally, we consider supervised and unsupervised statistical approaches to identify putative subtypes within a population. However, we emphasize that subtype identification should be linked to a particular outcome or question. We conclude with novel hybrid approaches that can identify subtypes tied to outcomes, and may help advance precision diagnostic and treatment tools.
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Affiliation(s)
- Eric Feczko
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA; Department of Medical Informatics and Clinical Epidemiology Oregon Health & Science University, Portland, OR 97239, USA.
| | - Oscar Miranda-Dominguez
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA
| | - Mollie Marr
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA
| | - Alice M Graham
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR 97239, USA
| | - Joel T Nigg
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR 97239, USA
| | - Damien A Fair
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR 97239, USA; Advanced Imaging Research Center Oregon Health & Science University, Portland, OR 97239, USA.
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Hess CW. SyNoPsis: A Novel Perspective on Schizophrenia. Neuropsychobiology 2019; 75:98-99. [PMID: 29258083 DOI: 10.1159/000485220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Mapelli A, Veyret-Morau M, Rezzoug D, Klein A, Baubet T. Children of jihadists: a medical framework for returnees in France. Lancet 2019; 393:2489. [PMID: 31232365 DOI: 10.1016/s0140-6736(19)31119-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Alessandra Mapelli
- AP-HP, Avicenne Hospital, Department of Infant, Child and Adolescent Psychiatry and Paris 13 University, Bobigny 93000, France
| | - Maurween Veyret-Morau
- AP-HP, Avicenne Hospital, Department of Infant, Child and Adolescent Psychiatry and Paris 13 University, Bobigny 93000, France.
| | - Dalila Rezzoug
- AP-HP, Avicenne Hospital, Department of Infant, Child and Adolescent Psychiatry and Paris 13 University, Bobigny 93000, France
| | - Anaelle Klein
- AP-HP, Avicenne Hospital, Department of Infant, Child and Adolescent Psychiatry and Paris 13 University, Bobigny 93000, France
| | - Thierry Baubet
- AP-HP, Avicenne Hospital, Department of Infant, Child and Adolescent Psychiatry and Paris 13 University, Bobigny 93000, France
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Conway CC, Forbes MK, Forbush KT, Fried EI, Hallquist MN, Kotov R, Mullins-Sweatt SN, Shackman AJ, Skodol AE, South SC, Sunderland M, Waszczuk MA, Zald DH, Afzali MH, Bornovalova MA, Carragher N, Docherty AR, Jonas KG, Krueger RF, Patalay P, Pincus AL, Tackett JL, Reininghaus U, Waldman ID, Wright AG, Zimmermann J, Bach B, Bagby RM, Chmielewski M, Cicero DC, Clark LA, Dalgleish T, DeYoung CG, Hopwood CJ, Ivanova MY, Latzman RD, Patrick CJ, Ruggero CJ, Samuel DB, Watson D, Eaton NR. A Hierarchical Taxonomy of Psychopathology Can Transform Mental Health Research. Perspect Psychol Sci 2019; 14:419-436. [PMID: 30844330 PMCID: PMC6497550 DOI: 10.1177/1745691618810696] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [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: 12/18/2022]
Abstract
For more than a century, research on psychopathology has focused on categorical diagnoses. Although this work has produced major discoveries, growing evidence points to the superiority of a dimensional approach to the science of mental illness. Here we outline one such dimensional system-the Hierarchical Taxonomy of Psychopathology (HiTOP)-that is based on empirical patterns of co-occurrence among psychological symptoms. We highlight key ways in which this framework can advance mental-health research, and we provide some heuristics for using HiTOP to test theories of psychopathology. We then review emerging evidence that supports the value of a hierarchical, dimensional model of mental illness across diverse research areas in psychological science. These new data suggest that the HiTOP system has the potential to accelerate and improve research on mental-health problems as well as efforts to more effectively assess, prevent, and treat mental illness.
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Affiliation(s)
- Christopher C. Conway
- Department of Psychological Sciences, College of William & Mary, Williamsburg, VA, USA
| | - Miriam K. Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | | | - Eiko I. Fried
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Michael N. Hallquist
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
| | - Roman Kotov
- Department of Psychiatry, State University of New York, Stony Brook, NY, USA
| | | | - Alexander J. Shackman
- Department of Psychology and Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, USA
| | - Andrew E. Skodol
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
| | - Susan C. South
- Purdue University, Department of Psychological Sciences, West Lafayette, IN, USA
| | - Matthew Sunderland
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Monika A. Waszczuk
- Department of Psychiatry, State University of New York, Stony Brook, NY, USA
| | - David H. Zald
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | | | - Natacha Carragher
- Medical Education and Student Office, Faculty of Medicine, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Anna R. Docherty
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Katherine G. Jonas
- Department of Psychiatry, State University of New York, Stony Brook, NY, USA
| | - Robert F. Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Praveetha Patalay
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Aaron L. Pincus
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
| | | | - Ulrich Reininghaus
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, The Netherlands
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Aidan G.C. Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Bo Bach
- Psychiatric Research Unit, Slagelse Psychiatric Hospital, Slagelse, Denmark
| | - R. Michael Bagby
- Departments of Psychology and Psychiatry, University of Toronto, Toronto, Canada
| | | | - David C. Cicero
- Department of Psychology, University of Hawaii at Manoa, HI, USA
| | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - Colin G. DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | | | - Masha Y. Ivanova
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Robert D. Latzman
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Camilo J. Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Douglas B. Samuel
- Purdue University, Department of Psychological Sciences, West Lafayette, IN, USA
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Nicholas R. Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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Waddle MR, Niazi S, Aljabri D, White L, Kaleem T, Naessens J, Spaulding A, Habboush J, Rummans T, Miller R. Cost of Acute and Follow-Up Care in Patients With Pre-Existing Psychiatric Diagnoses Undergoing Radiation Therapy. Int J Radiat Oncol Biol Phys 2019; 104:748-755. [PMID: 30904707 DOI: 10.1016/j.ijrobp.2019.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/04/2019] [Accepted: 03/12/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The impact of psychiatric comorbidities on the cost of cancer care in radiation oncology practices is not well studied. We assessed the acute and 24-month follow-up costs for patients with and without pre-existing psychiatric comorbidities undergoing radiation therapy. METHODS AND MATERIALS Patients with cancer undergoing radiation therapy at our institution from 2009 to 2014 were denoted as having pre-existing psychiatric conditions (Psych group) if they had associated billing codes for any of the 422 International Classification of Diseases, 9th revision psychiatric conditions during the 12 months before their cancer diagnosis. The Elixhauser comorbidity index was calculated, excluding psychiatric categories. Medicare reimbursement was assigned to professional services, and Medicare departmental cost-to-charge ratios were applied to service line hospital charges and adjusted for inflation to create 2017 standardized costs. Acute (0-6 month) and follow-up (6-24 month) costs were subcategorized into clinic, emergency department, hospital inpatient, and outpatient costs. RESULTS Among 1275 patients, 126 (9.9%) had at least 1 pre-existing psychiatric diagnosis. On univariate analysis, both acute and long-term costs were higher in the Psych group. The largest significant differences in costs were follow-up hospital inpatient costs ($5861 higher; 95% confidence interval [CI], $687-$11,035; P = .002), follow-up hospital outpatient costs ($2086 higher; 95% CI, -$142 to $4,314; P = .040), and follow-up emergency department costs ($396 higher; 95% CI, $149-$643; P < .001). Age, race, sex, and treatment modalities were comparable, but the Psych group patients had more median comorbidities (2 vs 1) and had more respiratory cancer diagnoses than the nonpsychiatric group (31% vs 17%). On multivariate analysis adjusted for age, sex, cancer diagnosis, and comorbidities, global follow-up costs remained 150% higher in the Psych group (P < .001). Acute costs were similar after adjustment (P = .63). CONCLUSIONS Psychiatric comorbidities independently predict elevated healthcare costs in patients treated for cancer. Radiation oncology payment models should consider adjustments to account for psychiatric comorbidities because addressing these may mitigate cost differential.
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Affiliation(s)
- Mark R Waddle
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Shehzad Niazi
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, Florida
| | - Duaa Aljabri
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrhman Bin Faisal University, Dammam, Saudi Arabia
| | - Launia White
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
| | - Tasneem Kaleem
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - James Naessens
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida; Division of Health Care Policy & Research, Mayo Clinic, Jacksonville, Florida
| | - Aaron Spaulding
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
| | - Jacob Habboush
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Teresa Rummans
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, Florida
| | - Robert Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida.
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Kwakernaak S, Swildens WE, Theunissen JR, de Valk GJJ, Cahn W, Janssen RTJM. [Regional healthcare labels: differences in care needs and psychosocial functioning]. Tijdschr Psychiatr 2019; 61:305-316. [PMID: 31180569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Severe mental illnesses (SMI) are associated with high mental healthcare and other healthcare costs. In 2012, mental healthcare labels were developed to create more transparency between insurance companies, municipalities, and mental healthcare. The labels are based on care intensity, and should provide a regional overview of the present groups of patients with SMI.<br/> AIM: Explore the functionality and validity of the used labels in relation to needs for care and psychosocial functioning.<br/> METHOD: The ROM data (needs for care, functioning) from 706 patients were tested per label by Chi-square tests and ANOVAs. For two high complex labels (alarming care avoiders and persons with safety risks), repeated measures ANOVAs and McNemar tests were used to analyse changes in functioning and needs over time.<br/> RESULTS: To a limited extent, the labels were distinctive in care needs and functioning. The most restrictions in functioning and (unfulfilled) needs were present in the labels 'alarming care avoiders' and 'avoiding danger'. These findings were stable over time.<br/> CONCLUSION: The labels are not sufficiently distinctive. To enhance regional care planning, it is desirable to combine existing information on healthcare labels with information on care needs and functioning. KEY WORDS functioning, mental healthcare labels, needs for care, routine outcome monitoring, severe mental illness.
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de Giambattista C, Ventura P, Trerotoli P, Margari M, Palumbi R, Margari L. Subtyping the Autism Spectrum Disorder: Comparison of Children with High Functioning Autism and Asperger Syndrome. J Autism Dev Disord 2019; 49:138-150. [PMID: 30043350 PMCID: PMC6331497 DOI: 10.1007/s10803-018-3689-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since Hans Asperger's first description (Arch Psych Nervenkrankh 117:76-136, 1944), through Lorna Wing's translation and definition (Psychol Med 11:115-129, 1981), to its introduction in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM, 1994), Asperger Syndrome has always aroused huge interest and debate, until vanishing in the DSM fifth edition (2013). The debate regarded its diagnostic validity and its differentiation from high functioning autism (HFA). The present study aimed to examine whether AS differed from HFA in clinical profiles and to analyze the impact of DSM-5's innovation. Differences in cognitive, language, school functioning and comorbidities, were revealed when 80 AS and 70 HFA patients (3-18 years) were compared. Results suggested that an AS empirical distinction within autism spectrum disorder should be clinically useful.
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Affiliation(s)
- Concetta de Giambattista
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Hospital Polyclinic of Bari, University of “Aldo Moro” Bari, Piazza Giulio Cesare 1, 70100 Bari, Italy
| | - Patrizia Ventura
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Hospital Polyclinic of Bari, University of “Aldo Moro” Bari, Piazza Giulio Cesare 1, 70100 Bari, Italy
| | - Paolo Trerotoli
- Medical Statistic, Department of Biomedical Science and Human Oncology, University of “Aldo Moro” Bari, Bari, Italy
| | - Mariella Margari
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Hospital Polyclinic of Bari, University of “Aldo Moro” Bari, Piazza Giulio Cesare 1, 70100 Bari, Italy
| | - Roberto Palumbi
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Hospital Polyclinic of Bari, University of “Aldo Moro” Bari, Piazza Giulio Cesare 1, 70100 Bari, Italy
| | - Lucia Margari
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Hospital Polyclinic of Bari, University of “Aldo Moro” Bari, Piazza Giulio Cesare 1, 70100 Bari, Italy
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Abstract
Given the failure of psychiatry to develop clinically useful biomarkers for psychiatric disorders, and the concomitant failure to develop significant advances in diagnosis and treatment, the National Institute of Mental Health (NIMH) in 2010 launched the Research Domain Criteria (RDoC), a framework for research based on the assumption that mental disorders are disorders of identifiable brain neural circuits, with neural circuitry at the center of units of analysis ranging from genes, molecules, and cells to behavior, self-reports, and paradigms. These were to be integrated with five validated dimensional psychological constructs such as negative and positive valence systems. Four years later, the NIMH stated that the ultimate goal of RDoC is precision medicine for psychiatry, with the assumption that precision medications will normalize dysfunctional neural circuits. How this could be accomplished is not obvious, given that neural circuits are widely distributed, have unclear boundaries, and exhibit a significant degree of neuroplasticity, with multiple circuits present in any given disorder. Moreover, the early focus on neural circuitry has been criticized for its reductionism and neglect of the more recent RDoC emphasis on the integration and equivalence of biological and psychological phenomena. Yet this seems inconsistent with the priorities of the NIMH director, an advocate of the central role of neural circuitry and projects such as the Brain Initiative and the Human Connectome Project. Will such projects, at a cost of at least $10 billion, lead to precision medications for mental disorders, or further diminish funding for clinical care and research?
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Affiliation(s)
- Charles E Dean
- Mental Health Service Line,Minneapolis Veteran Administration Medical Center,One Veterans Drive, Minneapolis Minnesota, 55147,USA
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Chow KK, Chan O, Yu MW, Lo CS, Tang DY, Chow DL, Siu BW, Cheung EF. Prevalence and Screening of Mental Illness among Remand Prisoners in Hong Kong. East Asian Arch Psychiatry 2018; 28:134-138. [PMID: 30563950] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES This study aimed to validate the Correctional Mental Health Screen (CMHS) in the Hong Kong prison population and determine the prevalence of psychiatric disorders among remand prisoners in Hong Kong and the associated factors of mental illness. METHODS This cohort study was conducted at the Lai Chi Kok Reception Centre and the Tai Lam Centre for Women in Hong Kong. Remand prisoners aged ≥21 years were recruited between May and August 2014. Sociodemographic and clinical data were collected. Each remand prisoner was assessed using the appropriate CMHS for males or for females, then interviewed by a specialist psychiatrist using the Structured Clinical Interview for DSM-IV for current affective disorder and psychotic disorder for cross-validation. RESULTS A total of 245 remand prisoners were recruited (150 males and 95 females; mean age, 25.8 years). Of them, 51% (55% males and 44% females) had a lifetime history of psychiatric disorder, whereas 39.6% (46% males and 29.5% females) had a current psychiatric disorder. The most common psychiatric disorder was substance use disorder (>36%), followed by mood disorder (>20%), psychotic disorder (5.3%), and lifetime neurotic disorder (3.7%). Living in a public housing estate (odds ratio [OR] = 1.99), a history of childhood conduct problem (OR = 2.40), and a forensic history (OR = 1.97) were associated with an increased risk of having a psychiatric disorder. The CMHS had good diagnostic efficiency after cross-validation with the Structured Clinical Interview for DSM-IV. CONCLUSION Psychiatric disorders are prevalent in remand prisoners in Hong Kong. The CMHS is an effective tool to screen remand prisoners for timely treatment of prisoners with mental health needs.
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Affiliation(s)
- K Kw Chow
- Department of Forensic Psychiatry, Castle Peak Hospital
| | - O Chan
- Department of Forensic Psychiatry, Castle Peak Hospital
| | - M Wm Yu
- The Chinese University of Hong Kong
| | - C Sl Lo
- Department of Forensic Psychiatry, Castle Peak Hospital
| | - D Yy Tang
- Department of Forensic Psychiatry, Castle Peak Hospital
| | | | - B Wm Siu
- Department of Forensic Psychiatry, Castle Peak Hospital
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Siu BW, Chan O, Au-Yeung CC, Chow KK, Liu AC, Tang DY, Lui SH, Cheung EF, Lam M. Profiling Mentally Ill Offenders in Hong Kong: a 5-year Retrospective Review Study. East Asian Arch Psychiatry 2018; 28:114-121. [PMID: 30563947] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES This study aimed to determine the prevalence of mental illness in offenders referred to psychiatrists from January 2011 to March 2016 and any associations between crime and mental illness in these offenders. METHODS Case notes of offenders referred to psychiatrists at the Siu Lam Psychiatric Centre from 1 January 2011 to 31 March 2016 were reviewed. Data on sex, age on admission, educational level, principal psychiatric diagnosis, index offence, source and reason of referral, and outcome were collected. RESULTS Case notes were reviewed for 4492 offenders (75% males) aged 14 to 93 (mean, 40.6) years. Of these, 68% were referred by the courts for psychiatric report and 32% were referred by correctional institutions for psychiatric assessment and treatment. Approximately 73% of them had a diagnosable mental disorder. The most common principal psychiatric diagnoses were schizophrenia and related disorders (25%), mental and behavioural disorders due to psychoactive substance use (20%), and mood disorders (9%). The most common index offences were theft and related offences (22%), acts intended to cause injury (20%), and illicit drug offences (11%). Offences involving violence were more prevalent in males than in females (p < 0.001). In terms of the three most common principal psychiatric diagnoses, 'acts intended to cause injury' was most prevalent in those with 'schizophrenia and other related disorders' than in those with the other two diagnoses (31% vs 19% vs 17%, p < 0.001). 'Theft and related offences' was most prevalent in those with mood disorders than in those with other two diagnoses (38% vs 20% vs 18%, p < 0.001). 'Illicit drug offences' was most prevalent in those with 'mental and behavioural disorders due to psychoactive substance' than those with other two diagnoses (22% vs 8% vs 6%, p < 0.001). CONCLUSIONS The prevalence of mental disorders among offenders referred to psychiatrists is high. The pattern of associations between crime and mental disorders in these offenders is comparable with that reported in overseas studies. As Siu Lam Psychiatric Centre is the only facility in Hong Kong for mentally ill offenders, our sample is representative, and our results provide cross-sectional pattern of forensic psychiatric service utilisation in Hong Kong.
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Affiliation(s)
- B Wm Siu
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - O Chan
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - C Cy Au-Yeung
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - K Kw Chow
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - A Cy Liu
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - D Yy Tang
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - S H Lui
- Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | | | - M Lam
- Department of General Adult Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
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Ward HB, Fromson JA, Cooper JJ, De Oliveira G, Almeida M. Recommendations for the use of ECT in pregnancy: literature review and proposed clinical protocol. Arch Womens Ment Health 2018; 21:715-722. [PMID: 29796968 DOI: 10.1007/s00737-018-0851-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 01/19/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
Abstract
Psychiatric disorders are common in pregnancy, affecting 15-29% of pregnant women. Untreated depression has negative health consequences for mother and fetus. Electroconvulsive therapy (ECT) is an effective option for the treatment of severe depression, high suicide risk, catatonia, medication-resistant illness, psychotic agitation, severe physical decline, and other life-threatening conditions. To our knowledge, however, there is no literature that consolidates all the evidence on maternal and fetal risks associated with untreated depression, medications, and ECT then translating it into one cohesive protocol that could serve as a management guide and a source of reassurance to health-care providers involved in such practice. Hoping to facilitate ECT access to perinatal patients, the authors combined their multidisciplinary clinical experience (in perinatal psychiatry, neuropsychiatry and neuromodulation, and anesthesiology) at three different centers in the USA (Brigham and Women's Hospital/Harvard Medical School, The University of Chicago, and Brown University) with a careful and critical literature review and propose guidelines for the administration of ECT in pregnancy. A comprehensive review of the relevant literature regarding both ECT and psychotropic medications in pregnancy was performed, including meta-analyses of randomized controlled trials published in general medicine, anesthesiology, psychiatry, and obstetrics journals and guidelines. The indication and appropriateness of ECT in pregnancy must be carefully weighed against the risks of untreated maternal illness and those of alternative treatment options. The safety of ECT in pregnancy has been documented over the last 50 years. The adverse effects in pregnancy are similar to the risks of ECT in any individual. The most common risk to the mother is premature contractions and preterm labor, which occur infrequently and are not clearly caused by ECT. The rates of miscarriages were not significantly different from that of the general population. There have been no associations of ECT with congenital anomalies, either morphologic or behavioral, and no neurocognitive disturbances in the child. ECT is a reasonably safe and effective treatment alternative for management of many psychiatric disorders in pregnant patients. The authors provide recommendations for treatment modifications in pregnancy-based physiologic changes that occur during that period and consolidate them into a protocol that can assist clinicians in improving access and safety of ECT for pregnant patients.
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Affiliation(s)
- Heather Burrell Ward
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - John A Fromson
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Joseph J Cooper
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Gildasio De Oliveira
- Hasbro Children's, Miriam and Newport Hospitals, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- The School of Public Health of Brown University, Providence, RI, USA
| | - Marcela Almeida
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Division of Women's Mental Health and Reproductive Psychiatry, Department of Psychiatry,, Harvard Medical School, 1153 Centre Street, Boston, MA, 02130, USA.
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50
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Varga S. "Relaxed" natural kinds and psychiatric classification. Stud Hist Philos Biol Biomed Sci 2018; 72:49-54. [PMID: 30396827 DOI: 10.1016/j.shpsc.2018.10.001] [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] [Received: 10/27/2017] [Revised: 07/12/2018] [Accepted: 10/01/2018] [Indexed: 06/08/2023]
Abstract
This paper starts out highlighting a particular criticism that psychiatry faces and continues by investigating approaches to classification in psychiatry that operate with a "relaxed" (non-essentialist) notion of natural kind. Two accounts are examined, one by Rachel Cooper (2005; 2013) and one based on the work of Richard Boyd (1991; 1999; 2003; 2010). While these accounts do not directly pursue such a goal, the main aim is to probe whether deploying a "relaxed" notion of natural kind would be able to neutralize the criticism. While the conclusion is in the negative, the analysis raises doubts that it is possible to completely neutralize this criticism without assuming an overly simplistic view of the causal structure of the world.
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Affiliation(s)
- Somogy Varga
- Department of Philosophy, University of Memphis, 327 Clement Hall, Memphis, TN, 38152, USA.
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