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Mental ill-health is rife in all corners of the world. Mental illness diagnosis simultaneously names the problem and labels a person. Taking a social representations perspective, this phenomenological study explores how 12 people living with a mental disorder in Barcelona, Spain, experienced their diagnosis. They experienced having to process what this “diagnosis for life”meant for their sense of self. Immediate encounters of stereotyping and changes in their social relations, reinforced their experience of being “stigmatized for life” and seen as “mentally ill all the time”. Participants did however also note that the diagnosis helped them make sense of the past and the future, including enabling access to specific benefits, which supported their recovery and helped them make ends meet –highlighting the ambivalence of mental illness diagnosis. Thisstudy highlights the need to consider the social context and patients’ narrated experiences of diagnosis centre stage.Keywords: mental health; mental diseases; psychological diagnosis; psychiatric diagnosis; social representation; stigmatization; Spain, Os problemas de saúde mental são comuns em todos os cantos do mundo. O diagnóstico dedoença mental simultaneamente nomeia o problema e rotula uma pessoa. Na perspectiva das representações sociais, este estudo fenomenológico explora como 12 pessoas que vivem com um transtorno mental em Barcelona, Espanha, experienciaram seu diagnóstico. Eles tiveram que lidar com oque o “diagnóstico para a vida”significava no senso de identidade. Os encontros mediados por estereótipos e mudanças nas relações sociais reforçaram a experiência de serem “estigmatizados para a vida”e vistos como “doentes mentais o tempo todo”. Contudo, os participantes também percebem que o diagnóstico os ajudou a entender o passado e o futuro, incluindo o acesso a benefícios específicos que contribuiu na sua recuperação e para sobreviver economicamente -destacando a ambivalência do diagnóstico de doença mental. Este estudo destaca a necessidade de considerar o contexto social e as experiências dos pacientes.Palavras-chave:saúde mental; doenças mentais; diagnóstico psicológico; diagnóstico psiquiátrico; representação social; estigmatização; Espanha, Los problemas de salud mental son comunes en todos los rincones del mundo. El diagnóstico de enfermedad mental simultáneamente nombra el problema y etiqueta a una persona. Desde la perspectiva de las representaciones sociales, este estudio fenomenológico explora cómo 12 personas que viven con un trastorno mental en Barcelona, España, experimentaron su diagnóstico. Ellos tuvieron que lidiar con lo que significaba el “diagnóstico para toda la vida”en el sentido de identidad. Los encuentros mediados por estereotipos y cambios en las relaciones sociales reforzaron la experiencia de ser “estigmatizados de por vida” y vistos como “enfermos mentales todo el tiempo”. Sin embargo, los participantes también perciben que el diagnóstico les ayudó a comprender el pasadoy futuro, incluyendo el acceso a beneficios específicos que contribuyó a su recuperación y a sobrevivir económicamente, destacando la ambivalencia del diagnóstico de enfermedad mental. Esteestudio destaca la necesidad de considerar el contexto social y las experiencias de los pacientes.Palabras clave:salud mental; enfermedades mentales; diagnóstico psicológico; diagnóstico psiquiátrico; representación social; estigmatización; España

Background Despite the adverse impact diagnostic errors can have, clinical interviewing and decision-making in psychiatric practice have received relatively little empirical attention. When diagnosing patients, clinicians tend to fall back on a specific (heuristic) rule of thumb, the positive test strategy, a confirmatory approach that increases the risk of confirmation bias. Method and results A group of 83 clinical psychologists and psychiatrists was asked to give their diagnostic hypotheses about two vignettes. We found them to self-generate significantly (i.e., p < .01; d = 1.57) more confirming than disconfirming questions to test their initial diagnostic impressions, with supervisors considering significantly more differential diagnoses than the less experienced post-grads/residents. When offered a list of 100 potentially relevant diagnostic queries, the supervisors selected fewer confirming and proportionally more disconfirming themes. Conclusions Our results demonstrate that irrespective of clinical experience mental-health clinicians indeed tend to use a confirmatory thinking style that contrasts with the stricter principle of falsification. More field-based research on this topic is needed, as well as studies probing whether a systematized diagnostic approach is feasible in psychiatric practice and increases diagnostic accuracy and patient satisfaction.

Background and Aim: People with serious mental illness have high rates of bloodborne viruses (BBVs) but often have poor access to medical care. We sought to define the burden of hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV in a long-stay inpatient cohort with serious mental illness. Emphasis was placed on elucidating BBV prevalence, risk factors, and access to care. Method(s): We prospectively approached all patients (n = 46) admitted to a long-stay mental health admission unit at a tertiary referring hospital over a 2-week period and invited each person to complete a BBV risk factor survey, opt-out BBV screening, and liver assessment using transient elastography and other non-invasive liver stiffness assays. This was part of a quality assurance initiative. Result(s): Baseline demographics showed a young cohort (median age, 39.5 years), with a male preponderance (71.7%). The primary psychiatric diagnoses were schizophrenia and schizoaffective disorders (95.7%). Almost two-thirds (63%) had a secondary diagnosis of substance-misuse disorders. Serology was obtained for 31 patients (67.4%). Of those screened for HBV, 15 (53.3%) were unvaccinated, four (13.3%) had previous HBV exposure, and 10 (33.3%) were vaccinated. No cases of HBV viremia were identified. HCV serology was positive (HCV antibody positive) in 11 patients (36.7%). Each had a history of intravenous drug use. Importantly, seven patients (23.3%) had successfully been treated for HCV and one (3.3%) had active viremia. The remaining cases likely reflected spontaneous clearance. To assess disease severity, transient elastography and the aspartate aminotransferase to platelet ratio index (APRI) were used as validated markers of liver fibrosis. APRI showed higher rates of fibrosis in the HCV antibody positive cohort, but this was not statistically significant compared with the HCV-naive cohort. Liver stiffness measurement conducted in the HCV antibody positive study group was similar and showed two

Background and Aim: People with serious mental illness have high rates of bloodborne viruses (BBVs) but often have poor access to medical care. We sought to define the burden of hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV in a long-stay inpatient cohort with serious mental illness. Emphasis was placed on elucidating BBV prevalence, risk factors, and access to care. Method(s): We prospectively approached all patients (n = 46) admitted to a long-stay mental health admission unit at a tertiary referring hospital over a 2-week period and invited each person to complete a BBV risk factor survey, opt-out BBV screening, and liver assessment using transient elastography and other non-invasive liver stiffness assays. This was part of a quality assurance initiative. Result(s): Baseline demographics showed a young cohort (median age, 39.5 years), with a male preponderance (71.7%). The primary psychiatric diagnoses were schizophrenia and schizoaffective disorders (95.7%). Almost two-thirds (63%) had a secondary diagnosis of substance-misuse disorders. Serology was obtained for 31 patients (67.4%). Of those screened for HBV, 15 (53.3%) were unvaccinated, four (13.3%) had previous HBV exposure, and 10 (33.3%) were vaccinated. No cases of HBV viremia were identified. HCV serology was positive (HCV antibody positive) in 11 patients (36.7%). Each had a history of intravenous drug use. Importantly, seven patients (23.3%) had successfully been treated for HCV and one (3.3%) had active viremia. The remaining cases likely reflected spontaneous clearance. To assess disease severity, transient elastography and the aspartate aminotransferase to platelet ratio index (APRI) were used as validated markers of liver fibrosis. APRI showed higher rates of fibrosis in the HCV antibody positive cohort, but this was not statistically significant compared with the HCV-naive cohort. Liver stiffness measurement conducted in the HCV antibody positive study group was similar and showed two

Bakgrund: Trots stora framgångar inom den psykiatriska vårdvetenskapen fortsätter psykiatriska sjukdomar att växa fram utbrett över hela världen. Genom coping kan en individ hantera de inre och yttre krav som ställs och överskrider individens personliga resurser. Psykiatriska diagnoser kan för en oerfaren sjuksköterska upplevas som främmande eller otäckt. Detta kan bero på bristande förståelse och kunskap kring psykiatriska diagnoser varför det är viktigt att öka kunskapen inom området. Syfte: Syftet med denna studie var att beskriva vilka copingstrategier personer med psykiatrisk diagnos använder. Metod: En beskrivande litteraturstudie, artikelsökningen genomfördes i databaserna Medline via Pubmed samt PsycINFO vilket medförde totalt tretton artiklar som inkluderas i resultatdelen. Resultatet baseras på tolv kvalitativa artiklar och en kvalitativ och kvantitativ artikel. Huvudresultat: Resultatet består av tre huvudteman, problemfokuserad, känslofokuserad och meningsbaserad coping. Dessa copingstrategier gav upphov till mening, känslor av säkerhet och sinnesro, tillhörighet, glädje och skapade verktyg för att få en förbättrad förståelse för sina känslor och minimerad stress hos personer med en psykiatrisk diagnos. Resultaten visade att flest personer använde sig av problemfokuserade copingstrategier som inriktade sig på att aktivt sträva efter att förändra eller hantera det underliggande problemet. Slutsats: Studiens syfte var att beskriva vilka copingstrategier som personer med psykiatrisk diagnos använde. Resultaten visade att personer med psykiatrisk diagnos använde sig av olika kombinationer av copingstrategier i olika situationer utifrån olika behov. Att hantera sin situation med hjälp av rutiner, yttre stöd, medicinsk behandling, kontroll och förståelse av känslor, samt livssyn och tro framkom i resultatet som väsentliga faktorer. Att ha förståelse för att personer använder sig av individuella copingstrategier kan hjälpa sjuksköterskan att uppmuntra till nya

Bakgrund: Trots stora framgångar inom den psykiatriska vårdvetenskapen fortsätter psykiatriska sjukdomar att växa fram utbrett över hela världen. Genom coping kan en individ hantera de inre och yttre krav som ställs och överskrider individens personliga resurser. Psykiatriska diagnoser kan för en oerfaren sjuksköterska upplevas som främmande eller otäckt. Detta kan bero på bristande förståelse och kunskap kring psykiatriska diagnoser varför det är viktigt att öka kunskapen inom området. Syfte: Syftet med denna studie var att beskriva vilka copingstrategier personer med psykiatrisk diagnos använder. Metod: En beskrivande litteraturstudie, artikelsökningen genomfördes i databaserna Medline via Pubmed samt PsycINFO vilket medförde totalt tretton artiklar som inkluderas i resultatdelen. Resultatet baseras på tolv kvalitativa artiklar och en kvalitativ och kvantitativ artikel. Huvudresultat: Resultatet består av tre huvudteman, problemfokuserad, känslofokuserad och meningsbaserad coping. Dessa copingstrategier gav upphov till mening, känslor av säkerhet och sinnesro, tillhörighet, glädje och skapade verktyg för att få en förbättrad förståelse för sina känslor och minimerad stress hos personer med en psykiatrisk diagnos. Resultaten visade att flest personer använde sig av problemfokuserade copingstrategier som inriktade sig på att aktivt sträva efter att förändra eller hantera det underliggande problemet. Slutsats: Studiens syfte var att beskriva vilka copingstrategier som personer med psykiatrisk diagnos använde. Resultaten visade att personer med psykiatrisk diagnos använde sig av olika kombinationer av copingstrategier i olika situationer utifrån olika behov. Att hantera sin situation med hjälp av rutiner, yttre stöd, medicinsk behandling, kontroll och förståelse av känslor, samt livssyn och tro framkom i resultatet som väsentliga faktorer. Att ha förståelse för att personer använder sig av individuella copingstrategier kan hjälpa sjuksköterskan att uppmuntra till nya

Objectives:While early diagnosis of younger-onset dementia (YOD) is crucial in terms of accessing appropriate services and future planning, diagnostic delays are common. This study aims to identify predictors of delay to diagnosis in a large sample of people with YOD and to investigate the impact of a specialist YOD service on this time to diagnosis. Design(s):A retrospective cross-sectional study. Setting(s):The inpatient unit of a tertiary neuropsychiatry service in metropolitan Victoria, Australia. Participant(s):People diagnosed with a YOD.Measurements and methods:We investigated the following predictors using general linear modeling: demographics including sex and location, age at onset, dementia type, cognition, psychiatric diagnosis, and number of services consulted with prior to diagnosis. Result(s):A total of 242 inpatients were included. The mean time to diagnosis was 3.4 years. Significant predictors of delay included younger age at onset, dementia type other than Alzheimer's disease (AD) and behavioral-variant frontotemporal dementia (bvFTD), and increased number of services consulted. These predictors individually led to an increased diagnostic delay of approximately 19 days, 5 months, and 6 months, respectively. A specialized YOD service reduced time to diagnosis by 12 months. Conclusion(s):We found that younger age at onset, having a dementia which was not the most commonly occurring AD or bvFTD, and increasing number of services were significant predictors of diagnostic delay. A novel result was that a specialist YOD service may decrease diagnostic delay, highlighting the importance of such as service in reducing time to diagnosis as well as providing post-diagnostic support. Copyright © International Psychogeriatric Association 2020.

Objectives:While early diagnosis of younger-onset dementia (YOD) is crucial in terms of accessing appropriate services and future planning, diagnostic delays are common. This study aims to identify predictors of delay to diagnosis in a large sample of people with YOD and to investigate the impact of a specialist YOD service on this time to diagnosis. Design(s):A retrospective cross-sectional study. Setting(s):The inpatient unit of a tertiary neuropsychiatry service in metropolitan Victoria, Australia. Participant(s):People diagnosed with a YOD.Measurements and methods:We investigated the following predictors using general linear modeling: demographics including sex and location, age at onset, dementia type, cognition, psychiatric diagnosis, and number of services consulted with prior to diagnosis. Result(s):A total of 242 inpatients were included. The mean time to diagnosis was 3.4 years. Significant predictors of delay included younger age at onset, dementia type other than Alzheimer's disease (AD) and behavioral-variant frontotemporal dementia (bvFTD), and increased number of services consulted. These predictors individually led to an increased diagnostic delay of approximately 19 days, 5 months, and 6 months, respectively. A specialized YOD service reduced time to diagnosis by 12 months. Conclusion(s):We found that younger age at onset, having a dementia which was not the most commonly occurring AD or bvFTD, and increasing number of services were significant predictors of diagnostic delay. A novel result was that a specialist YOD service may decrease diagnostic delay, highlighting the importance of such as service in reducing time to diagnosis as well as providing post-diagnostic support. Copyright © International Psychogeriatric Association 2020.

Background: Despite the dominance of psychiatric diagnosis within mental healthcare systems, there is no validated measure of diagnosis impact on those who receive them. Consequently, there is also a paucity of statistically generalisable research on the experience of receiving and living with a diagnosis. Aims: To develop a valid and reliable measure of the effect of psychiatric diagnosis on recipients, the Diagnosis Impact Scale (DIS), for clinical and research use. Method: Measure development protocols used included the generation of an item pool, expert rating of items, and Three Step Test Interviews. Psychometric properties of the DIS were investigated, including internal consistency, convergent validity, discriminant validity, and criterion validity. A principal components analysis was carried out on a sample of 248 people with psychiatric diagnoses, followed by a two-parameter IRT analysis. Findings: The principal components analysis suggested that the 19-item DIS had two discrete subscales: Helpfulness of Diagnosis and Diagnosis-Related Self-Stigma. Each displayed excellent reliability in this sample, with Cronbach’s alphas of 0.93 (n=256) and 0.81 (n=263) for Helpfulness of Diagnosis and Diagnosis-Related Self-Stigma respectively. They were also found to have acceptable content and construct validity. Significant associations were found between both subscales and diagnosis type, perceived correct diagnosis, receipt of treatment due to diagnosis, and helpfulness of said treatment. Helpfulness of Diagnosis was significantly associated with age and time since diagnosis. Diagnosis-Related Self-Stigma was significantly associated with having multiple diagnoses, the number of these, and the type of healthcare professional who gave the diagnosis (e.g. GP or psychiatrist). The two-parameter IRT analysis showed that both subscales were within acceptable ranges for discrimination and differentiationbetween

Preterm birth research is poised to explore the mental health of adults born very preterm(VP; <32⁺⁰ weeks gestational age) and/or very low birth weight(VLBW; <1500g) through individual participant data meta-analyses, but first the previous evidence needs to be understood. We systematically reviewed and assessed the quality of the evidence from VP/VLBW studies with mental health symptoms or disorders appearing in adulthood, excluding childhood onset disorders. Participants (≥18 years, born >1970) included VP/VLBW individuals with controls born at term(≥37⁺⁰ weeks) or with normal birth weight(NBW; ≥2500g). Thirteen studies were included. Studies consistently showed an increased risk for psychotropic medication use for VP/VLBW adults in comparison to NBW/term controls, but whether VP/VLBW adults have an increased risk for mental health disorders or symptoms appearing in adulthood remains uncertain. The quality of the evidence was moderate (65.8%) to high (34.2%). Further research in larger samples is needed.

Background: Despite the dominance of psychiatric diagnosis within mental healthcare systems, there is no validated measure of diagnosis impact on those who receive them. Consequently, there is also a paucity of statistically generalisable research on the experience of receiving and living with a diagnosis. Aims: To develop a valid and reliable measure of the effect of psychiatric diagnosis on recipients, the Diagnosis Impact Scale (DIS), for clinical and research use. Method: Measure development protocols used included the generation of an item pool, expert rating of items, and Three Step Test Interviews. Psychometric properties of the DIS were investigated, including internal consistency, convergent validity, discriminant validity, and criterion validity. A principal components analysis was carried out on a sample of 248 people with psychiatric diagnoses, followed by a two-parameter IRT analysis. Findings: The principal components analysis suggested that the 19-item DIS had two discrete subscales: Helpfulness of Diagnosis and Diagnosis-Related Self-Stigma. Each displayed excellent reliability in this sample, with Cronbach’s alphas of 0.93 (n=256) and 0.81 (n=263) for Helpfulness of Diagnosis and Diagnosis-Related Self-Stigma respectively. They were also found to have acceptable content and construct validity. Significant associations were found between both subscales and diagnosis type, perceived correct diagnosis, receipt of treatment due to diagnosis, and helpfulness of said treatment. Helpfulness of Diagnosis was significantly associated with age and time since diagnosis. Diagnosis-Related Self-Stigma was significantly associated with having multiple diagnoses, the number of these, and the type of healthcare professional who gave the diagnosis (e.g. GP or psychiatrist). The two-parameter IRT analysis showed that both subscales were within acceptable ranges for discrimination and differentiationbetween

This dissertation contributes to the debate on street-level bureaucracy, which highlights how the decisions made by workers in public bureaucracies effectively become public policy. This debate has paid relatively little attention to the study of how professionals carry out their work by means of institutional categorization, a knowledge gap that this study helps to close. Moreover, this study contributes to the understanding of how persons with mental ill-health are matched with institutional categories. The aim of this dissertation is to shed light on the institutional categorization process involving persons with mental ill-health in two interrelated areas of welfare settings: primary healthcare and sickness insurance. To pursue this aim, 27 in-depth interviews with 30 participants (18 doctors and 12 social insurance officers) were performed. The interviews, which were based on vignettes – short hypothetical scenarios – made it possible to get insight into how doctors and social insurance officers would reason in a situation similar to that depicted in the vignette. This study emphasizes how discretion is exercised when individuals are matched with the institutional categories that doctors in primary health settings and social insurance officers have at their disposal. Ideally, this process is a rational process through which clients’ objective traits are assessed against the criteria that define the various institutional categories. However, the process is not straightforward; thus, different kinds of social mechanisms are linked to the processes of institutional categorization, such as signaling, screening, the logic of appropriateness, moral work, and discrimination. On a more practical level, this study emphasizes the difficulties imbued in the process of institutional categorization. There are multiple reasons for these difficulties. Human complexity is one of them: the interviewed professionals often work with situations that require responses to human dime

Traditionally, studies emphasize differences in neural measures between pathological and healthy groups, assuming a binary distinction between the groups, and a linear relationship between neural measures and symptoms. Here, we present four examples that show a continuous relation across the divide of normal and pathological states between neural measures and mental functions. This relation can be characterized by a nonlinear inverted-U shaped curve. Along this curve, mid-range or average expression of a neural measure is associated with optimal function of a mental feature (in healthy states), whereas extreme expression, either high or low, is associated with sub-optimal function, and occurs in different neural disorders. Neural expression between the optimal or intermediate and pathological or extreme values is associated with sub-optimal function and atrisk mental states. Thus, this model of neuro-mental relationship can be summarized as "average is good, extremes are bad". By focussing on neuro-mental relationships, this model can facilitate the transition of psychiatry from a categorical to a dimensional and individualized approach needed in the era of precision medicine.

Traditionally, studies emphasize differences in neural measures between pathological and healthy groups, assuming a binary distinction between the groups, and a linear relationship between neural measures and symptoms. Here, we present four examples that show a continuous relation across the divide of normal and pathological states between neural measures and mental functions. This relation can be characterized by a nonlinear inverted-U shaped curve. Along this curve, mid-range or average expression of a neural measure is associated with optimal function of a mental feature (in healthy states), whereas extreme expression, either high or low, is associated with sub-optimal function, and occurs in different neural disorders. Neural expression between the optimal or intermediate and pathological or extreme values is associated with sub-optimal function and atrisk mental states. Thus, this model of neuro-mental relationship can be summarized as "average is good, extremes are bad". By focussing on neuro-mental relationships, this model can facilitate the transition of psychiatry from a categorical to a dimensional and individualized approach needed in the era of precision medicine.

Traditionally, studies emphasize differences in neural measures between pathological and healthy groups, assuming a binary distinction between the groups, and a linear relationship between neural measures and symptoms. Here, we present four examples that show a continuous relation across the divide of normal and pathological states between neural measures and mental functions. This relation can be characterized by a nonlinear inverted-U shaped curve. Along this curve, mid-range or average expression of a neural measure is associated with optimal function of a mental feature (in healthy states), whereas extreme expression, either high or low, is associated with sub-optimal function, and occurs in different neural disorders. Neural expression between the optimal or intermediate and pathological or extreme values is associated with sub-optimal function and atrisk mental states. Thus, this model of neuro-mental relationship can be summarized as "average is good, extremes are bad". By focussing on neuro-mental relationships, this model can facilitate the transition of psychiatry from a categorical to a dimensional and individualized approach needed in the era of precision medicine.

Traditionally, studies emphasize differences in neural measures between pathological and healthy groups, assuming a binary distinction between the groups, and a linear relationship between neural measures and symptoms. Here, we present four examples that show a continuous relation across the divide of normal and pathological states between neural measures and mental functions. This relation can be characterized by a nonlinear inverted-U shaped curve. Along this curve, mid-range or average expression of a neural measure is associated with optimal function of a mental feature (in healthy states), whereas extreme expression, either high or low, is associated with sub-optimal function, and occurs in different neural disorders. Neural expression between the optimal or intermediate and pathological or extreme values is associated with sub-optimal function and atrisk mental states. Thus, this model of neuro-mental relationship can be summarized as "average is good, extremes are bad". By focussing on neuro-mental relationships, this model can facilitate the transition of psychiatry from a categorical to a dimensional and individualized approach needed in the era of precision medicine.

Traditionally, studies emphasize differences in neural measures between pathological and healthy groups, assuming a binary distinction between the groups, and a linear relationship between neural measures and symptoms. Here, we present four examples that show a continuous relation across the divide of normal and pathological states between neural measures and mental functions. This relation can be characterized by a nonlinear inverted-U shaped curve. Along this curve, mid-range or average expression of a neural measure is associated with optimal function of a mental feature (in healthy states), whereas extreme expression, either high or low, is associated with sub-optimal function, and occurs in different neural disorders. Neural expression between the optimal or intermediate and pathological or extreme values is associated with sub-optimal function and atrisk mental states. Thus, this model of neuro-mental relationship can be summarized as "average is good, extremes are bad". By focussing on neuro-mental relationships, this model can facilitate the transition of psychiatry from a categorical to a dimensional and individualized approach needed in the era of precision medicine.

This dissertation contributes to the debate on street-level bureaucracy, which highlights how the decisions made by workers in public bureaucracies effectively become public policy. This debate has paid relatively little attention to the study of how professionals carry out their work by means of institutional categorization, a knowledge gap that this study helps to close. Moreover, this study contributes to the understanding of how persons with mental ill-health are matched with institutional categories. The aim of this dissertation is to shed light on the institutional categorization process involving persons with mental ill-health in two interrelated areas of welfare settings: primary healthcare and sickness insurance. To pursue this aim, 27 in-depth interviews with 30 participants (18 doctors and 12 social insurance officers) were performed. The interviews, which were based on vignettes – short hypothetical scenarios – made it possible to get insight into how doctors and social insurance officers would reason in a situation similar to that depicted in the vignette. This study emphasizes how discretion is exercised when individuals are matched with the institutional categories that doctors in primary health settings and social insurance officers have at their disposal. Ideally, this process is a rational process through which clients’ objective traits are assessed against the criteria that define the various institutional categories. However, the process is not straightforward; thus, different kinds of social mechanisms are linked to the processes of institutional categorization, such as signaling, screening, the logic of appropriateness, moral work, and discrimination. On a more practical level, this study emphasizes the difficulties imbued in the process of institutional categorization. There are multiple reasons for these difficulties. Human complexity is one of them: the interviewed professionals often work with situations that require responses to human dime

BACKGROUND:An issue of critical importance for psychiatry and women's health is whether postpartum depression (PPD) represents a unique condition. The Diagnostic and Statistical Manual of Mental Disorders asserts that major depressive disorder (MDD) may present with peripartum onset, without suggesting any other differences between MDD and PPD. The absence of any distinct features calls into question the nosologic validity of PPD as a diagnostic category. The present study investigates whether symptom profiles differ between PPD and depression occurring outside the postpartum phase. METHODS:In a prospective, longitudinal study of parturient women (N = 239), we examine the manifestation of depression symptoms. We assess factor structure of symptom profiles, and whether factors are differentially pronounced during and after the postpartum period. RESULTS:Factors were revealed representing: Worry, Emotional/Circadian/Energetic Dysregulation, Somatic/Cognitive, Appetite, Distress Display, and Anger symptoms. The factor structure was validated at postpartum and after-postpartum timepoints. Interestingly, the Worry factor, comprising anxiety and guilt, was significantly more pronounced during the postpartum timepoint, and the Emotional/Circadian/Energetic Dysregulation factor, which contained sadness and anhedonia, was significantly less pronounced during the postpartum period. CONCLUSIONS:These results suggest that PPD may be a unique syndrome, necessitating research, diagnosis, and treatment strategies distinct from those for MDD. Results indicate the possibility that Worry is an enhanced feature of PPD compared to depression outside the postpartum period, and the crucial role of sadness/anhedonia in MDD diagnosis may be less applicable to PPD diagnosis.

Background: There is no screening tool for major depressive disorder (MDD) or post-traumatic stress disorder (PTSD) in asylum-seekers or refugees (ASR) that can be readily administered by non-mental health workers. Hence, we aimed to develop a brief, sensitive and rapidly administrable tool for non-mental health workers to screen for MDD and PTSD in ASR. Method(s): The screening tool was developed from an extant dataset (n = 121) of multiply screened ASR and tested prospectively (N = 192) against the M.I.N.I. (Mini International Neuropsychiatric Interview) structured psychiatric interview. Rasch, Differential Item Functioning and ROC analyses evaluated the psychometric properties and tool utility. Result(s): A 9-item tool with a median administration time of six minutes was generated, comprising two 'immediate screen-in' items, and a 7-item scale. The prevalence of PTSD &/or MDD using the M.I.N.I. was 32%, whilst 99% of other diagnosed mental disorders were comorbid with one or both of these. Using a cut-score of >=2, the tool provided a sensitivity of 0.93, specificity of 0.75 and predictive accuracy of 80.7%. Conclusion(s): A brief sensitive screening tool with robust psychometric properties that was easy to administer at the agency of first presentation was developed to facilitate mental health referrals for asylum-seekers and new refugees.Copyright © 2018 The Author(s).

Background: There is no screening tool for major depressive disorder (MDD) or post-traumatic stress disorder (PTSD) in asylum-seekers or refugees (ASR) that can be readily administered by non-mental health workers. Hence, we aimed to develop a brief, sensitive and rapidly administrable tool for non-mental health workers to screen for MDD and PTSD in ASR. Method(s): The screening tool was developed from an extant dataset (n = 121) of multiply screened ASR and tested prospectively (N = 192) against the M.I.N.I. (Mini International Neuropsychiatric Interview) structured psychiatric interview. Rasch, Differential Item Functioning and ROC analyses evaluated the psychometric properties and tool utility. Result(s): A 9-item tool with a median administration time of six minutes was generated, comprising two 'immediate screen-in' items, and a 7-item scale. The prevalence of PTSD &/or MDD using the M.I.N.I. was 32%, whilst 99% of other diagnosed mental disorders were comorbid with one or both of these. Using a cut-score of >=2, the tool provided a sensitivity of 0.93, specificity of 0.75 and predictive accuracy of 80.7%. Conclusion(s): A brief sensitive screening tool with robust psychometric properties that was easy to administer at the agency of first presentation was developed to facilitate mental health referrals for asylum-seekers and new refugees.Copyright © 2018 The Author(s).

The purpose of this article is reclaim the ethics relevance, in the comprehensive of the diagnosis inflation problem. To achieve the meaning aim, we are going to analyze six aspects, which are the most important in this business. These are: the psychiatric diagnosis, as a philosophical issue, which is the entrance (or beginning) for the mental health world; the DSM- 5 in comparative way with the DSM-IV and the DSM- IV-TR; the theoretical setting used in the understanding and application of the mental health criteria; the ethic education of the psychiatric professionals; the pharmaceutic marketing and the health speech, comprehended like a consum property. The investigation of all of these factors it will lead for the ethic reflexion but always in a interdisciplinary structure, because the diagnosis inflation is a multidimensional (or figurative) problem., El objetivo de este artículo es reivindicar el papel de la ética, en la compresión del problema de la inflación diagnóstica. Para alcanzar el propósito planteado se analizarán seis aspectos, que se comprenden como los más relevantes a la hora de llevar a cabo esta empenta. Estos son: el diagnóstico psiquiátrico, como problema filosófico, ya que es la puerta de entrada al mundo de la salud mental; el DSM-5 valorado comparativamente con el DSM-IV y el DSM-IV-TR; el marco teórico utilizado en la comprensión y aplicación de los parámetros de la salud mental; la educación ética de los profesionales de la psiquiatría; la publicidad farmacéutica y el discurso de la salud, entendido como un bien de consumo. El análisis de todos estos aspectos irá vertebrado por la reflexión ética pero siempre desde un marco interdisciplinar, ya que la inflación diagnóstica es una problemática multidimensional.

The purpose of this article is reclaim the ethics relevance, in the comprehensive of the diagnosis inflation problem. To achieve the meaning aim, we are going to analyze six aspects, which are the most important in this business. These are: the psychiatric diagnosis, as a philosophical issue, which is the entrance (or beginning) for the mental health world; the DSM- 5 in comparative way with the DSM-IV and the DSM- IV-TR; the theoretical setting used in the understanding and application of the mental health criteria; the ethic education of the psychiatric professionals; the pharmaceutic marketing and the health speech, comprehended like a consum property. The investigation of all of these factors it will lead for the ethic reflexion but always in a interdisciplinary structure, because the diagnosis inflation is a multidimensional (or figurative) problem., El objetivo de este artículo es reivindicar el papel de la ética, en la compresión del problema de la inflación diagnóstica. Para alcanzar el propósito planteado se analizarán seis aspectos, que se comprenden como los más relevantes a la hora de llevar a cabo esta empenta. Estos son: el diagnóstico psiquiátrico, como problema filosófico, ya que es la puerta de entrada al mundo de la salud mental; el DSM-5 valorado comparativamente con el DSM-IV y el DSM-IV-TR; el marco teórico utilizado en la comprensión y aplicación de los parámetros de la salud mental; la educación ética de los profesionales de la psiquiatría; la publicidad farmacéutica y el discurso de la salud, entendido como un bien de consumo. El análisis de todos estos aspectos irá vertebrado por la reflexión ética pero siempre desde un marco interdisciplinar, ya que la inflación diagnóstica es una problemática multidimensional.

BACKGROUND:An issue of critical importance for psychiatry and women's health is whether postpartum depression (PPD) represents a unique condition. The Diagnostic and Statistical Manual of Mental Disorders asserts that major depressive disorder (MDD) may present with peripartum onset, without suggesting any other differences between MDD and PPD. The absence of any distinct features calls into question the nosologic validity of PPD as a diagnostic category. The present study investigates whether symptom profiles differ between PPD and depression occurring outside the postpartum phase. METHODS:In a prospective, longitudinal study of parturient women (N = 239), we examine the manifestation of depression symptoms. We assess factor structure of symptom profiles, and whether factors are differentially pronounced during and after the postpartum period. RESULTS:Factors were revealed representing: Worry, Emotional/Circadian/Energetic Dysregulation, Somatic/Cognitive, Appetite, Distress Display, and Anger symptoms. The factor structure was validated at postpartum and after-postpartum timepoints. Interestingly, the Worry factor, comprising anxiety and guilt, was significantly more pronounced during the postpartum timepoint, and the Emotional/Circadian/Energetic Dysregulation factor, which contained sadness and anhedonia, was significantly less pronounced during the postpartum period. CONCLUSIONS:These results suggest that PPD may be a unique syndrome, necessitating research, diagnosis, and treatment strategies distinct from those for MDD. Results indicate the possibility that Worry is an enhanced feature of PPD compared to depression outside the postpartum period, and the crucial role of sadness/anhedonia in MDD diagnosis may be less applicable to PPD diagnosis.

Background: Mental health services have experienced an exponential rise in trans-identified client referrals over the past decade. This is in part due to media attention and a rapid spread of information through the Internet and emancipation of the lesbian, gay, bisexual, transgender and intersex (LGBTI) population in general. Objective(s): To review the historical development of gender diagnoses in psychiatry and the paradigm shift in clinical interventions. Method(s): A review of gender diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Disease (ICD) was undertaken along with a review of successive versions of the standards of care (SOC) published by the World Professional Association for Transgender Health (WPATH). Finding(s): A diagnosis relating to gender variance was first listed in DSM-2 (1968) as transvestitism [sic] under the parent category sexual deviations. Diagnoses in the DSM, fifth edition (DSM-5) (2013) are gender dysphoria in children and gender dysphoria in adolescents and adults. The parent category is gender dysphoria. Similarly, a diagnosis relating to gender variance was first listed in the ICD, eighth revision (-ICD-8) (1965) as transvestitism [sic] and again under the parent category sexual deviations. Proposed diagnoses in the ICD, eleventh revision (ICD-11) are gender incongruence of adolescence and adulthood. The proposed diagnosis of 'gender incongruence of childhood' remains controversial. It is proposed to move these diagnoses out of mental and behavioural disorders. Conclusion(s): Gender variance-related diagnoses in psychiatric classification systems have seen progressive depathologization of the condition over the past 7 decades. This is mirrored in changes to the shifting treatment paradigm resulting in less-restrictive access to clinical interventions including hormones and surgery. The changes pose significant clinical challenges for psychiatrists.

Background: Mental health services have experienced an exponential rise in trans-identified client referrals over the past decade. This is in part due to media attention and a rapid spread of information through the Internet and emancipation of the lesbian, gay, bisexual, transgender and intersex (LGBTI) population in general. Objective(s): To review the historical development of gender diagnoses in psychiatry and the paradigm shift in clinical interventions. Method(s): A review of gender diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Disease (ICD) was undertaken along with a review of successive versions of the standards of care (SOC) published by the World Professional Association for Transgender Health (WPATH). Finding(s): A diagnosis relating to gender variance was first listed in DSM-2 (1968) as transvestitism [sic] under the parent category sexual deviations. Diagnoses in the DSM, fifth edition (DSM-5) (2013) are gender dysphoria in children and gender dysphoria in adolescents and adults. The parent category is gender dysphoria. Similarly, a diagnosis relating to gender variance was first listed in the ICD, eighth revision (-ICD-8) (1965) as transvestitism [sic] and again under the parent category sexual deviations. Proposed diagnoses in the ICD, eleventh revision (ICD-11) are gender incongruence of adolescence and adulthood. The proposed diagnosis of 'gender incongruence of childhood' remains controversial. It is proposed to move these diagnoses out of mental and behavioural disorders. Conclusion(s): Gender variance-related diagnoses in psychiatric classification systems have seen progressive depathologization of the condition over the past 7 decades. This is mirrored in changes to the shifting treatment paradigm resulting in less-restrictive access to clinical interventions including hormones and surgery. The changes pose significant clinical challenges for psychiatrists.

Bakgrund: Patienter med psykiatriska diagnoser och deras närstående upplever att den somatiska vården inte lever upp till deras förväntningar och att vårdpersonal har bristande kompetens vad gällande bedömning och bemötande. Patienter upplever sig misstrodda när de presenterar sina symtom vilket leder till känslor som skuld och skam. Psykisk sjukdom ökar i världen och sjukvården har ännu inte lyckats möta vårdbehovet för denna patientgrupp. Syfte: Att beskriva sjuksköterskors upplevelser av att vårda patienter med psykiatriska diagnoser i den somatiska vården. Metod: En litteraturöversikt genomfördes för att få kunskap inom detta område. Författarna valde ut tio vetenskapliga artiklar, som alla var av kvalitativ design och svarade till det specifika syftet. Resultat: Tre kategorier framkom: Den första var Sjuksköterskors upplevelser i praktiken med underkategori Upplevelser av patienter där författarna presenterade hur sjuksköterskor uttryckte att de saknade färdigheter, fokuserade på patienters fysiska symtom och upplevde patienter som oförutsägbara och tidskrävande vilket ledde till känslor som frustration och rädsla. Den andra kategorin, Sjuksköterskors upplevda arbetsmiljö beskrev hur den fysiska och psykosociala arbetsmiljön hindrade sjuksköterskor från att tillgodose patienternas vårdbehov. Den tredje kategorin var Sjuksköterskors upplevda kompetens med underkategori Erfarenheter av att vårda. Sjuksköterskor upplevde att de saknade adekvat utbildning vilket hade en direkt inverkan på upplevelsen av att vårda. Diskussion: Litteraturöversiktens resultat visade en upplevd kunskapsbrist hos sjuksköterskan och en arbetsmiljö som hindrade vårdandet. Detta diskuterades utifrån bakgrund, resultat och Phil Barkers omvårdnadsteori., Background: Patients with psychiatric diagnoses and their families feel that somatic care does not live up to their expectations and that health professionals lack competence in the assessment and treatment for these diagnosis. Patients feel disbelieved when they present their symptoms, which leads to feelings of guilt and shame. Mental illness is increasing worldwide and the healthcare providers have not managed to meet the increased need for care. Aim: The aim was to describe nurses experiences of caring for patients with psychiatric diagnosis in a somatic care setting. Method: A literature review was conducted to gain a wider knowledge in this area. The authors chose ten scientific articles, all of which were of qualitative design and responded to the specific purpose. Results: Three categories emerged. The first was Nurses experience in practice with the sub-category Experiences of patients where the authors presented how nurses expressed that they lacked skills, focused on the patients physical symptoms and experienced patient´s as unpredictable and time consuming, which led to feelings of frustration and fear. The second category, Nurses experience of their work environment described how the physical and the psychosocial environment prevented nurses from meeting the patients care needs. The third category was Nurses experienced competence with the subcategory Experiences of nursing. Nurses felt that they lacked adequate education, which had a direct impact on the experience of caring for patients with psychiatric diagnosis. Discussion: The literature reviews result showed a perceived lack of knowledge for nurses and a work environment that hinder patient care. This was discussed on the basis of the background, result and Phil Barker´s nursing theory.

Bakgrund: Att leva som diagnostiserad med ett psykiatriskt tillstånd kan innebära flertalet utmaningar. Personer med psykiatriska tillstånd kan dagligen uppleva sig utsatta för fördomar, bevisligen inte enbart i sin vardag i samhället utan även inom vårdkontexten. Somatisk samsjuklighet är ett reellt problem som drabbar en stor del av de personer som diagnostiserats med psykiatriska tillstånd. Vårdpersonal beskrev upplevelser av rädsla och osäkerhet i möten med personer med psykiatriska tillstånd och de belyste bristande kunskaper kring hur de bör bemöta personer med psykiatriska tillstånd. Syfte: Syftet med studien var att belysa de erfarenheter personer med psykiatriska tillstånd beskrivit i kontakt med somatisk vård. Metod: Studien som utförts var en litteraturöversikt enligt Friberg. Genom sökningar med hjälp av databaser såsom Cinahl Complete och PubMed har författarna funnit studier som i litteraturöversikten analyserats och tematiserats. Resultat: Litteraturöversiktens resultat identifierade ett huvudtema: Psykiatriska patienters erfarenheter av somatisk vård och två underteman: Vårdpersonalens bemötande och Bemötandets betydelse för patienters upplevelser av delaktighet. Diskussion: Litteraturöversiktens resultat diskuterades i förhållande till utvalda budord från tidvattenmodellen. Resonemang fördes kring vikten av bemötande och delaktighet., Background: Living with a psychiatric diagnosis may entail numerous challenges for the individual. People diagnosed with mental illness can daily experience a vulnerability to prejudice, not only in their everyday life in society but also within the healthcare context. Comorbidity is a substantial problem among a considerable part of the population with psychiatric diagnosis. Healthcare staff has described experiences of fear and uncertainty when dealing with people with psychiatric diagnosis, they enlightened a lack of knowledge when it comes to properly responding to the needs of people with a psychiatric diagnosis. Aim: The aim of this study was to investigate the experiences people with mental illness describe in contact with somatic healthcare. Method: The authors carried out a literature review. Through searches in databases such as Cinahl Complete and PubMed they have found articles that were analyzed and divided into themes. Result: The result of the literature review identified one main theme: Psychiatric patients’ experiences of somatic care and two subthemes: Healthcare staffs’ treatment and the treatments effect on patient participation. Discussion: The results found in the literature review were discussed in relation to chosen commitments from the tidal model. Reasoning arguments concerning treatment and ways to promote patient participation were held and discussed.

Bakgrund: Patienter med psykiatriska diagnoser och deras närstående upplever att den somatiska vården inte lever upp till deras förväntningar och att vårdpersonal har bristande kompetens vad gällande bedömning och bemötande. Patienter upplever sig misstrodda när de presenterar sina symtom vilket leder till känslor som skuld och skam. Psykisk sjukdom ökar i världen och sjukvården har ännu inte lyckats möta vårdbehovet för denna patientgrupp. Syfte: Att beskriva sjuksköterskors upplevelser av att vårda patienter med psykiatriska diagnoser i den somatiska vården. Metod: En litteraturöversikt genomfördes för att få kunskap inom detta område. Författarna valde ut tio vetenskapliga artiklar, som alla var av kvalitativ design och svarade till det specifika syftet. Resultat: Tre kategorier framkom: Den första var Sjuksköterskors upplevelser i praktiken med underkategori Upplevelser av patienter där författarna presenterade hur sjuksköterskor uttryckte att de saknade färdigheter, fokuserade på patienters fysiska symtom och upplevde patienter som oförutsägbara och tidskrävande vilket ledde till känslor som frustration och rädsla. Den andra kategorin, Sjuksköterskors upplevda arbetsmiljö beskrev hur den fysiska och psykosociala arbetsmiljön hindrade sjuksköterskor från att tillgodose patienternas vårdbehov. Den tredje kategorin var Sjuksköterskors upplevda kompetens med underkategori Erfarenheter av att vårda. Sjuksköterskor upplevde att de saknade adekvat utbildning vilket hade en direkt inverkan på upplevelsen av att vårda. Diskussion: Litteraturöversiktens resultat visade en upplevd kunskapsbrist hos sjuksköterskan och en arbetsmiljö som hindrade vårdandet. Detta diskuterades utifrån bakgrund, resultat och Phil Barkers omvårdnadsteori., Background: Patients with psychiatric diagnoses and their families feel that somatic care does not live up to their expectations and that health professionals lack competence in the assessment and treatment for these diagnosis. Patients feel disbelieved when they present their symptoms, which leads to feelings of guilt and shame. Mental illness is increasing worldwide and the healthcare providers have not managed to meet the increased need for care. Aim: The aim was to describe nurses experiences of caring for patients with psychiatric diagnosis in a somatic care setting. Method: A literature review was conducted to gain a wider knowledge in this area. The authors chose ten scientific articles, all of which were of qualitative design and responded to the specific purpose. Results: Three categories emerged. The first was Nurses experience in practice with the sub-category Experiences of patients where the authors presented how nurses expressed that they lacked skills, focused on the patients physical symptoms and experienced patient´s as unpredictable and time consuming, which led to feelings of frustration and fear. The second category, Nurses experience of their work environment described how the physical and the psychosocial environment prevented nurses from meeting the patients care needs. The third category was Nurses experienced competence with the subcategory Experiences of nursing. Nurses felt that they lacked adequate education, which had a direct impact on the experience of caring for patients with psychiatric diagnosis. Discussion: The literature reviews result showed a perceived lack of knowledge for nurses and a work environment that hinder patient care. This was discussed on the basis of the background, result and Phil Barker´s nursing theory.

Bakgrund: Att leva som diagnostiserad med ett psykiatriskt tillstånd kan innebära flertalet utmaningar. Personer med psykiatriska tillstånd kan dagligen uppleva sig utsatta för fördomar, bevisligen inte enbart i sin vardag i samhället utan även inom vårdkontexten. Somatisk samsjuklighet är ett reellt problem som drabbar en stor del av de personer som diagnostiserats med psykiatriska tillstånd. Vårdpersonal beskrev upplevelser av rädsla och osäkerhet i möten med personer med psykiatriska tillstånd och de belyste bristande kunskaper kring hur de bör bemöta personer med psykiatriska tillstånd. Syfte: Syftet med studien var att belysa de erfarenheter personer med psykiatriska tillstånd beskrivit i kontakt med somatisk vård. Metod: Studien som utförts var en litteraturöversikt enligt Friberg. Genom sökningar med hjälp av databaser såsom Cinahl Complete och PubMed har författarna funnit studier som i litteraturöversikten analyserats och tematiserats. Resultat: Litteraturöversiktens resultat identifierade ett huvudtema: Psykiatriska patienters erfarenheter av somatisk vård och två underteman: Vårdpersonalens bemötande och Bemötandets betydelse för patienters upplevelser av delaktighet. Diskussion: Litteraturöversiktens resultat diskuterades i förhållande till utvalda budord från tidvattenmodellen. Resonemang fördes kring vikten av bemötande och delaktighet., Background: Living with a psychiatric diagnosis may entail numerous challenges for the individual. People diagnosed with mental illness can daily experience a vulnerability to prejudice, not only in their everyday life in society but also within the healthcare context. Comorbidity is a substantial problem among a considerable part of the population with psychiatric diagnosis. Healthcare staff has described experiences of fear and uncertainty when dealing with people with psychiatric diagnosis, they enlightened a lack of knowledge when it comes to properly responding to the needs of people with a psychiatric diagnosis. Aim: The aim of this study was to investigate the experiences people with mental illness describe in contact with somatic healthcare. Method: The authors carried out a literature review. Through searches in databases such as Cinahl Complete and PubMed they have found articles that were analyzed and divided into themes. Result: The result of the literature review identified one main theme: Psychiatric patients’ experiences of somatic care and two subthemes: Healthcare staffs’ treatment and the treatments effect on patient participation. Discussion: The results found in the literature review were discussed in relation to chosen commitments from the tidal model. Reasoning arguments concerning treatment and ways to promote patient participation were held and discussed.

Objective: To describe the nature of psychiatric morbidity in patients admitted to a critical care unit of a general hospital and referred to a consultation-liaison psychiatry service. Method(s): Analysis of clinical records on all patients admitted to a critical care unit and referred to consultation-liaison between 2010 to end of 2011. Descriptive statistics only are reported. Result(s): The referrals represented all age groups. Of those referred, 63.9% had a pre-existing psychiatric diagnosis and 64.7% had been admitted for intentional or accidental overdose. Conclusion(s): Those identified to have a pre-existing mental illness and who had engaged in treatment were found to be inadequately supervised. They require more extended care and monitoring for suicidality and co-morbid physical conditions.Copyright © The Royal Australian and New Zealand College of Psychiatrists 2015.

Objective: To describe the nature of psychiatric morbidity in patients admitted to a critical care unit of a general hospital and referred to a consultation-liaison psychiatry service. Method(s): Analysis of clinical records on all patients admitted to a critical care unit and referred to consultation-liaison between 2010 to end of 2011. Descriptive statistics only are reported. Result(s): The referrals represented all age groups. Of those referred, 63.9% had a pre-existing psychiatric diagnosis and 64.7% had been admitted for intentional or accidental overdose. Conclusion(s): Those identified to have a pre-existing mental illness and who had engaged in treatment were found to be inadequately supervised. They require more extended care and monitoring for suicidality and co-morbid physical conditions.Copyright © The Royal Australian and New Zealand College of Psychiatrists 2015.

This study evaluated the use of the Outline for Cultural Formulation (OCF) from the DSM-IV in the diagnosis of immigrants and refugee patients at an outpatient psychiatric clinic in Sweden. Using the OCF in conjunction with standard diagnostic procedures led to major revisions of diagnoses for 56.5% of patients. Anxiety disorders, especially PTSD, constitute the disorder group in which the most changes were made. In order to understand how information from the OCF interview led clinicians to revise diagnoses, data from clinical discussions were analysed through qualitative content analysis. This revealed four major themes related to the reevaluation, and at times confirmation, of given clinical psychiatric diagnoses: new information; expression of distress in emotional language; expression of distress in relation to life experiences; and improved understanding of the patient's suffering. The findings suggest that the OCF may be useful for: (a) formulating culture in relation to illness experiences, (b) contextualising diagnostic categorisation, and (c) improving overall understanding of the patient that may facilitate individualised planning of treatment and therapy.

This paper examines psychiatric diagnosis-making within biopsychiatry. The widely accepted statement that diagnosis is the result of clinical judgement is mainstream in psychiatric domain. However drawing on Actor-Network Theory and the notion of trajectory established by Strauss (2010), it is proposed that psychiatric diagnosis derives as well from the actions performed by psychotropics. These actions are the effects produced in the patient´s body and the significances carried by psychotropic drugs in clinical practices, concerning the information validated as scientific evidence for the substance. Through a case study carried out at a University Hospital in Barcelona, it is therefore described how the psychiatric diagnosis-making consists of a process of meaning attribution, where psychotropic drugs perform the conditions for the clinical expertise., El presente artículo analiza la elaboración del diagnóstico psiquiátrico en biopsiquiatría. La afirmación que el diagnóstico psiquiátrico es el resultado de un juicio clínico constituye un postulado básico en el dominio de la psiquiatría. En este estudio abrimos al debate tal afirmación. Haciendo uso de algunas herramientas que ofrece la Teoría del Actor-Red y del concepto de trayectoria desarrollado por Strauss (2010), vamos a proponer que el juicio diagnóstico psiquiátrico deviene a partir de las acciones realizadas por los psicofármacos. Estas acciones son los efectos producidos en los cuerpos de los pacientes y los significados que portan los psicofármacos, como sustancias resultantes del proceso de creación de la evidencia científica. En este sentido, el diagnóstico psiquiátrico puede ser comprendido como el desenlace producido a partir de la traducción psicofarmacológica en la trayectoria de la enfermedad. A partir de un estudio de caso que toma como unidad de análisis un Servicio de Psiquiatría de un Hospital Universitario de Barcelona, describiremos cómo la realización del juicio diagnóstico psiquiátrico implica un proceso de atribución de significados donde los psicofármacos performan las condiciones para la experticia clínica.

BackgroundDeletion of the recurrent ~600 kb BP4-BP5 chromosomal region 16p11.2 has been associated with a wide range of neurodevelopmental outcomes.MethodsTo clarify the phenotype of 16p11.2 deletion, we examined the psychiatric and developmental presentation of predominantly clinically referred individuals, with a particular emphasis on broader autism phenotype characteristics in individuals with recurrent ~600 kb chromosome 16p11.2 deletions. Using an extensive standardized assessment battery across three clinical sites, 85 individuals with the 16p11.2 deletion and 153 familial control subjects were evaluated for symptom presentation and clinical diagnosis.ResultsIndividuals with the 16p11.2 deletion presented with a high frequency of psychiatric and developmental disorders (>90%). The most commonly diagnosed conditions were developmental coordination disorder, phonologic processing disorder, expressive and receptive language disorders (71% of individuals >3 years old with a speech and language-related disorder), and autism spectrum disorder. Individuals with the 16p11.2 deletion not meeting diagnostic criteria for autism spectrum disorder had a significantly higher prevalence of autism-related characteristics compared with the familial noncarrier control group. Individuals with the 16p11.2 deletion had a range of intellectual ability, but IQ scores were 26 points lower than noncarrier family members on average.ConclusionsClinically referred individuals with the 16p11.2 deletion have high rates of psychiatric and developmental disorders and provide a genetically well-defined group to study the emergence of developmental difficulties, particularly associated with the broader autism phenotype.

This paper examines psychiatric diagnosis-making within biopsychiatry. The widely accepted statement that diagnosis is the result of clinical judgement is mainstream in psychiatric domain. However drawing on Actor-Network Theory and the notion of trajectory established by Strauss (2010), it is proposed that psychiatric diagnosis derives as well from the actions performed by psychotropics. These actions are the effects produced in the patient´s body and the significances carried by psychotropic drugs in clinical practices, concerning the information validated as scientific evidence for the substance. Through a case study carried out at a University Hospital in Barcelona, it is therefore described how the psychiatric diagnosis-making consists of a process of meaning attribution, where psychotropic drugs perform the conditions for the clinical expertise., El presente artículo analiza la elaboración del diagnóstico psiquiátrico en biopsiquiatría. La afirmación que el diagnóstico psiquiátrico es el resultado de un juicio clínico constituye un postulado básico en el dominio de la psiquiatría. En este estudio abrimos al debate tal afirmación. Haciendo uso de algunas herramientas que ofrece la Teoría del Actor-Red y del concepto de trayectoria desarrollado por Strauss (2010), vamos a proponer que el juicio diagnóstico psiquiátrico deviene a partir de las acciones realizadas por los psicofármacos. Estas acciones son los efectos producidos en los cuerpos de los pacientes y los significados que portan los psicofármacos, como sustancias resultantes del proceso de creación de la evidencia científica. En este sentido, el diagnóstico psiquiátrico puede ser comprendido como el desenlace producido a partir de la traducción psicofarmacológica en la trayectoria de la enfermedad. A partir de un estudio de caso que toma como unidad de análisis un Servicio de Psiquiatría de un Hospital Universitario de Barcelona, describiremos cómo la realización del juicio diagnóstico psiquiátrico implica un proceso de atribución de significados donde los psicofármacos performan las condiciones para la experticia clínica.

Objectives Rates of disability pension are greatly increased among people with low education. This study examines the extent to which associations between education and disability pensions might be explained by differences in working conditions. Information on individuals at age 13 years was used to assess confounding of associations. Method Two nationally representative samples of men and women born in 1948 and 1953 in Sweden (22 889 participants in total) were linked to information from social insurance records on cause (musculoskeletal, psychiatric, and other) and date (from 1986-2008) of disability pension. Education data were obtained from administrative records. Occupation data were used for measurement of physical strain at work and job control. Data on paternal education, ambition to study, and intellectual performance were collected in school. Results Women were found to have higher rates of disability pension than men, regardless of diagnosis, whereas men had a steeper increase in disability pension by declining educational level. Adjustment of associations for paternal education, ambition to study, and intellectual performance at age 13 had a considerable attenuating effect, also when disability pension with a musculoskeletal diagnosis was the outcome. Despite this, high physical strain at work and low job control both contributed to explain the associations between low education and disability pensions in multivariable models. Conclusion Working conditions seem to partly explain the increased rate of disability pension among men and women with lower education even though this association does reflect considerable selection effects based on factors already present in late childhood., AuthorCount:5

Background: Squalor is an epiphenomenon associated with a range of medical and psychiatric conditions. People living in squalor are not well described in the literature, and prior work has indicated that up to 50% do not have a psychiatric diagnosis. Squalor appears to be linked with neuropsychological deficits suggestive of the presence of impaired executive function. We present a case series of people living in squalor that examines their neuropsychological assessment and diagnosis. Method(s): Clinicians from local health networks were invited to submit neuropsychological reports of patients living in squalor. These selected reports were screened to ensure the presence of squalor and a comprehensive examination of a set of core neuropsychological domains. Assessments were included if basic attention, visuospatial reasoning, information processing speed, memory function, and executive function were assessed. Result(s): Sixty-nine neuropsychological reports were included. Sixty-eight per cent of the group underwent neuropsychological assessments during an inpatient admission. For participants where it was available (52/69), the mean Mini-Mental State Examination score was 25.29 (SD = 3.96). Neuropsychological assessment showed a range of cognitive impairment with nearly all the participants (92.75%) found to have frontal executive dysfunction. One person had an unimpaired neuropsychological assessment. Results indicated that dorsolateral prefrontal rather than orbitofrontal functions were more likely to be impaired. Vascular etiology was the most common cause implicated by neuropsychologists. Conclusion(s): Frontal executive dysfunction was a prominent finding in the neuropsychological profiles of our sample of squalor patients, regardless of their underlying medical or psychiatric diagnoses. Our study highlights the importance of considering executive dysfunction when assessing patients who live in squalor.Copyright © International Psychogeriatric Association 2014.

Background: Squalor is an epiphenomenon associated with a range of medical and psychiatric conditions. People living in squalor are not well described in the literature, and prior work has indicated that up to 50% do not have a psychiatric diagnosis. Squalor appears to be linked with neuropsychological deficits suggestive of the presence of impaired executive function. We present a case series of people living in squalor that examines their neuropsychological assessment and diagnosis. Method(s): Clinicians from local health networks were invited to submit neuropsychological reports of patients living in squalor. These selected reports were screened to ensure the presence of squalor and a comprehensive examination of a set of core neuropsychological domains. Assessments were included if basic attention, visuospatial reasoning, information processing speed, memory function, and executive function were assessed. Result(s): Sixty-nine neuropsychological reports were included. Sixty-eight per cent of the group underwent neuropsychological assessments during an inpatient admission. For participants where it was available (52/69), the mean Mini-Mental State Examination score was 25.29 (SD = 3.96). Neuropsychological assessment showed a range of cognitive impairment with nearly all the participants (92.75%) found to have frontal executive dysfunction. One person had an unimpaired neuropsychological assessment. Results indicated that dorsolateral prefrontal rather than orbitofrontal functions were more likely to be impaired. Vascular etiology was the most common cause implicated by neuropsychologists. Conclusion(s): Frontal executive dysfunction was a prominent finding in the neuropsychological profiles of our sample of squalor patients, regardless of their underlying medical or psychiatric diagnoses. Our study highlights the importance of considering executive dysfunction when assessing patients who live in squalor.Copyright © International Psychogeriatric Association 2014.

Informant discrepancies have been reported between parent and adolescent measures of depressive disorders and suicidality. We aimed to examine the concordance between adolescent and parent ratings of depressive disorder using both clinical interview and questionnaire measures and assess multi-informant and multi-method approaches to classification.

This paper describes the rationale for the new diagnosis of somatic symptom disorder (SSD) within DSM5. SSD represents a consolidation of a number of previously listed diagnoses. It deemphasizes the centrality of medically unexplained symptoms and defines the disorder on the basis of persistent somatic symptoms associated with disproportionate thoughts, feelings, and behaviors related to these symptoms. Data are presented concerning reliability, validity, and prevalence of SSD, as well as tasks for future research, education, and clinical practice.

Urgida por la necesidad de justificarla e incluirla como una rama médica, así como de otorgarle credibilidad y defender su autoridad al abordar los llamados desórdenes mentales, la profesión psiquiátrica se ha inclinado a privilegiar los modelos biológicos y conceptualizar estos fenómenos como resultados de disfunciones orgánicas. Sin embargo, en este artículo se señala que la labor del psicopatólogo supone una valoración comprensiva y biográfica de los marcos interpretativos, las acciones y la personalidad del enfermo como unidad intencional e histórica. Se reafirma la especificidad del discurso psicológico y psiquiátrico, y los supuestos de apoyo. Se discuten aspectos del diagnóstico y la labor clínica en psicopatología a la luz de la propuesta narrativa de Paul Ricoeur.

Urgida por la necesidad de justificarla e incluirla como una rama médica, así como de otorgarle credibilidad y defender su autoridad al abordar los llamados desórdenes mentales, la profesión psiquiátrica se ha inclinado a privilegiar los modelos biológicos y conceptualizar estos fenómenos como resultados de disfunciones orgánicas. Sin embargo, en este artículo se señala que la labor del psicopatólogo supone una valoración comprensiva y biográfica de los marcos interpretativos, las acciones y la personalidad del enfermo como unidad intencional e histórica. Se reafirma la especificidad del discurso psicológico y psiquiátrico, y los supuestos de apoyo. Se discuten aspectos del diagnóstico y la labor clínica en psicopatología a la luz de la propuesta narrativa de Paul Ricoeur.

This paper describes the rationale for the new diagnosis of somatic symptom disorder (SSD) within DSM5. SSD represents a consolidation of a number of previously listed diagnoses. It deemphasizes the centrality of medically unexplained symptoms and defines the disorder on the basis of persistent somatic symptoms associated with disproportionate thoughts, feelings, and behaviors related to these symptoms. Data are presented concerning reliability, validity, and prevalence of SSD, as well as tasks for future research, education, and clinical practice.