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Kişilik bozukları tarih boyunca değişen tanılamalarla ve ekolden ekole değişen yaklaşımlarla açıklanmaya çalışılmıştır. Günümüzün tanı kitapçıklarında güncellenen yaklaşımlar ve bilimsel gelişmeler ile kişilik bozuklukları için gelişen ve daha anlaşılır olabilen tanı kategorileri oluşturulmaktadır. Yeni modeller tanı, tedavi ve klinisyenler arası ortak dil için önemli bir kaynak olabilir. Hem ICD-11’de hem de DSM-5 III. ana bölümünde daha önceki kişilik bozuklukları tanı yaklaşımının ötesinde yeni modelleri öne çıkarmıştır. Her iki modelde de kişilik işlevselliği değerlendirilerek kişilik bozukluğu incelenmektedir. Değerlendirmede önce işlevselliğin bozulmasının şiddet seviyesi, daha sonra, benlikte, kimlikte ve ikili ilişkilere yansıması gibi özellikler incelenmektedir. DSM-5 III. ana bölümde yer alan alternatif model kişilik bozuklukları bölümünde, kişilik bozukluklarında öne çıkan 5 temel özellik 25 alt özellik ve işlevselliğin değerlendirildiği bir içeriğe sahipken, ICD-11 kişilik bozukluğu modeli beş özellik ve sınırda örüntüsünü ve tanımlamasını içeren bir yaklaşımı ve işlevselliğin değerlendirildiği 4 boyutlu bir yapıyı içermektedir. İki modelin kişilikte öne çıkan kişilik özellikleri birbiriyle tamamen örtüşmemektedir. Örneğin, Psikotizm DSM-5 KB AM’de bir kişilik özelliği olarak kendine yer bulurken, ICD-11’de kişilik bozukluklarında bu özellik yer bulmamıştır. Sınırda örüntüsü DSM-5 KB AM’de bir özellik gibi isimlendirilmemektedir ancak ICD-11 sınırda örüntüsünü bir tür özellik olarak ele almaktadır. Bu durum iki kılavuz arasındaki önemli farklılıklardandır. Benzer şekilde işlevselliğin ve bozukluğun değerlendirildiği ölçütler birbirleriyle uyumlu ve paralel ilerlememektedir. Bu da iki farklı kılavuzun farklı şiddet seviyelerini eşik olarak kabul ettiği anlamını taşımaktadır. Ancak her iki modelinde kategorisel modeller yerine kişilik özelliklerin görülebildiği ve daha boylamsal süreçlerin içerdiği kişilik bozuklukları yaklaşımını kabul ettiği söylenebilir. Yeni modellerin birbirleriyle farklıklar göstermesi, tanı ve tedavi bakımından ortak dilin gelişmesine engel gibi yorumlanabilir. Türkçe dilinde alternatif kişilik bozuklukları modelleri üzerinde yeterli çalışma bulunmaması nedeniyle bu konuda yapılacak daha fazla araştırmaya ihtiyaç duyulmaktadır., Personality disorders tried to be explained by changing diagnoses and approaches varying from school to school throughout history. With the updated approaches and scientific developments in today's diagnostic booklets, developing and more understandable diagnostic categories for personality disorders are created. New models can be an important resource for diagnosis, treatment and common language among clinicians. Both ICD-11 and DSM-5 main part section III. have highlighted new models beyond the previous personality disorders diagnostic approach. In both models, personality disorders are examined according to severity levels and prominent personality features model. Moreover, personality disorder includes structures that take into account the course of basic personality traits such as self, identity and bilateral relations. While DSM-5 part III. Alternative model on personality disorders section has a content of 5 prominent features, 25 sub-features and functionality which are all for evaluating the disorder, the ICD-11 model includes an approach that includes five features and borderline pattern and definitions, and a 4-dimensional structure in which functionality is evaluated. Although both models include models of features that stand out in personality but not completely overlap with each other. For example, while Psychoticism finds its place as a personality trait in alternative model in section III of DSM-5, as it is not accepted in personality feature in ICD-11. In contrast, the borderline pattern is not named as a feature in DSM-5 in section III, but the ICD-11 treats the borderline pattern as a kind of feature. This is one of the important differences between the two guidelines. Similarly, the criteria by which functionality and impairment are evaluated are not compatible with each other and do not progress in parallel. This means that two different guidelines accept different severity levels as thresholds. However, it can be said that both models accept the personality disorders approach, which includes longitudinal processes in which personality traits can be seen instead of categorical models. The differences between the new models can be interpreted as an obstacle to the development of a common language in terms of diagnosis and treatment. Since there are not enough studies on alternative personality disorder models in Turkish, more research is needed on this subject.

Some critics argue that the type of psychiatric diagnosis found in the DSM and ICD are superfluous and should be abandoned. These are known as categorical polythetic psychiatric diagnoses. To receive a categorical polythetic psychiatric diagnosis an individual need only exhibit some, rather than all, of the symptoms on the diagnostic criteria. Consequently, categorical polythetic psychiatric diagnoses only associate an individual with a range of symptoms rather than specify which symptoms they have. Drawing upon Ronald Giere’s account of scientific models, I portray categorical polythetic psychiatric diagnoses as abstract models which guide the building of less abstract models. These models can specify which symptoms a particular individual has. Additionally, categorical polythetic psychiatric diagnoses can guide investigation of symptoms towards difficult to spot symptoms, guide investigation towards changing symptoms and guide investigation towards how symptoms manifest. These important roles mean categorical polythetic psychiatric diagnoses should not be abandoned.

BackgroundDespite a high prevalence of mental disorders among asylum seekers, many barriers to mental healthcare exist. Cultural and contextual factors strongly influence the experience and expression of psychological distress, putting asylum seekers at greater risk of misdiagnosis and inappropriate treatment. The Cultural Formulation Interview (CFI) is a useful tool to map out cultural and contextual factors of mental disorders; however, to the best of our knowledge, it has not yet been investigated in asylum seekers specifically. The primary aim of this study is to evaluate the value of the CFI in the psychiatric assessment of asylum seekers. Second, we will describe the themes relevant to psychiatric distress in asylum seekers that are identified by the CFI. In addition, asylum seekers’ experience of the CFI will be evaluated.Methods and analysisThis cross-sectional, mixed-method clinical study aims to recruit a group of 60–80 asylum seekers (age 15–29) with mental health symptoms. Data will be collected using structured (MINI, PCL-5, HDRS-17, WHOQoL-BREF & BSI) and semi-structured (CFI & CFI-debriefing) questionnaires to assess cultural background, contextual factors, and illness severity. Multidisciplinary case discussions will be held after the completion of interviews, following a methodological stepped approach. Combining qualitative and quantitative research techniques, this study aims to generate reliable knowledge on working with the CFI in asylum seekers. Based on the findings, recommendations for clinicians will be developed.DiscussionThis study addresses the knowledge gap on using the CFI in asylum seekers. Compared to prior studies, it will provide new insights into the use of the CFI in the specific context of working with asylum seekers.Ethics and disseminationPrior research on the CFI in asylum seekers is limited, partly because of their high vulnerability and low access to care. The study protocol has been tailored in close collaboration with several stakeholders and validated after piloting. Ethical approval has already been obtained. Together with the stakeholders, the results will be translated into guidelines and training materials. Recommendations to policymakers will also be provided.

O objetivo deste estudo foi compreender o relacionamento dos filhos com mães portadoras de transtorno bipolar do humor, a partir do referencial teórico junguiano. Analisou-se o impacto da psicopatologia da mãe na vida de seus filhos, a percepção deles em relação ao vínculo afetivo que possuem com suas mães e as possibilidades/ impossibilidades de interações entre ambos. Foram realizadas e analisadas seis entrevistas com pessoas dos sexos feminino e masculino, idade adulta, filhas e filhos de mães com esse diagnóstico. As entrevistas seguiram um roteiro de perguntas abertas e a aplicação de desenhos com a temática da relação mãe e filho. Observou-se que o diagnóstico psiquiátrico de transtorno bipolar de humor nas mães acarretou prejuízos emocionais para os filhos, interferindo diretamente na fase de desenvolvimento de alguns participantes que, por vezes, assumiram o papel de cuidadores em idade ainda precoce e apresentaram perceptíveis características de personalidade ansiosa. Por outro lado, a dor pareceu transformar-se em resiliência e criatividade, somada ao suporte social, mostrou-se um caminho para uma condição mais fortalecida e para que esses indivíduos se tornassem protagonistas de suas próprias histórias.

Objective: Based on a single intake interview, mental health clinicians must distill their assessment to brief statements reflecting essential information. We explored how clinicians organi...

Objective: The authors examined access to care among persons with serious mental illness during the pandemic and disparities in use of virtual care among this population versus among individuals with other psychiatric diagnoses. Methods: Data from the Veterans Health Administration were used to examine whether the number of visits for serious mental illness differed for January-September 2019 versus the same period in 2020. Mixed-effects regression analyses tested whether the post-COVID-19 rate of growth in virtual care differed for people with serious mental illnesses versus those with other diagnoses. Results: Fewer visits for serious mental illnesses occurred during the initial weeks of the pandemic but not subsequently. The rate of growth in video visits during 2020 was slower for serious mental illnesses than for other psychiatric diagnoses. Conclusions: Several months after the pandemic's start, the total number of visits for serious mental illnesses was similar to 2019; however, adoption of video care was slower than for other psychiatric diagnoses.

Eating disorders (EDs) are complex psychiatric diagnoses requiring specialized care. Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa and is also efficacious for other EDs. This study describes practice changes due to the implementation of an integrated interdisciplinary FBT-aligned treatment program for EDs at a large tertiary care hospital in the United States. We examined the feasibility and acceptability of implementation, barriers to implementation, and impact on providers' roles over a one-year period. Practice changes came with shifts in roles, and were largely experienced as acceptable with good suitability. Barriers identified may inform future interdisciplinary implementation efforts.

Background: despite numerous attempts to reduce the use of mechanical restraint (MR), this technique continues to be widely applied in many acute psychiatric care settings. In order to reduce MR, a better understanding of the variables associated with its use and duration in different clinical environments is essential. Aim: to determine the proportion of patients subjected to MR and the duration thereof in two acute care psychiatric units; and to identify the variables associated with the use and duration of MR. Methods: descriptive study of all patients admitted to the acute psychiatric units at the Parc de Salut Mar (Barcelona, Spain) in the year 2018. The number and percentage of patients subjected to MR, as well as the duration of each episode were assessed. The following data were also registered: sociodemographic characteristics, psychiatric diagnosis, and presence of cultural and/or language barriers. Multivariate analyses were performed to assess determinants of MR and its duration. Results: of the 464 patients, 119 (25.6%) required MR, with a median of 16.4 h per MR. Two factors - a diagnosis of psychotic disorder [Odds ratios (OR) = 0.22; 95%CI: 0.06-0.62; P = 0.005] and the presence of a language barrier (OR = 2.13; 95%CI: 1.2-3.7; P = 0.007) - were associated with a significantly higher risk of MR. Male sex was associated with a longer duration of MR (B = -19.03; 95%CI: -38.06-0.008; P = 0.05). Conclusion: the presence of a language barrier and a psychotic disorder diagnosis are associated with a significantly higher risk of MR. Furthermore, male sex is associated with a longer duration of MR. Individualized restraint protocols that include the required tools are necessary to ultimately limit the use of mechanical restraint.

Introduction: Self harm or suicidal attempt is one of the most common primary psychiatric emergencies. It has been increasing daily but unfortunately people seeking attention and help from psychiatrist is still lagging. This study aims to observe psychiatric comorbidities among self-harm or suicidal attempt. Material And Method: Those patients who presented with suicidal attempts and related problems in Nobel Medical College Teaching hospital, Biratnagar were assessed for socio demographic and clinical variables. Convenience sampling method was used. MINI 6.0 was applied to all the patients to see for psychiatric disorders. Those who had positive psychiatric disorders in MINI 6.0 were then reassessed according to ICD-10 (International classification of diseases, clinical description and diagnostic guidelines) and final psychiatric disorder was considered. Becks’ suicide intent scale was used to assess the intensity of suicide. Data entry was done using Microsoft Excel and statistical analysis was done by using IBM SPSS Version 16.0. Results: The result showed that 56.17% of the participants had some form of psychiatric comorbidities. The commonest among them was depression (23.97%), adjustment disorder (21.9%), followed by alcohol use disorder (5.47%) and others. The most common method of suicidal attempt was by poisoning (86.3%), followed by hanging (7.5%) and self- inflicted cut injury (6.2%). Psychosocial stressors were present in 84.9% of patients and 15.1% did not have notable psychosocial stressors. Conclusion: Patients with self-harm or suicidal attempt have common psychiatric comorbidities depression and adjustment disorder being the most prevalent entities. Hence, every suicidal attempt becomes common psychiatric emergency condition in Nepal.

Teaching an online course on mental health and the law during a global pandemic, the subject of psychiatric diagnosis and the pros and cons of diagnostic categories arose very early in the conversa...

In 1911, Aaron Rosanoff published among the first pedigree studies of psychiatric illness, and the first ever in the United States, claiming that the neuropathic constitution was transmitted in as a Mendelian recessive disorder. In 1917, Abraham Myerson harshly critiqued that study, focusing on the very wide phenotypic definition of neuropathic constitution. Here, I describe Rosanoff and Myerson's backgrounds, the details of Rosanoff's study, and Myerson's critique and put this controversy in the context of the history of psychiatric genetics, emphasizing four themes: a) the close interrelationship between psychiatric diagnosis and models of genetic transmission, b) the strong attraction of Mendelian models to psychiatric geneticists after their 1900 rediscovery, c) the controversy about whether familial transmission of psychiatric illness is largely homogeneous or heterogeneous, and d) the methods taken by researchers to the problems of psychiatric genetics that typically emerged as part of their broader approach to the nature of psychiatric illness.

Background Catatonia is a presenting sign for many primary psychiatric disorders but it can also herald medical and neurological conditions. Increasing research has highlighted co-occurrence catatonia and delirium and how this combination warrants a thorough medical workup. Case presentation We present a case of a middle-aged woman with catatonia and delirium secondary to neurosarcoidosis only involving the brain; we document her 30-day hospitalization and intensive medical work-up that eventually revealed isolated neurosarcoidosis. This is the first reported case to our knowledge in the literature of catatonia occurring due to isolated neurosarcoidosis. Conclusion For this patient, albeit with a history of schizophrenia, the presence of delirium pushed the medical team to pursue a comprehensive work up instead of relying on a psychiatric diagnosis as the explanation for her puzzling clinical presentation. This case report supports a paradigm shift for physicians to think of catatonia similar to delirium: A syndrome that results from an underlying condition that must be treated in order to resolve the catatonia.

Children at risk for placement instability are subpopulation in out-of-home care with a critical need for enhanced mental health services, but little is known about the types and adequacy of the mental services they receive. This descriptive study sought to identify the types of mental health services and psychotropic medications provided to children with a risk for moves, foster parents’ perceptions of their adequacy, consistency of therapy services with evidence-based models, and racial and gender differences in service provision. Foster parents completed telephone surveys for a randomly selected sample of 144 children aged 8–14 in specialized or traditional family foster care with a history of placement moves or hospitalizations in a large state in the US. Over two-thirds of children were reported to have mental health diagnoses, with ADHD most frequent (52%). Most children with a diagnosis received psychotherapy (75%) and psychotropic medications (90%). The majority did not receive additional services. A quarter received therapy supporting use of behavioral interventions in foster homes, with 40% of foster parents reporting this was inadequate. Additionally, half reported inadequate initial training. No racial differences in services were reported. However, girls were more likely to receive therapy described as trauma-focused than boys (30.9% and 5.6%, respectively); more boys received treatment for anger (17%) and psychotropic medication (60%). Findings indicate that children at risk for multiple moves receive a high level of services, but questions are raised about the content and adequacy of these services. Evidence-based psychosocial interventions are needed to support positive outcomes and potentially reduce psychotropic medication use.

This paper offers a philosophical analysis of the connection between mental disorder and suicide risk. In contemporary psychiatry, it is commonly suggested that this connection is a causal connection that has been established through empirical discovery. Herein, I examine the extent to which this claim can be sustained. I argue that the connection between mental disorder and increased suicide risk is not wholly causal but is partly conceptual. This in part relates to the way suicidality is built into the definitions of some psychiatric diagnoses. It also relates to the broader normative assumption that suicidal behavior is by definition mentally disordered behavior. The above has significant epistemological implications, which I explore. I propose that the claim that suicide is connected with mental disorder cannot be justified solely by appealing to empirical evidence but also warrants a justification on conceptual and normative grounds.

BackgroundWe have previously argued that psychiatric diagnosis, by focusing on pathology, minimises the role of psychosocial factors. Despite suggestions that traditional diagnosis is the only way to access treatment services, we have recommended standardised use of existing codes for possible social determinants and precise description of psychological phenomena.AimsThis study examines the current use of social determinant and phenomenological codes in mental health care records.MethodsData provided by a local NHS Trust included 21,701 cases with a first contact date between 01 January 2015 and 01 January 2016, 4656 of whom received a primary diagnosis.ResultsOverall, codes for possible social determinants were used on only 43 occasions, for 39 individuals (0.8% of the 4656 people receiving a primary diagnosis). Comparison with relevant baseline frequencies revealed a highly significant under-reporting of key social determinants. 19 cases (0.4% of 4.656) used codes for precise description of specific psychological phenomena.ConclusionsAvailable ICD codes for social determinants and specific psychological phenomena are under-used in clinical practice.

Many children with a range of psychiatric diagnoses manifest impaired levels of emotion dysregulation (ED). Over the past decade, there has been increasing examination of psychosocial interventions for ED. We found preliminary evidence of positive effects for a wide range of psychosocial treatments that were associated with improvements in emotion recognition, emotional reactivity, and emotion regulation. More studies are needed because results are limited by the small number of controlled trials, heavy reliance on parent ratings, and heterogeneity of the samples.

Objective Head trauma causes a significant number of deaths as well as temporary and permanent disabilities every year. In this study, the prevalence of attention-deficit/hyperactivity disorder (ADHD) in primary school children who visited the emergency department (ED) for mild head trauma and the role of ADHD in mild head trauma of this age group were investigated. Methods It was performed with 134 children of primary school age (6-12 years) who were admitted to the ED with mild head trauma and 134 children (control group) who presented with complaints other than head trauma. Turgay DSM-IV-Based Child and Adolescent Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S) was used to evaluate the children for suspected ADHD. According to this scale, some children were referred to the child and adolescent psychiatry department (CAPD) for further evaluation. At the CAPD outpatient clinics, the children who were referred from the ED were examined in detail according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, for possible diagnosis of ADHD. After evaluation of their sociodemographic characteristics and the ADHD test scores that were recorded, the diagnosis of ADHD in these children was established or ruled out. Results It was observed that 41 of the 134 children (30.60%) who presented to the ED with mild head trauma and 12 of the 134 children (8.96%) in the control group were diagnosed with ADHD (P = 0.0001). When ADHD is corrected for sex, 29 of the 41 cases (70.7%) diagnosed with ADHD were boys and 12 (29.3%) were girls (P = 0.000). According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, when the patients who had been diagnosed with ADHD were grouped according to the ages of the children, no statistically significant difference was found between the groups in terms of ADHD (P = 0.097). Conclusions The prevalence of ADHD has been found to be higher in children of primary school age who present to the ED with mild head trauma. Hence, it can be deduced that the diagnosis of childhood ADHD increases the risk of presenting to the ED with head trauma. We believe that it is very important to keep the possible diagnosis of ADHD in mind and to refer that cases to the CAPD in case of high clinical suspicion, especially in primary school boys who are admitted to the ED with mild head trauma. We believe that in this way, morbidity and mortality due to head trauma in this age group can be significantly reduced. © Wolters Kluwer Health, Inc. All rights reserved.

Rapid review on psychological consequences of epidemics on health care workers: risk factors, prevalence of psychiatric disorders, and strategies for its treatment. We aim to identify and synthesize the available evidence on: 1) Risk factors for psychological distress, and identification of prevalence of psychiatric diagnosis during epidemics in health care workers (HCW). We will include all evidence of mental disorders in HCW, as a consequence of SARS, MERS, and COVID-19, and the related predisposing risk factors; 2) Strategies for the prevention and treatment of psychological distress in HCW during epidemics. We will include all evidence on strategies aimed at preventing or reducing the consequences of epidemic on psychological wellbeing in HCW, which have been adopted during and after past or current epidemics.

In this study, the authors aimed to assess both nighttime and daytime blood pressure (BP) variability using 24‐hour ambulatory BP monitoring (ABPM) in persons with and without psychiatric conditions and with or without selective serotonin reuptake inhibitors (SSRIs) or serotonin‐norepinephrine reuptake inhibitors (SNRIs) treatment. In this retrospective study, patients who underwent psychiatric evaluation and ABPM within 6 months of each other between January 1, 2012 and December 31, 2017 were identified using billing data. Participants were divided into three groups—participants with no psychiatric diagnosis and no psychiatric medicine (−Diagnosis/−Medication), those with psychiatric diagnosis and on SSRIs/SNRIs (+Diagnosis/+Medication), and psychiatric diagnosis but no psychiatric medications (+Diagnosis/−Medication). Day and nighttime systolic and diastolic BPs were compared between groups controlling for relevant variables using multivariable linear regression models. A total of 475 participants met inclusion criteria including 135 in the −Diagnosis/−Medication group, 232 in the +Diagnosis/+Medication group, and 108 in the +Diagnosis/−Medication group. In adjusted multivariable analysis, the +Diagnosis/+Medication group had higher nighttime systolic BP (median 120 vs 110 mm (Hg); p = .01) and nighttime diastolic BP (median 68 vs 63 mm (Hg); p = .006) as compared to −Diagnosis/−Medication. No statistically significant differences in BPs between the −Diagnosis/−Medication and +Diagnosis/−Medication groups were observed, after adjustment. Use of SSRIs/SNRIs was associated with significantly higher nocturnal systolic and diastolic BP among patients with psychiatric diagnosis using SSRIs/SNRIs but not associated with psychiatric diagnosis without SSRI/SNRI use. SSRIs/SNRIs use may be associated with higher BP levels and this merits future prospective studies using ABPM to assess day and nighttime BP changes with SSRIs/SNRIs use.

Abstract. In Switzerland, assisted suicide (AS) may be granted on the basis of a psychiatric diagnosis. This pilot study explored the moral attitudes and beliefs of nurses regarding these practices through a quantitative survey of 38 psychiatric nurses. The pilot study, which serves to inform hypothesis development and future studies, showed that participating nurses supported AS and valued the reduction of suffering in patients with severe persistent mental illness. Findings were compared with those from a previously published study presenting the same questions to psychiatrists. The key differences between nurses’ responses and psychiatrists, may reflect differences in the burden of responsibility, while similarities might capture shared values worth considering when determining treatment efforts. More information is needed to determine whether these initial findings represent nurses’ views more broadly.

The study's aim was to explore the capacity of community-based providers of residential supports and services to support people with intellectual and developmental disabilities who transitioned out of state-operated institutions into community-based settings. Receiving agency survey results from 65 agencies and individual-level variables of 2,499 people who had transitioned from an institution to a community-based setting indicated that people who returned to an institution post-transition tended to be younger, have a higher IQ score, were more likely to have a psychiatric diagnosis, tended to have shorter previous lengths of stay at an institution, transitioned to larger settings, and received services from an agency receiving behavioral health technical assistance as compared to those who remained in their transition settings.

Adverse childhood experiences (ACEs) have long been recognized for negatively influencing individual outcomes such that each additional ACE exposure increases the risk for negative health and behavioral outcomes. Little is known, however, about how the more recent accumulation of ACEs occurring in follow-up periods influence global functioning considering the past accumulation of ACEs reported at baseline by justice-involved adolescents. Participants were 851 adolescents who completed the Northwestern Juvenile Project (NJP), a longitudinal survey. OLS regression models were used to examine the influence of follow-up and baseline ACEs on the functional impairment of youth. Results indicate that both follow-up and baseline ACEs were associated with worse functioning over time with baseline ACEs demonstrating a greater effect. This study highlights the importance of assessing accumulations of ACEs over time for adolescents in the juvenile justice system and considering how youth of different characteristics and experiences may differently encounter functional impairment. Implications for offering trauma-informed services to disrupt the effects of adversity on adolescents’ functioning are discussed.

An outstanding question in the stigma literature is the extent to which negative responses are provoked by diagnostic labels, rather than observable symptoms of mental illness. Experimental studies frequently use vignettes to identify the unique effects of diagnostic labels on social responses to people with mental illness, independent of their behaviour or socio-demographic characteristics.The current article identifies, evaluates, and synthesises the body of experimental vignette studies of labelling effects.A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were subjected to quality evaluation and narrative synthesis.Of 1511 articles screened, 22 met inclusion criteria. Most studies focused on the diagnostic categories of attention deficit hyperactivity disorder, schizophrenia spectrum disorders, and autism spectrum disorder. The literature reported diverse effects, with diagnostic disclosure either exacerbating, mitigating, or not affecting stigma. The quality of studies was generally acceptable but the review identified an over-reliance on convenience sampling and unvalidated measures.Results highlight the complexity of labelling effects, which diverge across diagnostic categories and social contexts. The review emphasises the need for expansion of diagnostic labels and contexts studied, standardisation of validated attitude scales, incorporation of behavioural outcomes, and diversification of samples.

Objective: Use of risperidone in preschool-aged children is growing, with rising concerns of adverse metabolic consequences. Longitudinal data on risperidone-related weight gain in preschoolers are scarce. We aimed to evaluate changes in body mass index (BMI) that are associated with risperidone treatment in preschoolers. Method: We analyzed naturalistic, longitudinal data on 141 preschool children (112 boys, 29 girls) receiving psychiatric care. Mean patient age at baseline was 5.0 years (SD=0.8) and average follow-up period was 1.3 years (SD=0.8), with >8 mean BMI measurements per patient. We studied the effect of risperidone exposure ( n=78) on age-and-sex-standardized BMI (BMI Z-score) implementing mixed models with random subject intercepts to account for repeated measures, covarying for multiple confounders including demographics, stimulant treatment and psychiatric diagnoses. We employed similar models to study dose and duration effects. Results: Risperidone treatment was significantly associated with an increase in BMI (effect size of exposure=0.45 SD (SE=0.06), t (949)=7.7, pConclusion: Similar to older populations, risperidone treatment in preschoolers is associated with significant weight gain, with evidence for dose effects. Findings provide critical data that can inform clinicians.

An understanding of the lived experiences of self-injuring youth can inform our efforts to support and facilitate recovery. This study aimed to explore the experiences of non-suicidal self-injury (NSSI) and the journey of recovery among youth in India. Semi-structured interviews were conducted with five participants aged 18 to 27 years with varied psychiatric diagnoses and a history of NSSI, seeking treatment at a tertiary care neuropsychiatric hospital in India. Thematic analysis of the interviews indicated four emergent themes: The Interpersonal Crucible of Self-injury, My Journey of Self-injury, My Journey of Recovery and Co-travellers on the Journey of Recovery. The first theme described varied early and current interpersonal adversities with family, peers and partners. The second theme included personal definitions, functions and experiences of self-injury. The last two themes describe idiosyncratic meanings and criteria for recovery, perspectives and challenging processes of recovery from self-injuring, and a range of enabling and hindering influences from family, friends and the therapeutic space. The findings point to the importance of a developmental perspective in the emergence of NSSI and the need to assess and support individualised recovery pathways.

Introduction: The aim of this study is to reveal the socio-demographic and certain clinical characteristics of elderly patients admitted to the emergency department after a suicide attempt.Methods: This is a cross-sectional study. The universe of the study consisted of 96 patients aged 60 and over who were admitted to emergency department of Izmir Dokuz Eylul University Hospital between 2015-2019 due to a suicide attempt. Information for the study was obtained by retrospectively scanning the files of the patients.Results: Mean age of the 96 patients included in the study was 68.22 ± 9.45 years. The most common suicide method among the patients was drug overdose (n: 59, 61.45%). It was found that 45.05% of the patients who attempted suicide had a known psychiatric diagnosis (n:41). The suicide rate of women (n:42, 43.75%) who were primary school graduates (p=0.026), had a known psychiatric illness (p=0.001), continuously used drugs (p=0.002) and used antidepressants (p, Giriş: İntihar girişimi nedeni ile acil servise başvuran yaşlı hastaların sosyo-demografik ve belirli klinik özelliklerini ortaya koymaktır.Yöntem: Kesitsel tipte planlanmış bir araştırmadır. Çalışmanın evreni; İzmir Dokuz Eylül Üniversite Hastanesi acil servisine, 2015-2019 yılları arası, intihar girişimi nedeniyle başvuran 60 yaş ve üzeri toplam 96 hastadan oluşmuştur. Çalışma için bilgiler hastaların dosyaları geriye dönük olarak taranarak elde edilmiştir. Bulgular: Çalışmaya alınan toplam 96 hastanın yaş ortalaması 68,22±9,45 olarak hesaplanmıştır. İntihar yöntemi olarak hastalar en çok ilaç içme yöntemini (n:59, %61,45) kullandıkları görülmüştür. İntihar girişiminde bulunan hastaların %45,05’inin bilinen bir psikiyatrik hastalık tanısı olduğu bulunmuştur (n:41). İlkokul mezunu olan (p=0,026), bilinen bir psikiyatrik hastalığı bulunan (p=0,001), sürekli ilaç kullanan (p=0,002) ve antidepresan kullanan (p

Psychiatric diagnoses may be a risk factor for poor colorectal cancer (CRC) surgery outcomes. The authors investigated the risk of psychiatric diagnoses and benefit of mental health treatment for surgery outcomes among CRC patients.This retrospective cohort study of patients undergoing CRC surgery in the 2000-2014 period identified documentation of psychiatric diagnosis and mental health treatment (no treatment, medication only, psychotherapy only, or both medication and psychotherapy) 30 days before surgery. Associations between psychiatric diagnoses, mental health treatment, and postoperative outcomes (postoperative complications, length of stay [LOS], and 90-day readmission rate) were evaluated with multivariable generalized estimating equations.Among 58,961 patients undergoing CRC surgery, 9,029 (15.3%) had psychiatric diagnoses, 4,601 (51.0%) of whom received preoperative mental health treatment (90.0% psychiatric medication, 6.7% psychotherapy, and 3.0% medication and psychotherapy). Patients with psychiatric diagnoses had an increased risk for postoperative complications (odds ratio [OR]=1.09, 95% confidence interval [CI]=1.03-1.15) and 90-day readmission (OR=1.11, 95% CI=1.06-1.17) compared with patients without psychiatric diagnoses. Patients with psychiatric diagnoses who received no mental health treatment or only medication had a 7%-17% increased risk for postoperative complications and 90-day readmission compared with patients without psychiatric diagnoses. Patients who received medication only also had a 4% increase in LOS relative to patients without psychiatric diagnoses. Patients with psychiatric diagnoses receiving only psychotherapy and patients without psychiatric diagnoses had similar postoperative outcomes.Preoperative psychiatric diagnoses were associated with worse postoperative outcomes. Surgical quality-improvement efforts should focus on identifying patients with preoperative psychiatric diagnoses and addressing these conditions presurgery.

Background: Limited research has investigated whether replacing psychiatric diagnosis with psychological formulation-based approaches has implications for lay attitudes to mental health. The presen...

Psychiatric diagnoses (PD) present a significant burden on elective surgery patients and may have potentially dramatic impacts on outcomes. As ailments of the spine can be particularly debilitating, the effect of PD on outcomes was compared between elective spine surgery patients and other common elective orthopedic surgery procedures. This study included 412,777 elective orthopedic patients who were concurrently diagnosed with PD within the years 2005 to 2016. 30.2% of PD patients experienced a post-operative complication, compared to 25.1% for non-PD patients (p 0.001). Mood Disorders (bipolar or depressive disorders) were the most commonly diagnosed PD for all elective Orthopedic procedures, followed by anxiety, then dementia (p 0.001). Logistic regression analysis found PD to be a significant predictor of higher cost to charge ratio (CCR), length of stay (LOS), and death (all p 0.001). Between, hand, elbow, and shoulder specialties, spine patients had the highest odds of increased CCR and unfavorable discharge, and the second highest odds of death (all p 0.001).

Norm and illness, stages of illness, forms of illness differ from each other in qualitative, and not quantitative characteristics. Psychometric tools are unable to capture the gestalt of the clinical picture and determine the qualitative changes taking place in it. The article argues for the pseudoscientific basis and unreliability of quantitative measurements of intelligence, personality, statics and dynamics of mental illness.

Critics who are concerned over the epistemological status of psychiatric diagnoses often describe them as being constructed. In contrast, those critics usually see symptoms as relatively epistemologically unproblematic. In this paper I show that symptoms are also constructed. To do this I draw upon the demarcation between data and phenomena. I relate this distinction to psychiatry by portraying behaviour of individuals as data and symptoms as phenomena. I then draw upon philosophers who consider phenomena to be constructed to argue that symptoms are also constructed. Rather than being ready made in the world I show how symptoms are constructs we apply to the world. I highlight this with a historical example and describe methodological constraints on symptom construction. I show the epistemic problems with psychiatric diagnoses are also applicable to symptoms. Following this, I suggest that critics of psychiatric diagnoses should extend their criticism to symptoms or, if they still believe symptoms are relatively epistemologically unproblematic, should rethink their concerns over psychiatric diagnoses.

We examined frequency and reasons for dropout from follow-up care at an outpatient mental health service for older people in South-Western Nigeria. This was a cross-sectional study. Administrative reviews of 201 case records of clinic attendees who received a psychiatric diagnosis that required follow-up consultations were conducted. Records were those of patients seen between January 2015 and December 2017. Chart extraction was followed by Key Informant Interview (KII) to explore the reasons for drop out and partial non-attendance. We identified 37(18.4%) regular clinic attendees, as well as 147(73.1%) and 17(8.5%) dropout and partially attending patients, respectively. Approximately 45.6% of the dropouts occurred after the first consultation. In KII, distance from the hospital, long waiting times and financial constraints were the common reasons for dropout. The findings of this study should inform the development of strategies to improve access to mental health services in Nigeria and other low- and middle-income countries.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common psychiatric diagnoses given in childhood. The recommended treatment is medication in combination with behavioural intervent...

Cognitive impairment and varied psychiatric manifestations are common in thyroid disorders. But autoimmune thyroid disorders masquerading as dementia or psychotic disorders without other overt systemic features of dysthyroidism are rare. Here we are presenting a detailed analysis of four heterogeneous cases of thyroid related cognitive impairments mimicking and fulfilling criteria of known psychiatric diagnosis for a brief period of time, requiring multiple psychotropic medications without any significant improvement. Cognitive impairment and behavioral abnormalities with a known psychiatric diagnosis, with unknown temporal profiling of anti-thyroid peroxidase (TPO) positivity, without encephalopathy and subsequent complete or partial responsiveness with levothyroxin, point towards a possible new entity not well explored so far.

Aim Early therapy can improve developmental outcomes for preterm infants. However, preterm infants who are referred have low enrolment in early therapy services following neonatal intensive care unit (NICU) discharge. This manuscript aims to investigate the relationship between infant medical and sociodemographic factors and enrolment in early therapy services post-NICU discharge, when system-related barriers to access are minimised. Methods This was a retrospective investigation of 89 families with infants born ≤32 weeks of gestation. Families were approached for enrolment into early therapy services following NICU discharge through Baby Bridge programming, which aims to improve access to therapy services following NICU discharge. Results Seventy-three (82%) families enrolled in early therapy services, and 16 (18%) families declined. Parents were more likely to enrol in early therapy if they had public insurance (P = 0.01), a maternal psychiatric diagnosis (P = 0.02) or additional children under 18 years in the home (P = 0.01). No infant medical factors were related to enrolment. Conclusion Although enrolment rates were high, 18% of families refused therapy services, despite removing system-related barriers to access. Targeted interventions can be developed to increase enrolment in early therapy services among populations who are most likely to refuse therapy services after NICU discharge.

The modern editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), beginning with DSM-III in 1980, emerged in response to notable challenges to psychiatry’s practices and ways of knowing in the early 1970s. Because these challenges threatened psychiatry’s scientific self-understanding and moral authority, they exemplify what Alasdair MacIntyre has termed “epistemological crisis.” As a response to crisis, the modern DSM has been a stunning political achievement, providing the central diagnostic constructs around which psychiatric research, practice, and reimbursement has been organized for four decades. Indeed, the DSM’s authority survives in the face of ongoing trenchant scientific and philosophical critique. But if psychiatry is to be healthy, it must be epistemologically humble, reckoning honestly with the limits of the DSM before a future epistemological crisis destabilizes it entirely.

The most common diagnoses after childhood sexual abuse are Post-Traumatic Stress Disorder and depression. The aim of this study is to design a decision support system to help psychiatry physicians in the treatment of childhood sexual abuse. Computer aided decision support system (CADSS) based on ANN, which predicts the development of PTSD and Major Depressive Disorder, using different parameters of the act of abuse and patients was designed. The data of 149 girls and 21 boys who were victims of sexual abuse were included in the study. In the designed CADDS, the gender of the victim, the type of sexual abuse, the age of exposure, the duration until reporting, the time of abuse, the proximity of the abuser to the victim, number of sexual abuse, whether the child is exposed to threats and violence during the abuse, the person who reported the event, and the intelligence level of the victim are used as input parameters. The average accuracy values for all three designed systems were calculated as 99.2%. It has been shown that the system designed by using these data can be used safely in the psychiatric assessment process, in order to differentiate psychiatric diagnoses in the early post-abuse period.

The Strengths and Difficulties Questionnaire (SDQ) is widely used, based on evidence of its value for screening. This evidence primarily regards the single informant total difficulties scale and separate difficulties subscales. We assessed to what degree adolescents’ SDQ profiles that combined all self- and parent-rated subscales were associated with use of care and psychiatric diagnoses, and examined the added value thereof over using only a single informant and the total scale. Cluster analysis was used to identify common SDQ profiles based on self- and parent-reports among adolescents aged 12–17 in mental healthcare (n = 4282), social care (n = 124), and the general population (n = 1293). We investigated associations of the profiles with ‘care use’ and ‘DSM-IV diagnoses’, depending on gender. We identified six common SDQ profiles: five profiles with varying types and severities of reported difficulties, pertaining to 95% of adolescents in care, and one without difficulties, pertaining to 55% of adolescents not in care. The types of reported difficulties in the profiles matched DSM-IV diagnoses for 88% of the diagnosed adolescents. The SDQ profiles were found to be more useful for predicting care use and diagnoses than SDQ scores reported by the adolescent as single informant and the total difficulties scale. The latter indicated the presence of problems among 42–63% of the adolescents in care, missing a substantial number of adolescents with reported emotional difficulties and borderline problem severity. These findings advocate the use of combined self- and parent-rated SDQ score profiles for screening. Electronic supplementary material The online version of this article (10.1007/s00787-020-01667-5) contains supplementary material, which is available to authorized users.

Recent editions of diagnostic manuals in psychiatry have focused on providing quick and efficient operationalized criteria. Notwithstanding the genuine value of these classifications, many psychiatrists have argued that the operationalization approach does not sufficiently accommodate the rich and complex domain of patients’ experiences that is crucial for clinical reasoning in psychiatry. How can we increase the role of phenomenology in the process of diagnostic reasoning in psychiatry? I argue that this could be done by adopting a clinical staging approach in diagnostic reasoning in psychiatry. The approach has the resources to include the progressive nature of patients’ experiences to a much greater degree than is currently practiced. It can address the recent plea for increasing the role of phenomenology in psychiatric diagnosis by offering a model for clinical reasoning that goes beyond the operationalized, static criteria of diagnostic manuals, without depriving us of their benefits.

Russian and world psychiatry are characterized by significant differences: the first can be called as the psychiatry of domestic traditions, and the second one as the psychiatry of scientific facts. Russian psychiatry is marked by emphatic devotion to national theoretical schools, an appeal in scientific discussions to the authority of famous psychiatrists of the past, a tendency to speculative psychopathological constructions, the use of archaic psychiatric terms with unclear content, insufficient attention to the principles of evidence-based medicine, or even outright disregard for these principles. The natural consequences of Russian psychiatrys traditionalism are the arbitrariness of psychiatric diagnosis and the frequent use of medicines and treatment methods without proper evidence of their effectiveness and safety.

Contains fulltext : 250999.pdf (Publisher’s version ) (Open Access) 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

This study aims to investigate the sociodemographic features, clinical correlates, criminal behavior characteristics, and the level of criminal liability of sexual offenders who were referred for forensic psychiatric assessment at a forensic unit in the city of Rio de Janeiro in 2008. All written reports made by court-appointed Crimes sexuais e imputabilidade penal Sexual offenses and criminal liability psychiatric experts involving sexual offenses were reviewed. A total of 44 expert reports were identified. All alleged offenders were male. Nineteen (43.2%) offenders did not receive any psychiatric diagnosis. Nine offenders (20.4%) were diagnosed with mental retardation. In 16 cases (36.4%), some form of mental or neurological disorder was diagnosed. Of the total sample, 31 (70.4%) offenders were considered fully liable, eight (18.2%) partially liable, and five (11.4%) not liable by reason of insanity. The sexual crimes allegedly perpetrated by the offenders were rape (n = 14; 32%), attempted rape (n = 4; 9%), indecent assault (n = 26; 59%), and indecent exposure (n = 5, 11.4%). In 10 cases (22.7%), the offender was under the influence of alcohol at the moment of the offense. The systematic psychiatric evaluation of individuals who perpetrate sexual crimes may contribute to improve strategies for intervention, prevention and risk assessment of criminal recurrence of these individuals, in the community, in prisons or in forensic services or psychiatric care communities.

Individuals diagnosed with schizophrenia are often assigned other psychiatric diagnoses during their lives. The significance of changing diagnosis has not been widely studied.Our aim was to examine the association between diagnostic change and later outcome.Individuals' diagnostic history, clinical and social outcomes were extracted from the AESOP-10 study, a 10-year follow-up of first episode psychosis cases. The association between outcome and different patterns of diagnosis over time were assessed using linear or logistic regression.Individuals always diagnosed with schizophrenia (Individuals always and never diagnosed with schizophrenia had different outcomes. In cases of diagnostic instability participants had similar outcomes to those always assigned the diagnosis they changed to irrespective of initial diagnosis.

WHAT IS KNOWN ON THE SUBJECT?: All health service users in Belgium have the right to be informed about their diagnosis. There is a whole spectrum of prognoses for psychosis, but many practitioners show a bias towards believing that psychosis is always regressive. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper is a first person narrative of one thread through my experiences as a mental health service user: the story of my diagnoses. A case study of the functions and impacts of diagnosis. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Practitioners need to reflect on the impact diagnosis can have on a person and avoid assumptions that the experience and prognosis is universal. A diagnosis can play a positive therapeutic role. ABSTRACT: Purpose The purpose of this paper is to stimulate nurses and other mental health professionals to reflect on what they understand by a psychiatric diagnosis and how they use this understanding. Background I have twenty years' experience as mental health service user, and in this time, I have received numerous diagnoses which have had a variety of impacts on me. Methods The paper began as notes drawn from introspection. I ordered my memories and reflections chronologically to reconstruct this narrative. Keypoints My case makes the point that psychiatric diagnosis is not an established, universal science like in somatic medicine, but a still evolving complex of contradictions and opinions and should not be treated as authoritative. I aim to challenge what I see as a general overestimation of how much a diagnosis tells you about a person and how you should treat them.

Eating disorders are one of the most common causes of pediatric hospitalizations due to primary mental health diagnoses. The purpose of this article is to discuss the challenges clinical psychologists face in working with patients with eating disorders and their families during medical admissions. Using the Psychiatry Consultation Service at a tertiary pediatric academic medical center in the Northeast as a framework, authors present the responsibilities of clinical psychologists on this service and their role within the larger, interdisciplinary team. Topics addressed also include systemic challenges, medical and psychiatric comorbidities, and differential psychiatric diagnoses. Case examples are provided to highlight various challenges as well as potential solutions and approaches. Clinical implications, limitations, and directions for future research are also discussed.

Body dysmorphic disorder (BDD) is a psychiatric diagnosis characterized by a debilitating preoccupation with perceived appearance defects that are not noticeable to others. The International OCD Fo...