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This paper presents a review of past and current research on the diagnosis of Asperger syndrome (AS) in children. It is suggested that the widely used criteria for diagnosing AS in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV are insufficient and invalid for a reliable diagnosis of AS. In addition, when these diagnostic criteria are applied, there is the potential bias of receiving a diagnosis towards the high-functioning end of the autism spectrum. Through a critical review of 69 research studies carried out between 1981 and 2010, this paper shows that six possible criteria for diagnosing AS (specifically, the age at which signs and symptoms related to autism become apparent, language and social communication abilities, intellectual abilities, motor or movement skills, repetitive patterns of behaviour and the nature of social interaction) overlap with the criteria for diagnosing autism. However, there is a possibility that some finer differences exist in the nature of social interaction, motor skills and speech patterns between groups with a diagnosis of AS and autism. These findings are proposed to be of relevance for designing intervention studies aimed at the treatment of specific symptoms in people with an autism spectrum disorder. [ABSTRACT FROM PUBLISHER]

Abstract Recently, some philosophers of psychiatry (viz., Rachel Cooper and Dominic Murphy) have analyzed the issue of psychiatric classification. This paper expands upon these analyses and seeks to demonstrate that a consideration of the history of the Diagnostic and Statistical Manual of Mental Disorders (DSM) can provide a rich and informative philosophical perspective for critically examining the issue of psychiatric classification. This case is intended to demonstrate the importance of history for philosophy of psychiatry, and more generally, the potential benefits of historically-informed approaches to philosophy of science. [ABSTRACT FROM AUTHOR]

Purpose--The paper's aim is to review how relevant the World Health Organization's Mental Health Gap Action Programme (mhGAP) initiative is to mental health care in non-Western societies. Design/methodology/approach--The paper provides a review of the programme and its relevance to mental health care by drawing on available literature and evidence. Findings--mhGAP promotes the idea that mental health problems exist as problems within individuals, that they represent a substantial, though largely hidden, proportion of the world's overall disease burden, and that mental health services need scaling up across the globe to improve outcomes. However, mental health outcomes do not appear any better in those countries with the most developed services and the initiative does not seem to properly engage an evidence base that is at odds with the direction of travel the initiative recommends. Originality/value--The paper explores these contradictions and argues that, whether intentional or not, mhGAP reflects and is part of the global neo-liberal economic system and functions largely to expand the market for a particularly Western approach to understanding mental distress. [ABSTRACT FROM AUTHOR]

This consensus statement is an executive summary of several papers resulting from a 2009 consensus process comprising nine work groups and 37 members of the World Professional Association for Transgender Health (WPATH). The purpose of this group was to put forth recommendations for the upcoming revision of the DSM with respect to the Gender Identity Disorder diagnoses. The consensus process was collaborative, interdisciplinary, and evidence based. A majority (but not all) of the participants believed that a diagnosis related to Gender Identity Disorder should remain in the DSM, and many advocated changes in name, diagnostic criteria, and placement within the DSM. The proposed name is Gender Dysphoria, and the diagnostic criteria should be distress based. Placement should be outside the chapter on Sexual Disorders and possibly within Psychiatric Disorders Related to a Medical Condition. If there were to be a diagnostic category for childhood, there should also be separate categories for adults and adolescents. A Not Otherwise Specified category should be retained, and Disorders of Sex Development should not be an exclusionary criterion for Gender Dysphoria. [ABSTRACT FROM AUTHOR]

Despite a wealth of studies on differences regarding the biobehavioral and social–psychological bases of mental disorders in men and women and repeated calls for increased attention, women-specific issues have so far not been comprehensively addressed in past diagnostic classification systems of mental disorders. There is also increasing evidence that this situation will not change significantly in the upcoming revisions of ICD-11 and DSM-V. This paper explores reasons for this continued failure, highlighting three major barriers: the fragmentation of the field of women's mental health research, lack of emphasis on diagnostic classificatory issues beyond a few selected clinical conditions, and finally, the “current rules of game” used by the current DSM-V Task Forces in the revision process of DSM-V. The paper calls for concerted efforts of researchers, clinicians, and other stakeholders within a more coherent and comprehensive framework aiming at broader coverage of women-specific diagnostic classificatory issues in future diagnostic systems. [ABSTRACT FROM AUTHOR]

The tenth revision of the International Classification of Mental and Behavioural Disorders (ICD-10) introduced the category F23 ‘Acute and transient psychotic disorders’ (ATPD) to incorporate clinical concepts such as the French bouffée délirante, cycloid psychosis (Germany), and the Scandinavian reactive and schizophreniform psychoses. The aim of this paper is to review the literature on ATPD and to examine how it has been differentiated from the other categories of F2 group ‘schizophrenia and related disorders’. Papers published between 1993 and 2007 were found through searches in Medline, PsychInfo and Google Scholar. Further references were identified from book chapters and comprehensive reviews of the topic. ATPD is reported as being prevalent in females and as having onset in early-middle adulthood. Although follow-up studies suggest that its outcome is more favourable than other disorders in the F2 group, ATPD tends to recur and half of cases convert mainly into either schizophrenia or affective disorders. No evidence supports the view that the traditional conditions subsumed under ATPD all refer to this diagnostic category. The lack of defining features and poor prognostic validity argue against the separation of ATPD from borderland categories. [ABSTRACT FROM AUTHOR]

The article discusses various perspectives related to psychiatric nosology. It criticizes the way the "Diagnostic and Statistical Manual of Mental Disorders" (DSM)-III/IV defines illnesses, claiming that DSM is not a textbook of psychiatric disorders. There are other better words for aitia, the plural of aithion (a myth which explains the origin of something) than simply "causes." Moreover, future studies in classification of mental illnesses should focus on the misuses and abuses of DSM-III/IV.

AbstractThe scientific classification of human psychopathology raises a host of important philosophical issues ranging over all major areas of philosophical inquiry; logic, semantics, ontology, epistemology and ethics. The paper focuses on the major views of the ontological status of our psychodiagnostic constructs; idealism, nominalism and finally, neoaristotelian realism. Idealism holds that our psychodiagnostic constructs represent ideal essences, instantiated imperfectly by individual mental patients of the same psychodiagnostic class. These ideal essences are construed either as abstract forms dwelling in an autonomous realm of eternal abstract objects – platonistic idealism – or as ideal objects emerging in and grasped directly by a pure or absolute consciousness – husserlian idealism. By contrast, nominalism claims that our psychodiagnostic constructs are nothing but conventional common names of sets of individual mental patients, invented and adopted on purely pragmatic grounds such as their practical utility, especially in predicting their clinical course and outcome under various types of treatment. Finally, neoaristotelian realism holds that, though our psychodiagnostic constructs are concepts, and thus of our own making, they are not arbitrary ones but grounded in objective features shared by individual mental patients of a given psychodiagnostic class. It is argued that both idealism and nominalism are flawed and thus untenable – though for different reasons – and a refined version of neoaristotelian realism defended.Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: This article examines the status of the literature on night-eating syndrome (NES) according to five criteria that have been proposed by Blashfield, Sprock, and Fuller1 (Compr Psychiatry 1990;31:15–19) to determine whether NES warrants inclusion in the psychiatric nosology as a distinct eating disorder. Method: Relevant research papers were identified in Medline and PsychInfo using the search term “night-eating syndrome.” Results: None of the five criteria was met. Specifically, at the time of review, there were not yet 25 empirical papers on NES; no commonly accepted definition of or assessment approach to NES has been adopted; the utility and validity of NES need to be established, and NES needs to be differentiated more clearly from other eating disorder syndromes. Conclusion: This review suggests that the most pressing step toward clarifying the status of NES is to develop a uniform definition of NES. Once accomplished, research can progress to accumulating the necessary evidence to determine whether NES should be included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006 [ABSTRACT FROM AUTHOR]

Aims Over the past two decades, many nosological issues have been addressed by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) substance use disorders workgroups. Even with those efforts, there are key issues that have not been resolved and must be revisited, or addressed de novo, by the workgroups. These lingering points are broad, due to the array of substances classified under the diagnostic umbrella of substance use disorders. They include substantive issues ranging from dimensional approaches, similar criteria for each substance, cut-points and thresholds, distinct abuse and dependence classifications, new criteria and drugs, to less substantive ones, such as the adjectives used to describe the severity of the behaviors. Results This paper describes the characteristics of the data sets that will be needed to resolve the key nosological issues. Ten points are described: (1) data must be true to nomenclature under study; (2) flexible regarding rearrangements of scoring algorithms; (3–4) able to assess substances individually and retain former versions of the criteria; (5) not rely on shortened versions; (6) utilize samples that are generalizable; (7) make diagnoses with transparent algorithms; (8) combine mixed methods for corroborating data; (9) utilize assessments that collect reliable and valid diagnoses and criteria; and (10) stretch the limits by allowing for new discoveries. Conclusions This paper describes each of these and gives examples of the limitations and strengths of data for the purpose of defining a useful, unified concept of addictive behaviors. [ABSTRACT FROM AUTHOR]

Aims Since the publication of the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV), many studies have addressed substance use disorders (SUD) in adolescents. Based on that adolescent literature, this paper suggests further research to help guide decisions about revising for DSM-V the SUD criteria in DSM-IV. Method The author has reviewed the ‘Substance Related Disorders’ section of DSM-IV-TR, recalled his experience in helping to draft that section, accessed relevant articles in PubMed and reviewed his own extensive file of literature citations. Results This paper suggests six questions for adolescent research to help guide the framers of DSM-V’s ‘Substance Related Disorders’ section: (a) DSM-IV did not provide a diagnosis of cannabis withdrawal; should DSM-V continue that position? (b) Should SUD be included or referenced among ‘Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence’? (c) Can inter-rater reliability of the substance abuse (SA) criteria be improved with altered example situations, text descriptions or phrasing of the current criteria? (d) Between ages 14 and 18 years is earlier onset of SUD a severity marker that could be incorporated into DSM-V as a predictor of worse course? (e) In DSM-V could a phenotypic descriptor of pathological multi-substance involvement document severity and predict course of SUD? (f) Could clinicians and patients benefit from DSM-V-related postpublication procedures for classifying emerging new drugs into DSM-V’s categories? Conclusion Without substantive changes in SA or substance dependence diagnostic criteria, research may improve the usefulness of those criteria for adolescents. [ABSTRACT FROM AUTHOR]

The article examines why psychiatric diagnoses are neither circular nor uniformative nor lacking in explanatory value despite the absence of known pathophysiological processes as part of their diagnostic criteria. Topics include problems and inadequacies in DSM-5 psychiatric diagnostic categories, mistaken beliefs about the nature, scope, and purpose of the diagnostic categories, and diagnoses that embody so little descriptive or causal content as to be trivially nonexplanatory.

Purpose The purpose of this article is to fill the need for an updated concept analysis of compassion fatigue. Methods This review used Rodgers' Evolutionary Model to direct the analysis of 25 papers published between 2005 and 2015. This review focused strictly on healthcare providers in the formal healthcare setting. Conclusions The authors provided an analysis of the evolution of compassion fatigue and identified surrogate terms, attributes and defining characteristics, and antecedents and consequences of the term, true to Rodgers' Evolutionary Model. Related terms are also discussed and a brief case model is provided. Clinical Relevance A better understanding of compassion fatigue will allow researchers and clinicians to identify its causes, prevention, and treatment. This could impact the rate at which healthcare providers leave clinical practice and their ability to compassionately engage with patients. [ABSTRACT FROM AUTHOR]

BackgroundAlthough specific phobia is highly prevalent, associated with impairment, and an important risk factor for the development of other mental disorders, cross-national epidemiological data are scarce, especially from low- and middle-income countries. This paper presents epidemiological data from 22 low-, lower-middle-, upper-middle- and high-income countries.MethodData came from 25 representative population-based surveys conducted in 22 countries (2001–2011) as part of the World Health Organization World Mental Health Surveys initiative (n = 124 902). The presence of specific phobia as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition was evaluated using the World Health Organization Composite International Diagnostic Interview.ResultsThe cross-national lifetime and 12-month prevalence rates of specific phobia were, respectively, 7.4% and 5.5%, being higher in females (9.8 and 7.7%) than in males (4.9% and 3.3%) and higher in high- and higher-middle-income countries than in low-/lower-middle-income countries. The median age of onset was young (8 years). Of the 12-month patients, 18.7% reported severe role impairment (13.3–21.9% across income groups) and 23.1% reported any treatment (9.6–30.1% across income groups). Lifetime co-morbidity was observed in 60.5% of those with lifetime specific phobia, with the onset of specific phobia preceding the other disorder in most cases (72.6%). Interestingly, rates of impairment, treatment use and co-morbidity increased with the number of fear subtypes.ConclusionsSpecific phobia is common and associated with impairment in a considerable percentage of cases. Importantly, specific phobia often precedes the onset of other mental disorders, making it a possible early-life indicator of psychopathology vulnerability. [ABSTRACT FROM PUBLISHER]

Purpose - Over the last ten years, there has been greater interest in the diagnosis of personality disorder (PD) in people with intellectual and developmental disabilities (IDD). One important characteristic of a diagnostic system is that it should have validity as a contribution to utility. PD has been found to have a predictive relationship with violence and the purpose of this paper is to review two methods for the diagnosis of PD in offenders with IDD in order to evaluate the utility of the diagnoses. Design/methodology/approach - In total, 212 offenders with ID were recruited from three settings - maximum-security, medium/low security and community services. Diagnoses of PD in the case files were compared with a structured system of diagnosis based on DSM-IV traits. Findings - There were significant differences between the two systems with a significantly higher frequency of PD diagnosis in the community forensic setting in the structured assessment system. There was no relationship between the case files diagnosis of PD and future violence but there was a significant predictive relationship between the structured diagnosis of PD and future violence with an AUC = 0.62. Research limitations/implications - As with all such studies, the research is limited by the quality of the case files available to the researchers. Practical implications - Only the structured assessment of PD had utility for the prediction of violence. Reasons for the differences between the systems are discussed and suggestions made on how a diagnosis of PD can be structured for the busy clinician. Social implications - The accurate diagnosis of PD has important implications since the PD is a crucial addition to any violence risk evaluation. Originality/value - This study is the first of its kind to review the way in which clinicians assess PD. [ABSTRACT FROM AUTHOR]

Data on the course of major depressive disorder (MDD) among people living with HIV (PLWH) are needed to inform refinement of screening and interventions for MDD. This paper describes the incidence and persistence rate of MDD in PLWH in Uganda. 1099 ART-naïve PLWH attending HIV clinics in Uganda were followed up for 12 months. MDD was assessed using the DSM IV based Mini-International Neuropsychiatric Interview with a prevalence for MDD at baseline of 14.0 % (95 % CI 11.7-16.3 %) reported. Multivariable logistic regression was used to determine predictors of incident and persistent MDD. Cumulative incidence of MDD was 6.1 per 100 person-years (95 % CI 4.6-7.8) with significant independent predictors of study site, higher baseline depression scores and increased stress. Persistence of MDD was 24.6 % (95 % CI 17.9-32.5 %) with independent significant predictors of study site, higher baseline depression scores, and increased weight. Risks of incident and persistent MDD observed in this study were high. Potentially modifiable factors of elevated baseline depressive scores and stress (only for incident MDD) were important predictors of incident and persistent MDD. [ABSTRACT FROM AUTHOR]

The underlying structure of obsessive-compulsive disorder (OCD) remains to be confirmed in child and adolescent populations. In this paper we report the first factor analytic study of individual OCD items from Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). OCD symptoms were assessed using the CY-BOCS symptom checklist in a sample of 854 patients with OCD (7-18 years of age) recruited from clinics in five countries. Pooled data were subjected to exploratory and confirmatory factor analysis (CFA) to identify the optimal factor structure. Various models were tested for age and gender subgroups. Also, the invariance of the solution across age and gender was tested and associations with demographic and clinical factors were explored. A three-factor model provided the best-fit solution. It consisted of the following factors: (1) harm/sexual, (2) symmetry/hoarding, (3) contamination/cleaning. The factor structure was invariant for age and gender across subgroups. Factor one was significantly correlated with anxiety, and factor two with depression and anxiety. Factor three was negatively correlated with tic disorder and attention-deficit/hyperactivity disorder (ADHD). Females had higher scores on factor two than males. The OCD symptom structure in children and adolescents is consistent across age and gender and similar to results from recent child and adolescents although hoarding may not be a separate factor. Our three-factor structure is almost identical to that seen in early studies on adults. Common mental disorders had specific patterns of associations with the different factors. [ABSTRACT FROM AUTHOR]

Background: Common mental disorders, such as mood, anxiety, and substance use disorders, are significant contributors to disability globally, including India. Available research is, however, limited by methodological issues and heterogeneities. Aim: The present paper focuses on the 12-month prevalence and 12-month treatment for anxiety, mood, and substance use disorders in India. Materials and Methods: As part of the World Health Organization World Mental Health (WMH) Survey Initiative, in India, the study was conducted at eleven sites. However, the current study focuses on the household sample of 24,371 adults (≥18 years) of eight districts of different states, covering rural and urban areas. Respondents were interviewed face-to-face using the WMH Composite International Diagnostic Interview after translation and country-specific adaptations. Diagnoses were generated as per the International Classification of Diseases, 10th edition, Diagnostic Criteria for Research. Results: Nearly 49.3% of the sample included males. The 12-month prevalence of common mental disorders was 5.52% - anxiety disorders (3.41%), mood disorders (1.44%), and substance use disorders (1.18%). Females had a relatively higher prevalence of anxiety and mood disorders, and lower prevalence of substance use disorders than males. The 12-month treatment for people with common mental disorders was 5.09% (range 1.66%--11.55% for individual disorders). The survey revealed a huge treatment gap of 95%, with only 5 out of 100 individuals with common mental disorders receiving any treatment over the past year. Conclusion: The survey provides valuable data to understand the mental health needs and treatment gaps in the Indian population. Despite the 12-month prevalence study being restricted to selected mental disorders, these estimates are likely to be conservative due to under-reporting or inadequate detection due to cultural factors. [ABSTRACT FROM AUTHOR]

This paper provides an overview of the design and cohort characteristics of the Social Spectrum Study: a clinical cohort study that used a two-phase sampling design to identify children at risk for ASD. After screening 1281 children aged 2.5-10 years who had been consecutively referred to one of six mental health services in the Netherlands, children who screened positive for ASD (n = 428) and a random selection of screen negatives (n = 240) were invited to participate in diagnostic assessments and questionnaires regarding the child, family and society. A 1-year follow-up was also conducted. Results from this study may contribute to knowledge of the identification and characterization of children with ASD, family processes, and the impact of ASD on the family and society. [ABSTRACT FROM AUTHOR]

Objective: This clinical update review focuses on treatment approaches of neuropsychiatric manifestations in Parkinson's disease.Methods: We conducted a systematic search of the literature using Pubmed and selected recent and relevant papers for this review.Results: Neuropsychiatric symptoms in Parkinson's disease usually require optimization of levodopa therapy as a first step. Most psychotropic drugs can be used in Parkinson's disease, however there is still lack of an evidence base due to limited studies and difficulties in diagnosis of neuropsychiatric disorders. Non-pharmacological treatments have also proved effective in Parkinson's disease. Cognitive impairment requires special consideration.Conclusions: Management of neuropsychiatric manifestations in Parkinson's disease is complicated by the lack of evidence. Treatment should be individualized and benefits and risks must be balanced. [ABSTRACT FROM AUTHOR]

Objective: This clinical update review focuses on the classification and description of common neuropsychiatric manifestations in Parkinson's disease (PD).Method: We conducted a systematic search of the literature using Pubmed and selected the most recent and relevant papers for this review.Results: Neuropsychiatric manifestations in PD are are very frequent and may arise from an abnormal psychopathological response to the disease, neurobiological changes related to the disease itself, complications of treatments or a combination of all of these.Conclusions: Neuropsychiatric symptoms may precede the motor clinical presentation of PD. Early recognition is essential. [ABSTRACT FROM AUTHOR]

School-aged children with autism spectrum disorders (ASDs) have delayed gestural development, in comparison with age-matched typically developing children. In this study, an intervention program taught children with low-functioning ASD gestural comprehension and production using video modelling (VM) by a computer-generated robot animation. Six to 12-year-old children with ASD ( N = 20; IQ < 70) were taught to recognize 20 gestures produced by the robot animation (phase I), to imitate these gestures (phase II) and to produce them in appropriate social contexts (phase III). Across the three phases, significant differences were found between the results of the pretest and the immediate and follow-up posttests; the results of both posttests were comparable, after controlling for the children's motor and visual memory skills. The children generalized their acquired gestural skills to a novel setting with a human researcher. These results suggest that VM by a robot animation is effective in teaching children with low-functioning ASD to recognize and produce gestures. Lay Description What is already known about this topic: Children with autism spectrum disorders (ASDs) have difficulties with nonverbal communication., Children with ASD have difficulties in recognizing and producing gestures., What this paper adds: A multiphase therapeutic intervention program using video modelling (VM) of robot animation is effective to promoting the gestural communication skills, both recognition and production, in children with low-functioning ASD., Children with ASD have improved their skills to recognize the taught gestures (phase I), imitate them (phase II) and produce them in appropriate social contexts (phase III)., Children with ASD are able to generalize the acquired skills to human-to-human interactions after the intervention program., Implications for practice and/or policy: VM of a robot animation is effective in teaching children with low-functioning ASD both gesture recognition and gesture production., The multiphase therapeutic intervention protocol can be recommended for clinicians or teachers in special schools to teach children with low-functioning ASD gestural communication skills. [ABSTRACT FROM AUTHOR]

Objectives:Identifying depression in older adults with cancer presents a set of unique challenges, as it combines the confounding influences of cancer and its treatment with the developmental changes associated with aging. This paper reviews the phenomenology of depression in older adults, and individuals diagnosed with cancer. Method:PsychInfo, PubMed, Web of Science, and Google Scholar databases were searched for English-language studies addressing the phenomenology, symptoms, or assessment of depression in older adults and those with cancer. Results:The Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria that appear to be relevant to both older adults and cancer patients are anhedonia, concentration difficulties, sleep disturbances, psychomotor retardation/agitation, and loss of energy. Possible alternative criteria that may be important considerations included constructs such as loss of purpose, loneliness, and irritability in older adults. Among cancer patients, tearfulness, social withdrawal, and not participating in treatment despite ability to do so were identified as potentially important symptoms. Conclusions:Current DSM criteria may not adequately assess depression in older cancer patients and alternative criteria may be important to inform the understanding and identification of depression in this population. Enhancing diagnostic accuracy of depression is important as both the over-diagnosis and under-diagnosis is accompanied with significant costs. Thus, continued research exploring the phenomenology and identifying effective indicators of depression in older cancer patients is needed. [ABSTRACT FROM AUTHOR]

The China Mental Health Survey (CMHS) is the first nationally representative community survey on mental disorders and mental health services in China. One-step diagnoses for mood disorders, anxiety disorders and substance use disorders were obtained using the Composite International Diagnostic Interview-3.0 (CIDI-3.0), according to the criteria and definition of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). A two-step procedure was applied for schizophrenia and other psychotic disorders, using psychosis screening section in CIDI-3.0 as a screening instrument and the Structured Clinical Interview for DSM-IV Axis I disorders (SCID) as a diagnostic tool. Dementia was diagnosed by the 10/66 dementia diagnosis package in a two-step design. The main aims of the CMHS were: (1) to investigate the prevalence of mood disorders, anxiety disorders, substance use disorders, schizophrenia and other psychotic disorders, and dementia; (2) to obtain data of service use of individuals with mental disorders in China; and (3) to analyse the social and psychological risk factors or correlates of mental disorders and mental health services. This paper presents a brief review of the background of the CMHS, its aims and measures. [ABSTRACT FROM AUTHOR]

The field has embarked on an effort to better integrate neurobiological and psychological dimensions of functioning with putative psychopathological syndromes. If successful, this effort aims to be a turning point as impactful as the change, a century ago, away from the study of symptom dimensions and toward the study of psychopathological syndromes. New statistical and neurobiological methods and findings hold considerable promise in this regard, and several papers in the present issue underscore these ongoing and important new directions. For this proposed direction to succeed, however, three guiding principles are necessary. First, the syndromal approach must continue to be viewed as provisional, and not reified. Second, in contrast, individual dimensions of neurobiology, psychology, personality, or symptoms should not be decontextualized but considered in relation to other traits and dimensions, syndromal configurations. Major clinical syndromes cannot be ignored. Third, following the Kraepelian insights of a century ago in addition to the more recent insights of developmental psychopathlogy, trait and dimension aspects of psychopathology need to be understood in their developmental context. Whether an integrated dimensional-categorical-developmental understanding of psychopathology can be extended to the entire nosology or only parts of it remains to be seen. [ABSTRACT FROM AUTHOR]

Objective: To examine outcomes from a four-part webinar series on affirming approaches to working with trans and non-binary young people in terms of Australian psychologists' confidence in working with this population. Method: The author designed and ran a webinar series for the Australian Psychological Society (APS) in early 2018. Of the 76 webinar registrants, 55 completed a survey both before the first webinar, and after completing all of the webinar series. The first survey collected information about demographics, past clinical and training experiences, awareness of the DSM-5 diagnosis of "gender dysphoria", and confidence in working with trans and non-binary young people. The first survey also included open-ended questions asking participants to define "cisgenderism", "transgender", and "non-binary". The second survey included the same questions and additionally asked about understandings of gender diversity, pathways to care, and awareness of the APS information sheet on affirming approaches. Results: Participants who had previously undertaken training, and previously worked with trans and non-binary people reported greater confidence prior to the webinar series. Statistically significant associations with confidence were found following the webinar series. Greater understanding of gender diversity and the APS information sheet were associated with confidence. Content analysis of the open-ended responses identified improved understandings of the three definitions for most participants after the webinar series. Conclusions: Training for psychologists providing affirming care to trans and non-binary young people is important not only for those who specifically work with this population, but also for generalists, given that many young people may require mental health care beyond that specific to gender transition. What is already known about this topic: Previous training and experience in working with trans and non-binary adults are related to increased confidence in providing clinical care, Training for healthcare professionals related to trans and non-binary adults results in increased confidence and knowledge, and The evidence base for affirming approaches to clinical care for trans and non-binary young people is in its infancy. What this topic adds: Training for healthcare professionals related to trans and non-binary young people is specifically associated with confidence, Theoretically informed training opportunities are associated with knowledge about terminology pertaining to trans and non-binary young people, and The training of informed knowledgeable generalists working with trans and non-binary young people can usefully supplement existing specialist paediatric gender services. [ABSTRACT FROM AUTHOR]

Hoarding disorder is a relatively new diagnosis in the DSM‐5, only just included in the most recent edition. The disorder has piqued the interest of many in the community, in part because of the hit TV show called "Hoarders." Although there is interest, there continues to be relatively few research studies into the causes, treatment, and management of this disorder specifically in adolescences. Yet, in the research that has been published, it often sites the disorder first appearing in adolescents. This paper will discuss the following elements of adolescent hoarding disorder: The potential etiology and risk factors noted in the literature, the DSM‐5 criteria for the diagnosis of hoarding disorder, and the characteristic signs and symptoms found in the adolescent presentation, as well as treatment. Finally, it will also include recommendations for healthcare professionals for early screening and treatment. [ABSTRACT FROM AUTHOR]

The article presents the discussion on addressing health equity starting at home. Topics include diagnostic terms and associated words having potential unintended consequences of harming people and contributing to social injustice; and offering little resistance while simultaneously shielding police from accountability.

Structural and functional MRI (magnetic resonance imaging) based diagnostic classification using machine learning has long held promise, but there are many roadblocks to achieving their potential. While traditional machine learning models suffered from their inability to capture the complex non-linear mapping, deep learning models tend to overfit the model. This is because there is data scarcity and imbalanced classes in neuroimaging; it is expensive to acquire data from human subjects and even more so in clinical populations. Due to their ability to augment data by learning underlying distributions, generative adversarial networks (GAN) provide a potential solution to this problem. Here, we provide a methodological primer on GANs and review the applications of GANs to classification of mental health disorders from neuroimaging data such as functional MRI and showcase the progress made thus far. We also highlight gaps in methodology as well as interpretability that are yet to be addressed. This provides directions about how the field can move forward. We suggest that since there are a range of methodological choices available to users, it is critical for users to interact with method developers so that the latter can tailor their development according to the users' needs. The field can be enriched by such synthesis between method developers and users in neuroimaging. [ABSTRACT FROM AUTHOR]

The current diagnosis of attention deficit hyperactivity disorder (ADHD) is based on history, clinical observation, and behavioral tests. There is a high demand to find biomarkers for the diagnosis of ADHD. The aim of this study is to analyze the serum profiles of several biomarkers, including homocysteine (Hcy), vitamin B12, vitamin D, ferritin, and iron, in a cohort of 133 male subjects (6.5–12.5 years), including 67 individuals with an ADHD diagnosis based on DSM-V criteria and 66 age-matched healthy boys (healthy controls, HC). Assessments for ADHD included the Iowa Conners' Teacher Rating Scale (CPRS) and the ADHDT test, as well as cognitive assessments using the Wechsler Intelligence Scale for Children-Revised (WISC-R) and the TROG-2 language comprehension test. Hcy and iron were quantified using spectrophotometry, while vitamin B12 and total 25-hydroxy vitamin D levels were determined using an electrochemiluminescence immunoassay (ECLIA) and ferritin was measured using a particle-enhanced immunoturbidimetric assay. The results showed significantly increased Hcy levels and decreased vitamin B12 levels in ADHD patients compared to HCs. Multiple logistic regression analysis indicated that Hcy is a potential prognostic indicator for ADHD. These results suggest that elevated homocysteine and decreased vitamin B12 may serve as markers for the diagnosis and prognosis of ADHD. [ABSTRACT FROM AUTHOR]

Two neurodevelopmental conditions, autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), have been associated with executive function (EF) impairments but the specificity of their impairments is still controversial. The present meta-analysis aimed to identify the differences in EF profiles of ASD, ADHD, and ASD+ADHD in relation to a control group of individuals with typical development (TD) and to understand whether the EF performance could change depending upon the type of measure used to assess EF (performance tests vs. questionnaires). Results from 36 eligible studies revealed that ADHD and ASD showed more difficulties than the TD group in tests and, particularly, in questionnaires. No significant differences in the EF profile emerged between ASD and ADHD when assessed through neuropsychological tests (d = 0.02), while significant differences emerged when assessed through questionnaires, with ADHD having higher ratings than ASD (d = −0.34). EF questionnaires and neuropsychological tests may catch two different constructs of EF, with the former being more predictive of everyday life EF impairments. The comparison between the double diagnosis group (ADHD+ASD) and the clinical groups pointed out that the former has a more similar EF profile to the ADHD-alone one and that it shows more difficulties than ASD-alone. [ABSTRACT FROM AUTHOR]

The existence of a female phenotype profile in autistic spectrum disorder is one of the current hypotheses to explain the diagnostic discrepancy between men and women. In this context, an international literature review was carried out to evidence and describe the characteristics of restricted interests found in girls with autistic spectrum disorder. A documentary search was conducted on PubMed and a systematic literature review was carried out based on the PRISMA methodology. We selected studies with a population of boys and girls diagnosed as autistic according to the DSM-IV or the DSM-5, in which quantitative and descriptive comparisons of restricted interests, according to gender were carried out. Nineteen studies were found to be relevant. Fifteen enabled a refining of the characteristics of restricted interests among females: fewer restricted interests were identified in comparison with boys, and the autistic girls' interests seem to be closer to those of neurotypical girls than to those of autistic boys, which thus led to more complex screening. Age and Intelligence quotient seem to be two factors that trigger variations in restricted interests differently according to gender. Representations among professionals also have an impact on diagnoses among girls. For future research, one of the perspectives could be a comparison between girls with autism and neurotypical girls to limit gender bias. The present results contribute to potentially extending knowledge of a female phenotypical profile in autism and show the need to improve the general population's awareness, to improve health professionals' training and possibly to revise the diagnostic tools. [ABSTRACT FROM AUTHOR]

The conceptualization of personality disorder has been refined through recent nosological advances introduced in the Alternative Model for Personality Disorders (AMPD). These advances locate self and interpersonal (dys)function at the core of personality pathology. Self-report personality assessment instruments have demonstrated promise in the assessment of Criterion A domains. However, research highlighting the utility of performance-based personality assessment instruments has been largely absent in these advances, despite acknowledgment of their potential. We adhered to PRISMA review guidelines to survey and assess the potential relevance and utility of select performance-based personality instruments in assessing Criterion A domains of the AMPD. We conclude that performance-based personality measures are uniquely positioned to assess maladaptive self- and interpersonal functioning and may address some limitations of self-report measures. Toward this end, we propose a working model that provides ranges of test scores that correspond to the 5-point scale of the Criterion A domains of the AMPD. [ABSTRACT FROM AUTHOR]

We posit the hypothesis that False Positive cases (FP) in machine learning classification models of suicidal behavior are at risk of suicidal behavior and should not be seen as sheer classification error. We trained an XGBoost classification model using survey data from 173,663 Norwegian adolescents and compared the classification groups for several suicide-related mental health indicators, such as depression, anxiety, psychological distress, and non-suicidal self-harm. The results showed that as the classification is made at higher risk thresholds - corresponding to higher specificity levels - the severity of anxiety and depression symptoms of the FP and True Positive cases (TP) become significantly more similar. In addition, psychological distress and non-suicidal self-harm were found to be highly prevalent among the FP group, indicating that they are indeed at risk. These findings demonstrate that FP are a relevant risk group for potential suicide prevention programs and should not be dismissed. Although our findings support the hypothesis, we account for limitations that should be examined in future longitudinal studies. Furthermore, we elaborate on the rationale of the hypothesis, potential implications, and its applicability to other mental health outcomes. [ABSTRACT FROM AUTHOR]

Biology education plays a vital role in nurturing the understanding of learners about the intricacy of life. Various efforts have emerged to strengthen learning biological concepts but there were still studies that showed that learners have low mastery in some aspects. To determine how well students understood various biological topics, including human physiology, Concept inventory tests (CIT) were used. The concept inventory test may be able to spot students' misconceptions and ultimately lead to improved comprehension. The crafted CIT developed with the aid of a table of specifications based on Bloom's taxonomy of cognitive domain was assessed according to its validity and reliability. In validation, content validity and item analysis were considered while reliability test was employed through Cronbach's alpha. Distractor analysis was also performed to determine possible source of misconception per item. The CIT was administered to 120 senior high school STEM students (50.8% from the private schools, 37.5% in regular public schools and 11.7% from public schools with special programs in science). The results displayed high content validity with a mean of 4.83 for content validity and an average Aiken's validity coefficient of 0.98. It also highlighted that the test is moderately difficult with the test difficulty of 0.58, as well as, discriminatory with a discriminating level of 0.46. After item classification, 63 items were retained (39 accepted, 24 for revisions) and Chronbach's alpha (a=0.74) indicated good internal consistency. The concept inventory test propounds to be a good classroom test with minor items to be revised. [ABSTRACT FROM AUTHOR]

Compare developmental profiles and core ASD symptom manifestation between male and female toddlers with DSM-5 ASD. Retrospective record review of 500 toddlers (79% male) at time of ASD diagnosis. There were no differences in developmental functioning between males and females. When adjusting for multiple comparisons, sex differences were only noted for sensory seeking behavior occurring at a higher frequency in females. Overall, there were no significant differences in demographic characteristics, developmental functioning, or manifestation of core ASD symptoms between males versus female toddlers at the time of DSM-5 ASD diagnosis. [ABSTRACT FROM AUTHOR]

Background: Mental health service providers are increasingly interested in patient perspectives. We examined rates and predictors of patient-reported satisfaction and perceived helpfulness in a cross-national general population survey of adults with 12-month DSM-IV disorders who saw a provider for help with their mental health. Methods: Data were obtained from epidemiological surveys in the World Mental Health Survey Initiative. Respondents were asked about satisfaction with treatments received from up to 11 different types of providers (very satisfied, satisfied, neither satisfied nor dissatisfied, somewhat dissatisfied, very dissatisfied) and helpfulness of the provider (a lot, some, a little, not at all). We modelled predictors of satisfaction and helpfulness using a dataset of patient-provider observations (n = 5,248). Results: Most treatment was provided by general medical providers (37.4%), psychiatrists (18.4%) and psychologists (12.7%). Most patients were satisfied or very satisfied (65.9-87.5%, across provider) and helped a lot or some (64.4-90.3%). Spiritual advisors and healers were most often rated satisfactory and helpful. Social workers in human services settings were rated lowest on both dimensions. Patients also reported comparatively low satisfaction with general medical doctors and psychiatrists/psychologists and found general medical doctors less helpful than other providers. Men and students reported lower levels of satisfaction than women and nonstudents. Respondents with high education reported higher satisfaction and helpfulness than those with lower education. Type of mental disorder was unrelated to satisfaction but in some cases (depression, bipolar spectrum disorder, social phobia) was associated with low perceived helpfulness. Insurance was unrelated to either satisfaction or perceived helpfulness but in some cases was associated with elevated perceived helpfulness for a given level of satisfaction. Conclusions: Satisfaction with and perceived helpfulness of treatment varied as a function of type of provider, service setting, mental status, and socio-demographic variables. Invariably, caution is needed in combining data from multiple countries where there are cultural and service delivery variations. Even so, our findings underscore the utility of patient perspectives in treatment evaluation and may also be relevant in efforts to match patients to treatments. [ABSTRACT FROM AUTHOR]

This study aims to identify the sensory characteristics of children with both developmental disabilities such as ASD and ADHD and a history of child maltreatment (DM group), children with developmental disabilities (DD group), and typically developed children (TD group). The sensory characteristics of 24 children were assessed through virtual reality and self-administered questionnaires. The results elucidated that the duration of gazing at the "teacher" (60–75 s) was significantly different with the DM group's gaze being shorter than the DD group's gaze (p = 0.042). The duration of the "others" gaze (45–60 s) was also significantly different with the DM group's gaze being longer than the DD and TD groups' gaze (p = 0.018; p = 0.030). Additionally, the scores for tactile sensitivity, taste/smell sensitivity, under-responsive/seeks sensation, and the total short-term sensory profile were significantly different between the DM-DD and DD-TD groups. The scores of the heart rate perception test and Multidimensional Assessment of Interoceptive Awareness were significantly lower in the DM and DD groups. In conclusion, children who have experienced trauma and developmental disabilities may have different sensory characteristics than children with only developmental disabilities or none, implying the need for further research and tailored care. [ABSTRACT FROM AUTHOR]

The intertwined relationship between religion and mental health has been accounted for since the earliest recorded history. This study aimed to explore the relationship between the concept of diseases of the spiritual heart (DOTSH) from the Islamic–Sufi perspective and the medical–psychiatric concept of mental disorder. We examined two essential documents as our primary data sources: (1) Al Ghazali's Ihya Ulumuddin (Revivals of Religion Sciences) Volume III entitled the Quarter of the Destructive and (2) The Diagnostic and Statistical Manual, Fifth Version, Text Revision (DSM-5-TR). We employed a document analysis of the qualitative method by applying six steps of data analysis. We reviewed the English version of Al Ghazali's book to identified DOTSH. In this stage, we found six DOTSH categories which comprised of 40 DOTSH. Then, we searched the correspondence of DOTSH's categories to the DSM-5-TR criteria for mental disorders. We found that all DOTSH categories correspond to DSM-5-TR diagnostics criteria, diagnostic features or diagnostic associated features. We concluded that spiritual heart diseases not only present as symptoms but also can be regarded as mental disorder preconditions that require preventive intervention. [ABSTRACT FROM AUTHOR]

In this rejoinder, I comment on Irmak's 2014 article titled "Schizophrenia or Possession?" published in the Journal of Religion and Health (Irmak, 2014; JORH 53(3):773–777. https://doi.org/10.1007/s10943-012-9673-y). After providing a brief overview of the article and two commentaries on it, I examine the role that demonic possession may or may not play in the development and course of schizophrenia. While keeping an open mind to the possibility of evil influences on the course of illness in those with or without psychosis, I emphasize that schizophrenia is a neurobiological illness that requires compassionate care and expert psychobiological treatment. [ABSTRACT FROM AUTHOR]

Spinal injuries, including cervical and thoracolumbar fractures, continue to be a major public health concern. Recent advancements in machine learning and deep learning technologies offer exciting prospects for improving both diagnostic and prognostic approaches in spinal injury care. This narrative review systematically explores the practical utility of these computational methods, with a focus on their application in imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI), as well as in structured clinical data. Of the 39 studies included, 34 were focused on diagnostic applications, chiefly using deep learning to carry out tasks like vertebral fracture identification, differentiation between benign and malignant fractures, and AO fracture classification. The remaining five were prognostic, using machine learning to analyze parameters for predicting outcomes such as vertebral collapse and future fracture risk. This review highlights the potential benefit of machine learning and deep learning in spinal injury care, especially their roles in enhancing diagnostic capabilities, detailed fracture characterization, risk assessments, and individualized treatment planning. [ABSTRACT FROM AUTHOR]

Most adolescents and young adults who experience psychological distress do not seek professional help. This study aims to enhance the understanding of sociodemographic, psychological, and clinical characteristics associated with the underuse of health services by adolescents and young adults with mental disorders. Data from a cross-sectional, epidemiological study with a population-based sample (N = 1180 participants, 14–21 years old) were used. Participants completed a fully standardized, computer-assisted diagnostic interview (DIA-X-5/D-CIDI) administered by trained clinical interviewers to assess lifetime mental disorders according to DSM-5 as well as lifetime health service use for mental health problems, and completed self-report questionnaires to assess various psychological variables (e.g., stigma). Predictors of health service use were examined using univariate and multiple logistic regression analyses, data were weighted for age and sex to improve representativeness Of n = 597 participants with any lifetime mental disorder, 32.4% [95% CI 28.4; 36.7] had ever used any health services because of a mental health, psychosomatic, or substance use problem. Even less had received psychotherapeutic or pharmacological treatment (Cognitive Behavioral Therapy: 12.1% [9.5; 15.2]; other psychotherapy: 10.7% [8.4; 13.7]; medication: 5.4% [3.7; 7.8]). High education was associated with less health service use (low/ middle/ other vs. high education: 53.8% vs. 26.9%; OR = 0.26, p <.001). In the multiple regression model, stigma toward mental disorders was the single psychological variable associated with a reduced likelihood of using health services (OR = 0.69 [0.52; 0.90], p <.01). These findings draw attention to the treatment gap for mental disorders during adolescence and highlight related factors to be addressed in public health contexts. [ABSTRACT FROM AUTHOR]

Background—There is no validated dementia screening tool for multi-ethnic Asian populations comprising Chinese, Malays, and Indians. This study aimed to establish the psychometric properties of the Community Screening Instrument for Dementia (CSI-D), Chinese Mini Mental State Examination (CMMSE), and Elderly Cognitive Assessment Questionnaire (ECAQ) in multi-ethnic Singapore. Methods—Participants were randomly drawn from a community-based neurological diseases study of older adults conducted in Singapore, with oversampling to allow similar subject numbers from the three major ethnicities: Chinese, Malay, and Indian. The CSI-D, CMMSE, and ECAQ were administered by trained research nurses using a standardised translated questionnaire in a language the participant was most conversant in. Participants were independently diagnosed as a case/non-case of dementia using the DSM-IV. Results—There were 259 participants (85 Chinese, 85 Malays, and 89 Indians, mean age 70.15 years, 65.4% female, 58.8% had no/minimal formal education); 22.8% (n = 59) had dementia. Correlations between the measures were substantial. All the measures had acceptable overall discriminative abilities. Diagnostic accuracies of the instruments did not differ across the ethnic groups. Effects of education were present in the cognitive screening measures. Conclusions—The CSI-D, CMMSE, and ECAQ are valid dementia instruments in this multi-ethnic Asian setting. [ABSTRACT FROM AUTHOR]

Early, accurate identification of ADHD would improve outcomes while avoiding unnecessary medication exposure for non-ADHD youths, but is challenging, especially in primary care. The aim of this paper is to test the Strengths and Difficulties Questionnaire (SDQ) using a nationally representative sample to develop scoring weights for clinical use. The British Child and Adolescent Mental Health Survey ( N = 18,232 youths 5-15 years old) included semi-structured interview DSM-IV diagnoses and parent-rated SDQ scores. Areas under the curve for SDQ subscales were good (0.81) to excellent (0.96) across sex and age groups. Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 21.3×. For discriminating ADHD from other diagnoses, accuracy was fair (<0.70) to good (0.88); Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 4.47×. The SDQ is free, easy to score, and provides clinically meaningful changes in odds of ADHD that can guide clinical decision-making in an evidence-based medicine framework. [ABSTRACT FROM AUTHOR]

There is limited literature available on the comorbidity between autism spectrum disorder (ASD) and substance use disorder (SUD). This paper reviews existing literature and exemplifies the challenges of treating this population with a case report of an adult male with ASD and DSM-5 alcohol use disorder. This review and case study seeks to illustrate risk factors which predispose individuals with ASD to developing SUD and discuss the obstacles to and modifications of evidence-based treatments for SUD. A review of the therapeutic interventions implemented in the treatment of this young male are described to highlight potential recommendations for the general management of SUD in those with ASD. [ABSTRACT FROM AUTHOR]

BackgroundItem response theory (IRT) analyses of alcohol use disorder (AUD) and other psychological disorders are a predominant method for assessing overall and individual criterion severity for psychiatric diagnosis. However, no investigation has established the consistency of the relative criteria severities across different samples.MethodPubMed/Medline, PsycINFO, Web of Science and ProQuest databases were queried for entries relating to alcohol use and IRT. Study data were extracted using a standardized data entry sheet. Consistency of reported criteria severities across studies was analysed using generalizability theory to estimate generalized intraclass correlations (ICCs).ResultsA total of 451 citations were screened and 34 papers (30 unique samples) included in the research synthesis. The AUD criteria set exhibited low consistency in the ordering of criteria using both traditional [ICC = 0.16, 95% confidence interval (CI) 0.06–0.56] and generalized (ICC = 0.18, 95% CI 0.15–0.21) approaches. These results were partially accounted for by previously studied factors such as age and type of sample (e.g. clinical v. community), but the largest source of unreliability was the diagnostic instrument employed.ConclusionsDespite the robust finding of unidimensional structure of AUDs, inconsistency in the relative severities across studies suggests low replicability, challenging the generalizability of findings from any given study. Explicit modeling of well-studied factors like age and sample type is essential and increases the generalizability of findings. Moreover, while the development of structured diagnostic interviews is considered a landmark contribution toward improving psychiatric research, variability across instruments has not been fully appreciated and is substantial. [ABSTRACT FROM AUTHOR]

Mirroring the evolution of the conceptualization of autism has been changes in the diagnostic process, including the most recent revisions to the DSM-5 and the addition of severity-based diagnostic modifiers assigned on the basis of intensity of needed supports. A review of recent literature indicates that in research stratifying individuals on the basis of autism severity, core ASD symptomology is the primary consideration. This conceptualization is disparate from the conceptualization put forth in DSM-5 in which severity determination is based on level of needed support, which is also impacted by cognitive, language, behavioral, and adaptive functioning. This paper reviews literature in this area and discusses possible instruments that may be useful to inform clinical judgment in determining ASD severity levels. [ABSTRACT FROM AUTHOR]

Depression is a significant mental health issue that many social workers encounter in their practice. There is great deal of theoretical and empirical knowledge concerning depression that stems from different paradigms. In this paper, we argue for the importance of understanding depression from four paradigms, post-positivism, social constructivism, critical theory and Eastern paradigm, and we illuminate how depression would be known and dealt with by these paradigmatic approaches. Given multiple paradigms available in understanding depression, we argue that social workers need to have the ability to appreciate and discern these different paradigms. Such ability can help strengthen social work practice. We further illustrate an eclectic approach that not only allows social workers to recognise the utilities and limitations of different paradigms, but also enables them to be dynamic, effectively addressing a range of issues when working with a service user who has depression. [ABSTRACT FROM AUTHOR]

Objective The objective of this paper was to examine the relationships between perceived parental bonding, Early Maladaptive Schemas (Young et al., 2003), and outcome of schema therapy of Cluster C personality problems and whether the perceptions of parental bonding could be influenced by schema therapy. Method The sample consisted of 45 patients with panic disorder and/or agoraphobia and Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Cluster C personality traits who participated in an 11-week inpatient programme consisting of two phases; the first was a 5-week panic/agoraphobia-focused cognitive therapy, whereas the second phase was a personality-focused schema therapy. The patients were assessed at pre-treatment, mid-treatment and post-treatment and at 1-year follow-up. Results Opposite to our hypothesis, lower paternal care at pre-treatment was related to more reduction in Cluster C personality traits from pre-treatment to 1-year follow-up. Maternal protection was related to the schema domains of impaired autonomy and exaggerated standards. Overall schema severity and the schema emotional inhibition at pre-treatment were associated with less change in Cluster C traits. Perceived maternal care was reduced from pre-treatment to 1-year follow-up, and more reduction in maternal care was related to less reduction in Cluster C traits. Discussion Parental bonding failed to predict treatment outcome in the expected direction, but maternal protection was related to two of the schema domains. Overall schema severity and the particular schema emotional inhibition predicted outcome. Furthermore, perceived maternal care was reduced from before to after treatment. Future studies should examine these questions in larger samples of Cluster C patients receiving schema therapy of a longer duration. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Most schemas within the impaired autonomy domain and the schema self-sacrifice seem to be related to low perceived maternal protection., Overall schema severity and the schema emotional inhibition predict a poorer outcome of schema therapy of Cluster C personality problems, and therapy should give priority to emotional inhibition when this schema is endorsed., Therapists should be aware that schema therapy carries the risk to lead to a more negative view of mother's care during upbringing and this risk is accentuated with less benefit of therapy. [ABSTRACT FROM AUTHOR]