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The recent history of psychiatry is one of diagnostic expansion. Since the etiological model of mental illness was superseded by the symptom model around 1980, new diagnoses have continuously been added to the reigning manuals of psychopathology, most recently with DSM-5 and ICD-11. This article unfolds some of the criticism that has recently been directed at diagnostic psychiatry with a focus on two quite different lines of critical thought: One represented by a neuroscientific approach known as RDoC, which argues that psychiatry must move beyond symptoms and find the causes of mental illness in the brain (Insel et al., 2010), and another represented by a contextual approach known as PTMF, which argues that mental distress is by and large understandable in light of what happens to people (Boyle & Johnstone, 2020). These oppositional perspectives stand out as prototypical, and each contain valuable insights but also limitations. The article ends by arguing that the limitations can be overcome if the perspectives are united by a hybrid theory stating that mental illness is always a property of a relation between a person and an environment. Two such theories are introduced and discussed (Gannik, 2002; Wakefield, 1992). [ABSTRACT FROM AUTHOR]

Introduction: Psychiatric diagnoses are descriptive in nature, but the lay public commonly misconceives them as causal explanations. It is not known whether this logical error, a form of circular reasoning, can sometimes be mistakenly reinforced by health authorities themselves. In this study, we investigated the prevalence of misleading causal descriptions of depression in the information provided by authoritative mental health organizations on widely accessed internet sites. Methods: We searched for popular websites managed by leading mental health organizations and conducted a content analysis to evaluate whether they presented depression accurately as a description of symptoms, or inaccurately as a causal explanation. Results: Most websites used language that inaccurately described depression as a causal explanation to depressive symptoms. Conclusion: Leading professional medical and psychiatric organizations commonly confound depression, a descriptive diagnostic label, with a causal explanation on their most prominently accessed informational websites. We argue that the scientifically inaccurate causal language in depictions of psychiatric diagnoses is potentially harmful because it leads the public to misunderstand the nature of mental health problems. Mental health authorities providing psychoeducation should clearly state that psychiatric diagnoses are purely descriptive to avoid misleading the public. Plain Language Summary: Most psychiatric diagnoses are descriptive: They describe states of mental distress and dysfunction but do not in themselves contain causal explanations. Nonetheless, diagnoses in psychiatry are commonly talked about as if they are concrete entities that explain the symptoms they describe. In this study, we examined whether health organizations themselves contribute to this logical fallacy. We searched for popular websites managed by leading mental health organizations, and evaluated whether they discussed the diagnosis of depression accurately as a description, or inaccurately as a cause for depressive symptoms. We found that the majority of websites presented depression as a cause, instead of a description of symptoms. We discuss the potential harmful consequences of inaccurately presenting descriptive psychiatric diagnoses as causes. [ABSTRACT FROM AUTHOR]

Abstract Background There is a discussion among general practitioners and psychiatrists regarding over-diagnosing versus under-reporting of psychiatric diagnoses. A deeper understanding of this topic is relevant for providing reasonable health care and for planning future studies. A crucial factor to understanding this discussion is the difference in the prevalence of a disease in each sector. One way to attain knowledge about such prevalences is the analysis of routine care data of the sector in question. However, diagnosis-related data might be modified by several additional influencing factors. Aims This study aims to explore what kind of motives and modifying factors play a role for or against giving psychiatric diagnoses in psychiatric and general medical settings. Methods Twenty-six semi-structured interviews were conducted with German physicians in the fields of general medicine and psychiatry. Interviews were analysed using content analysis. Results The analysis revealed three major motivational categories for finding a diagnosis: (1) “objective matters” such as “categorisation for research”; (2) “functional and performance-related factors” such as “requirement for medication”, “billing aspects” that go with certain diagnoses or “access to adequate care” and (3) “Individual factors” such as the “personality of a physician”. Similarly, factors emerged that lead to not making psychiatric diagnoses like “fear of stigmatization among patients” or “detrimental insurance status with psychiatric diagnosis”. Additionally participants mentioned other reasons for “not diagnosing a psychiatric diagnosis“, such as “coding of other clinical pictures”. Conclusion The diagnostic process is a complex phenomenon that goes far beyond the identification of medical findings. This insight should be considered when processing and interpreting secondary data for designing health care systems or designing a study.

Abstract Psychological characterization of patients affected by Inflammatory Bowel Disease (IBD) focuses on comorbidity with psychiatric disorders, somatization or alexithymia. Whereas IBD patients had higher risk of stable anxiety and depression for many years after the diagnosis of the disease, there is a lack of studies reporting a comprehensive psychosomatic assessment addressing factors of disease vulnerability, also in the long-term. The objective of this investigation is to fill this gap in the current literature. The aims were thus to assess: a) changes between baseline and a 4-year follow-up in psychiatric diagnoses (SCID), psychosomatic syndromes (DCPR), psychological well-being (PWB-I), lifestyle, gastrointestinal symptoms related to IBD and Irritable Bowel Syndrome (IBS)-like symptoms b) stability of psychiatric and psychosomatic syndromes at 4-year follow-up. A total of 111 IBD outpatients were enrolled; 59.5% of them participated at the follow-up. A comprehensive assessment, including both interviews and self-report questionnaires, was provided at baseline and follow-up. Results showed increased psychiatric diagnoses, physical activity, consumption of vegetables and IBS-like symptoms at follow-up. Additionally, whereas psychiatric diagnoses were no longer present and new psychopathological pictures ensued at follow-up, more than half of the sample maintained psychosomatic syndromes (particularly allostatic overload, type A behavior, demoralization) from baseline to follow-up. Long-term presence/persistence of such psychosocial burden indicates the need for integrating a comprehensive psychosomatic evaluation beyond traditional psychiatric nosography in IBD patients. Moreover, since psychosomatic syndromes represent vulnerability factors of diseases, further studies should target subgroups of patients presenting with persistent psychosomatic syndromes and worse course of the disease.

Background: There is a discussion among general practitioners and psychiatrists regarding over-diagnosing versus under-reporting of psychiatric diagnoses. A deeper understanding of this topic is relevant for providing reasonable health care and for planning future studies. A crucial factor to understanding this discussion is the difference in the prevalence of a disease in each sector. One way to attain knowledge about such prevalences is the analysis of routine care data of the sector in question. However, diagnosis-related data might be modified by several additional influencing factors. Aims: This study aims to explore what kind of motives and modifying factors play a role for or against giving psychiatric diagnoses in psychiatric and general medical settings. Methods: Twenty-six semi-structured interviews were conducted with German physicians in the fields of general medicine and psychiatry. Interviews were analysed using content analysis. Results: The analysis revealed three major motivational categories for finding a diagnosis: (1) "objective matters" such as "categorisation for research"; (2) "functional and performance-related factors" such as "requirement for medication", "billing aspects" that go with certain diagnoses or "access to adequate care" and (3) "Individual factors" such as the "personality of a physician". Similarly, factors emerged that lead to not making psychiatric diagnoses like "fear of stigmatization among patients" or "detrimental insurance status with psychiatric diagnosis". Additionally participants mentioned other reasons for "not diagnosing a psychiatric diagnosis", such as "coding of other clinical pictures". Conclusion: The diagnostic process is a complex phenomenon that goes far beyond the identification of medical findings. This insight should be considered when processing and interpreting secondary data for designing health care systems or designing a study. [ABSTRACT FROM AUTHOR]

Crisis line responders initiate emergency dispatches by activating 911 or other local emergency services when individuals are determined to be at imminent risk for undesired outcomes. This study examined the association of characteristics, psychiatric diagnoses, and somatic symptoms with emergency dispatches in a national sample. Veterans Crisis Line data were used to identify contacts (i.e., calls, texts, chats, emails) that were linked with medical records and had a medical encounter in the year prior to contact. Hierarchical logistic regression clustered by responders was used to identify the association among demographics, psychiatric diagnoses, and somatic disorders, and emergency dispatches. Analyses examined 247,340 contacts from 2017 to 2020, with 27,005 (10.9%) emergency dispatches. Odds of an emergency dispatch increased with each diagnosis (three diagnoses Adjusted Odds Ratio [AOR] (95% CI) = 1.88 [1.81,1.95]). Odds were highest among individuals with substance use disorders (SUD) (alcohol AOR (95% CI) = 1.85 [1.80,1.91]; drugs AOR (95% CI) = 1.63 [1.58, 1.68]), which may be a result of intoxication or overdose during contact, requiring further research. Having more psychiatric and somatic conditions was associated with greater odds of an emergency dispatch, indicating that comorbidity contributed to the need for acute care. [ABSTRACT FROM AUTHOR]

Psychological characterization of patients affected by Inflammatory Bowel Disease (IBD) focuses on comorbidity with psychiatric disorders, somatization or alexithymia. Whereas IBD patients had higher risk of stable anxiety and depression for many years after the diagnosis of the disease, there is a lack of studies reporting a comprehensive psychosomatic assessment addressing factors of disease vulnerability, also in the long-term. The objective of this investigation is to fill this gap in the current literature. The aims were thus to assess: a) changes between baseline and a 4-year follow-up in psychiatric diagnoses (SCID), psychosomatic syndromes (DCPR), psychological well-being (PWB-I), lifestyle, gastrointestinal symptoms related to IBD and Irritable Bowel Syndrome (IBS)-like symptoms b) stability of psychiatric and psychosomatic syndromes at 4-year follow-up. A total of 111 IBD outpatients were enrolled; 59.5% of them participated at the follow-up. A comprehensive assessment, including both interviews and self-report questionnaires, was provided at baseline and follow-up. Results showed increased psychiatric diagnoses, physical activity, consumption of vegetables and IBS-like symptoms at follow-up. Additionally, whereas psychiatric diagnoses were no longer present and new psychopathological pictures ensued at follow-up, more than half of the sample maintained psychosomatic syndromes (particularly allostatic overload, type A behavior, demoralization) from baseline to follow-up. Long-term presence/persistence of such psychosocial burden indicates the need for integrating a comprehensive psychosomatic evaluation beyond traditional psychiatric nosography in IBD patients. Moreover, since psychosomatic syndromes represent vulnerability factors of diseases, further studies should target subgroups of patients presenting with persistent psychosomatic syndromes and worse course of the disease. [ABSTRACT FROM AUTHOR]

Self-diagnosis in psychiatry is where individuals diagnose themselves rather than rely upon official diagnosticians to supply a psychiatric diagnosis. The accuracy of self-diagnosis is a contested topic. In this paper, I outline what arguments are needed to see self-diagnosis as accurate and how different approaches to self-diagnosis require different arguments. I show how different arguments are required to justify accuracy for an autistic individual judging they are autistic compared to non-autistic individuals judging they are not autistic. Different arguments are required if a self-diagnosing individual accepts or rejects official diagnostic criteria. Finally, different arguments are required depending upon whether diagnoses are seen as objective entities, the product of theoretical virtues or practically useful groupings. All these approaches require unique arguments to justify the accuracy of self-diagnosis. Identifying the required arguments for different approaches is a stepping stone toward establishing whether those arguments and which of those arguments can be successfully justified. [ABSTRACT FROM AUTHOR]

AbstractThere is a scarcity of research on smoking in adolescents within a clinical (outpatient) sample, and there is no existing knowledge on the relationship between cyberbullying and smoking in this population. The primary aim of this study is to determine the prevalence of smoking among adolescents in a clinical sample. Additionally, it aims to examine the potential associations between smoking status and factors such as socioeconomic characteristics, psychiatric diagnoses, and cyberbullying levels. A cross-sectional study was performed on 200 adolescents who visited a tertiary child and adolescent psychiatry outpatient clinic. Participants were assessed using the DSM-5 based psychiatric evaluation, the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-DSM-5 Turkish Adaptation (K-SADS-PL-DSM-5-T), the Revised Cyber Bullying Inventory-II, and the Fagerström Test for Nicotine Dependence. The study found that 21% of the sample consisted of regular smokers, with a higher prevalence observed among older adolescents. The prevalence of depression and disruptive behavior disorders was significantly greater in the smoking group compared to other groups (p:0.043, p < 0.001, respectively). There was a significant difference in the scores for the cyberbullying bully subdimension among smokers (p = 0.013). The results of the multinomial logistic regression analysis indicated significant associations between smoking and age, maternal smoking status, friends smoking status, and a diagnosis of disruptive behavior disorder (p < 0.05 for all variables). This study reveals a significant prevalence of adolescent smoking in an outpatient clinic. These findings highlight the necessity of implementing focused smoking cessation interventions for this specific population. [ABSTRACT FROM AUTHOR]

Philosophers of science have recently called for experts-by-experience to be involved in revising psychiatric diagnoses. They argue that experts-by-experience can have relevant knowledge which is important for considering potential modifications to psychiatric diagnoses. I show how altering one diagnosis can impact individuals with a different diagnosis. For example, altering autism can impact individuals diagnosed with Attention Deficit Hyperactivity Disorder and Schizoid Personality Disorder through co-morbidity and differential diagnostic criteria. Altering autism can impact the population making up the diagnosis of Attention Deficit Hyperactivity Disorder and Schizoid Personality Disorder which can then influence which behaviour each diagnosis covers and which parts of the causal structure each diagnosis covers. Expanding one diagnosis can mean, if differential diagnostic criteria are present, that individuals who have a different diagnosis, or would one day have been diagnosed with that different diagnosis, are instead now diagnosed with the expanded diagnosis. Alternatively, if two diagnoses can be co-morbid then expanding one diagnosis can mean individuals who have a different diagnosis can now also receive the expanded diagnosis. Changing these can then impact the adequacy of symptoms formulated to cover behaviour and causal mechanisms formulated to cover the causal structure. This means experts-by-experience representing a range of diagnoses should be involved in decisions over modifying diagnoses they do not have. For example, Attention Deficit Hyperactivity Disorder individuals should be involved in decisions to modify autism. I discuss practical issues relating to how much say people with a range of diagnoses should have in relation to modifying a diagnosis which they do not have. We should employ a principle of equality whereby the level of say individuals with one diagnosis should have on another diagnosis should be equally reciprocated. [ABSTRACT FROM AUTHOR]

Long-COVID-19 symptoms are an emerging public health issue. This study sought to investigate demographics, chronic illness, and probable psychiatric diagnoses as correlates for long-COVID-19 in an urban adult sample. Self-report Qualtrics surveys were sent to students across City University of New York (CUNY) campuses in New York City in Winter 2021–2022. Binary logistic regressions were used to assess the relation of a range of factors with endorsement of long-COVID-19. Results demonstrated that Latinx participants endorsed higher odds of long-COVID-19, as compared to non-Latinx white participants. Participants who endorsed having a prior chronic illness and those who met the cut-off for probable psychiatric diagnoses all endorsed higher odds of long-COVID-19. Long-COVID-19 may be more likely among specific subpopulations and among persons with other ongoing physical and mental illness. [ABSTRACT FROM AUTHOR]

Objectives: Assess the validity of the Chinese version of the Dominic Interactive (DI), a 91-item, video-based diagnostic screening instrument for children that assesses four internalized disorders (phobias, separation anxiety disorder, generalized anxiety disorder, and major depressive disorder) and three externalized disorders (attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder). Methods: (1) Compare DI-generated "probable" or "possible" diagnoses to diagnoses based on the Development and Well-Being Assessment (DAWBA) instrument in 113 psychiatric outpatients and 20 community controls. (2) Administer DI to 1,479 children from elementary schools in Tianjin. Results: In the validation sample, DI with DAWBA concordance was much greater for internalized disorders (mean Kappa = 0.56) than for externalized disorders (mean kappa = 0.11). The positive predictive value of DI diagnoses ranged from 0.96 (generalized anxiety disorder) to 25% (oppositional defiant disorder) and negative from 0.81 to 0.96. Using "probable" cuts provides better results. In the survey, prevalence of probable DI disorders ranged from 1.0% (conduct disorder) to 13.1% (phobias). Internal consistency of all DI items was excellent (Cronbach alpha = 0.93) and that of the seven subscales ranged from 0.64 (phobias) to 0.87 (major depressive disorder). In multilevel SEM analyses, SRMR (Standardized root mean square residual) or each of the seven diagnoses was below 0.08 and each coefficient of determination was below 0.60. Conclusion: The Chinese DI is a convenient method of screening common mental disorders in Chinese children mainly for internalized disorders, which are the most prevalent diagnoses in that population. However its high negative predictive values for externalized could be used for screening. [ABSTRACT FROM AUTHOR]

ObjectivesAssess the validity of the Chinese version of the Dominic Interactive (DI), a 91-item, video-based diagnostic screening instrument for children that assesses four internalized disorders (phobias, separation anxiety disorder, generalized anxiety disorder, and major depressive disorder) and three externalized disorders (attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder).Methods(1) Compare DI-generated “probable” or “possible” diagnoses to diagnoses based on the Development and Well-Being Assessment (DAWBA) instrument in 113 psychiatric outpatients and 20 community controls. (2) Administer DI to 1,479 children from elementary schools in Tianjin.ResultsIn the validation sample, DI with DAWBA concordance was much greater for internalized disorders (mean Kappa = 0.56) than for externalized disorders (mean kappa = 0.11). The positive predictive value of DI diagnoses ranged from 0.96 (generalized anxiety disorder) to 25% (oppositional defiant disorder) and negative from 0.81 to 0.96. Using “probable” cuts provides better results. In the survey, prevalence of probable DI disorders ranged from 1.0% (conduct disorder) to 13.1% (phobias). Internal consistency of all DI items was excellent (Cronbach alpha = 0.93) and that of the seven subscales ranged from 0.64 (phobias) to 0.87 (major depressive disorder). In multilevel SEM analyses, SRMR (Standardized root mean square residual) or each of the seven diagnoses was below 0.08 and each coefficient of determination was below 0.60.ConclusionThe Chinese DI is a convenient method of screening common mental disorders in Chinese children mainly for internalized disorders, which are the most prevalent diagnoses in that population. However its high negative predictive values for externalized could be used for screening.

Background: Psychiatric illness may pose an additional risk of death for older adults during the COVID‐19 pandemic. Older adults in the community versus institutions might be influenced by the pandemic differently. This study examines excess deaths during the COVID‐19 pandemic among Medicare beneficiaries with and without psychiatric diagnoses (depression, anxiety, bipolar disorder, and schizophrenia) in the community versus nursing homes. Methods: This is a retrospective cohort study of a 20% random sample of 15,229,713 fee‐for‐service Medicare beneficiaries, from January 2019 through December 2021. Unadjusted monthly mortality risks, COVID‐19 infection rates, and case‐fatality rates after COVID‐19 diagnosis were calculated. Excess deaths in 2020, compared to 2019 were estimated from multivariable logistic regressions. Results: Of all included Medicare beneficiaries in 2020 (N = 5,140,619), 28.9% had a psychiatric diagnosis; 1.7% lived in nursing homes. In 2020, there were 246,422 observed deaths, compared to 215,264 expected, representing a 14.5% increase over expected. Patients with psychiatric diagnoses had more excess deaths than those without psychiatric diagnoses (1,107 vs. 403 excess deaths per 100,000 beneficiaries, p < 0.01). The largest increases in mortality risks were observed among patients with schizophrenia (32.4% increase) and bipolar disorder (25.4% increase). The pandemic‐associated increase in deaths with psychiatric diagnoses was only found in the community, not in nursing homes. The increased mortality for patients with psychiatric diagnoses was limited to those with medical comorbidities. The increase in mortality for psychiatric diagnoses was associated with higher COVID‐19 infection rates (1‐year infection rate = 7.9% vs. 4.2% in 2020), rather than excess case fatality. Conclusions: Excess deaths during the COVID‐19 pandemic were disproportionally greater in beneficiaries with psychiatric diagnoses, at least in part due to higher infection rates. Policy interventions should focus on preventing COVID‐19 infections and deaths among community‐dwelling patients with major psychiatric disorders in addition to those living the nursing homes. [ABSTRACT FROM AUTHOR]

The objective of this study was to characterize the different explanatory models of internalized stigma in people with mental disorders. A systematic search and review of the literature were conducted, and 13 articles were selected. Five explanatory models of internalized stigma were identified: the socio-cognitive model; the model of personal discrimination, internalized stigma, and intention to participate in collective actions; the internalized stigma model; the socio-cognitive-behavioral model; and the causality model of self-stigma-related factors in people with anxiety disorders. The models were found to include psychosocial, self-concept, and mental health variables. Notably, while the socio-cognitive model was the most tested, only some of the associated studies were fully validated. The model of personal discrimination, internalized stigma, and intention to participate in collective actions was fully validated; the rest were partially validated. Thus, it was concluded that models of internalized stigma explain this phenomenon from psychosocial variables such as acceptance and application of stereotypes. Cognitive-behavioral strategies, peer support, disclosure, and psychoeducational strategies are the most relevant for reducing internalized stigma. [ABSTRACT FROM AUTHOR]

Abstract Background Patients with opioid use disorder (OUD) frequently present with comorbid psychiatric illnesses which have significant implications for their treatment outcomes. Notably, these are often identified by self-report. Our study examined the sensitivity and specificity of self-reported psychiatric diagnoses against a structured diagnostic interview in a cohort of patients receiving outpatient pharmacological treatment for OUD. Methods Using cross-sectional data from adults receiving outpatient opioid agonist treatment for OUD in clinics across Ontario, Canada, we compared participants’ self-reported psychiatric diagnoses with those identified by the Mini Neuropsychiatric Interview (MINI) Version 6.0 administered at the time of study entry. Sensitivity and specificity were calculated for self-report of psychiatric diagnoses. Results Amongst a sample of 683 participants, 24% (n = 162) reported having a comorbid psychiatric disorder. Only 104 of these 162 individuals (64%) reporting a comorbidity met criteria for a psychiatric disorder as per the MINI; meanwhile, 304 (75%) participants who self-reported no psychiatric comorbidity were in fact identified to meet MINI criteria for a psychiatric disorder. The sensitivity and specificity for any self-reported psychiatric diagnoses were 25.5% (95% CI 21.3, 30.0) and 78.9% (95% CI 73.6, 83.6), respectively. Conclusions Our findings raise questions about the utility of self-reported psychiatric comorbidity in patients with OUD, particularly in the context of low sensitivity of self-reported diagnoses. Several factors may contribute to this including remittance and relapse of some psychiatric illnesses, underdiagnosis, and the challenge of differentiating psychiatric and substance-induced disorders. These findings highlight that other methods should be considered in order to identify comorbid psychiatric disorders in patients with OUD.

The second article in a series, this case study demonstrates how psychiatric diagnoses and treatment can ignore social, environmental, and personal history factors that likely caused a person's mental disorders. We examined the life of a woman who endured physical assault and rape by her father, a series of unsatisfactory romantic relationships, marriage to a man who repeatedly brutalized their children and her, the deaths of two children, and the burden of caring for eight surviving offspring. This woman occasionally exhibited symptoms of depression and emotional outbursts that led to her psychiatric hospitalization, psychotropic drugging, and ECT. Hospitalization and psychiatric drugs provided no relief, while ECT brought on memory impairment, difficulty concentrating, and bizarre persecutory beliefs. This case study revealed how psychiatric diagnosis and treatment can be irrelevant, ineffective, and harmful, while concealing institutional failures and helping to perpetuate social problems. [ABSTRACT FROM AUTHOR]

Introduction: Valid and reliable methods for diagnosing depression are essential. The present study aimed to test the performance of a new diagnostic interview for depression focusing on the core symptoms of depression. Method: We developed a diagnostic interview for depression: the CORE Diagnostic Interview, CORE-DI, which assesses each of the core features of depression on the four dimensions: quality, reactivity, globality, and fluctuations over time. The diagnostic performance of this interview was tested in a clinical study including 83 individuals presenting with various depressive symptoms, who were interviewed independently (1) by means of the CORE-DI and the Mini-International Neuropsychiatric Interview (M.I.N.I.), and (2) by highly skilled specialists in depression representing gold standard diagnoses. Results: We compared the outcome of the CORE-DI, the M.I.N.I., and the diagnosis made by clinicians, respectively, versus the gold standard diagnosis, using diagnostic efficiency statistics. The CORE-DI diagnosed depression with a high specificity (0.91, 95% CI: 0.85–0.97, for International Classification of Diseases [ICD]-10 criteria and 0.88, 95% CI: 0.81–0.95, for Diagnostic and Statistical Manual of Mental Disorders [DSM-5] criteria) compared to both M.I.N.I (specificity 0.44, 95% CI: 0.33–0.55) and clinical diagnoses (specificity 0.76, 95% CI: 0.67–0.85). The sensitivity of the CORE-DI was 0.61 (95% CI: 0.55–0.72) for ICD-10 criteria and 0.67 (95% CI: 0.57–0.77) for DSM-5 criteria. Discussion/Conclusion: The CORE-DI increased the specificity of the depression diagnosis substantially compared to clinical diagnoses and the diagnoses obtained by M.I.N.I. The results point to the usefulness of an elaborated and systematic assessment of the core symptoms in the examination of patients with depressive symptoms and thereby indicate a way for further development of specific diagnostic tools for depression in both clinical and research settings. However, it should be noted that the sensitivity of the CORE-DI was modest, and the psychometric properties of the CORE-DI might be different in other settings with higher or lower prevalence or severity of depressive symptoms. [ABSTRACT FROM AUTHOR]

Evaluating the resolution of parents of ill children can help in taking measures to alleviate their distress in a timely manner and promote children's rehabilitation. This study aims to develop and validate a nomogram for predicting the unresolved risk of parents of adolescents with psychiatric diagnoses. The data for 130 parents (modeling dataset = 90; validation dataset = 40) were collected. A nomogram was first developed to predict the unresolved risk for parents based on the logistic regression analysis in the modeling dataset. The internal and external validation then were conducted through quantifying the performance of the nomogram with respect to discrimination and calibration, respectively, in the modeling and validation datasets. Finally, the clinical use was evaluated through decision curve analyses (DCA) in the overall dataset. In the results, the nomogram consisted of six risk factors and provided a good discrimination with areas under the curve of 0.920 (95% CI , 0.862–0.978) in internal validation and 0.886 (95% CI , 0.786–0.986) in external validation. The calibration with good consistency between the observed probability and predicted probability was also found in both internal and external validation. DCA showed that the nomogram had a good clinical utility. In conclusion, the proposed nomogram exhibited a favorable performance with regard to its predictive accuracy, discrimination capability, and clinical utility, and, thus, can be used as a convenient and reliable tool for predicting the unresolved risk of parents of children with psychiatric diagnoses. [ABSTRACT FROM AUTHOR]

The perception of mental distress varies with time and culture, e.g., concerning its origin as either social or medical. This may be one reason for the moderate reliability of descriptive psychiatric diagnoses. Additionally, the mechanisms of action of most psychiatric treatments and psychotherapeutic interventions are generally unknown. Thus, these treatments have to be labeled as mostly unspecific even if they help in coping with mental distress. The psychiatric concept of mental disorders therefore has inherent limitations of precision and comprises rather fuzzy boundaries. Against this background, many people question the current process of diagnosing and categorizing mental illnesses. However, many scholars reject new approaches discussed in this context. They rather hold on to traditional diagnostic categories which therefore still play a central role in mental health practice and research and. In order to better understand the adherence to traditional psychiatric concepts, we take a closer look at one of the most widely adopted traditional concepts – the Stress-Vulnerability Model. This model has originally been introduced to tackle some problems of biological psychiatry. However, it has been misapplied with the result of drawing attention preferentially to biological vulnerability instead of a wider array of vulnerability factors including social adversity. Thus, in its current use, the Stress-Vulnerability Model provides only a vague theory for understanding mental phenomena. Therefore, we discuss the advantages and allegedly limited applicability of Crisis Theory as an alternative heuristic model for understanding the nature and development of mental distress. We outline the problems of this theory especially in applying it to severe mental disorders. We finally argue that an understanding of Crisis Theory supported by a systemic approach can be applied to most types of severe psychological disturbances implying that such an understanding may prevent or manage some negative aspects of the psychiatrization of psychosocial problems.

Evaluating the resolution of parents of ill children can help in taking measures to alleviate their distress in a timely manner and promote children's rehabilitation. This study aims to develop and validate a nomogram for predicting the unresolved risk of parents of adolescents with psychiatric diagnoses. The data for 130 parents (modeling dataset = 90; validation dataset = 40) were collected. A nomogram was first developed to predict the unresolved risk for parents based on the logistic regression analysis in the modeling dataset. The internal and external validation then were conducted through quantifying the performance of the nomogram with respect to discrimination and calibration, respectively, in the modeling and validation datasets. Finally, the clinical use was evaluated through decision curve analyses (DCA) in the overall dataset. In the results, the nomogram consisted of six risk factors and provided a good discrimination with areas under the curve of 0.920 (95% CI, 0.862–0.978) in internal validation and 0.886 (95% CI, 0.786–0.986) in external validation. The calibration with good consistency between the observed probability and predicted probability was also found in both internal and external validation. DCA showed that the nomogram had a good clinical utility. In conclusion, the proposed nomogram exhibited a favorable performance with regard to its predictive accuracy, discrimination capability, and clinical utility, and, thus, can be used as a convenient and reliable tool for predicting the unresolved risk of parents of children with psychiatric diagnoses.

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. [ABSTRACT FROM AUTHOR]

Based on a dataset, this paper examines the link between children's presenting problems and interparental relationships. The clinical discussion focuses specifically on the impact of parental relationship on mental illness. Using a protocol to measure both the physiological and verbal responses of the patients, it is observed that regardless of the psychiatric diagnoses given to these children or young adults, almost all of them were deeply involved in their parents' unresolved relational conflict. In the five case scenarios provided for illustration, the patients could articulate very clearly how concerned they were when they sensed their parent's relationship was at risk, and how their symptoms had served a function in maintaining the family equilibrium. Based on this clinical observation, it is important to develop a treatment approach that addresses mental illness in the family context. [ABSTRACT FROM AUTHOR]

Background: Patients with opioid use disorder (OUD) frequently present with comorbid psychiatric illnesses which have significant implications for their treatment outcomes. Notably, these are often identified by self-report. Our study examined the sensitivity and specificity of self-reported psychiatric diagnoses against a structured diagnostic interview in a cohort of patients receiving outpatient pharmacological treatment for OUD. Methods: Using cross-sectional data from adults receiving outpatient opioid agonist treatment for OUD in clinics across Ontario, Canada, we compared participants' self-reported psychiatric diagnoses with those identified by the Mini Neuropsychiatric Interview (MINI) Version 6.0 administered at the time of study entry. Sensitivity and specificity were calculated for self-report of psychiatric diagnoses. Results: Amongst a sample of 683 participants, 24% (n = 162) reported having a comorbid psychiatric disorder. Only 104 of these 162 individuals (64%) reporting a comorbidity met criteria for a psychiatric disorder as per the MINI; meanwhile, 304 (75%) participants who self-reported no psychiatric comorbidity were in fact identified to meet MINI criteria for a psychiatric disorder. The sensitivity and specificity for any self-reported psychiatric diagnoses were 25.5% (95% CI 21.3, 30.0) and 78.9% (95% CI 73.6, 83.6), respectively. Conclusions: Our findings raise questions about the utility of self-reported psychiatric comorbidity in patients with OUD, particularly in the context of low sensitivity of self-reported diagnoses. Several factors may contribute to this including remittance and relapse of some psychiatric illnesses, underdiagnosis, and the challenge of differentiating psychiatric and substance-induced disorders. These findings highlight that other methods should be considered in order to identify comorbid psychiatric disorders in patients with OUD. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract Background In Sweden, organized screening programs have significantly reduced the incidence of cervical cancer. For cancers overall, however, women with psychiatric diagnoses have lower survival rates than other women. This study explores whether women with psychiatric diagnoses participate in cervical cancer screening programs to a lesser extent than women on average, and whether there are disparities between psychiatric diagnostic groups based on grades of severity. Methods Between 2000 and 2010, 65,292 women within screening ages of 23–60 had at least two ICD-10 (International Statistical Classification of Diseases and Related Health Problems – Tenth Revision) codes F20*–F40* registered at visits in primary care or psychiatric care in Region Västra Götaland, Sweden. Participation in the cervical cancer screening program during 2010–2014 was compared with the general female population using logistic regression adjusted for age. Results Relative risk for participation (RR) for women diagnosed within psychiatric specialist care RR was 0.94 compared with the general population, adjusted for age. RR for diagnoses outside specialist care was 0.99. RR for psychoses (F20*) was 0.81. Conclusions Women with less-severe psychiatric diagnoses participate in the screening program to the same extent as women overall. Women who have received psychiatric specialist care participate to a lesser extent than women overall. The lowest participation rates were found among women diagnosed with psychoses.

Few studies on adjudicative competence explore the relationship between diagnosis, treatment, and restorability. Most focus on demographics and major psychiatric diagnosis with very few exploring the diagnoses common to the forensic population (i.e., personality disorders and substance abuse). Our study of 365 defendants who were incompetent to stand trial at a state psychiatric facility indicates that non‐restored defendants have a greater likelihood of cognitive disorders, misdemeanor charges, and histories of prior hospitalization, and less likelihood of personality disorders. In addition, the odds of having a substance use disorder and being medication non‐adherent was greater among restored defendants. The mean length of time to restoration (LOR) of 56 days was significantly different from the mean length of time to adjudication (LOA) for those not restored (88 days). This study supports prior literature on restorability while distinguishing those treated for psychosis from those treated for substance use and personality disorder. In its novel focus on medication adherence, the study expands the remediable factors available to clinical and forensic professionals and supports interventions that improve treatment and shorten the time to restoration. [ABSTRACT FROM AUTHOR]

The introduction of pre-trained language models in natural language processing (NLP) based on deep learning and the availability of electronic health records (EHRs) presents a great opportunity to transfer the “knowledge” learned from data in the general domain to enable the analysis of unstructured textual data in clinical domains. This study explored the feasibility of applying NLP to a small EHR dataset to investigate the power of transfer learning to facilitate the process of patient screening in psychiatry. A total of 500 patients were randomly selected from a medical center database. Three annotators with clinical experience reviewed the notes to make diagnoses for major/minor depression, bipolar disorder, schizophrenia, and dementia to form a small and highly imbalanced corpus. Several state-of-the-art NLP methods based on deep learning along with pre-trained models based on shallow or deep transfer learning were adapted to develop models to classify the aforementioned diseases. We hypothesized that the models that rely on transferred knowledge would be expected to outperform the models learned from scratch. The experimental results demonstrated that the models with the pre-trained techniques outperformed the models without transferred knowledge by micro-avg. and macro-avg. F-scores of 0.11 and 0.28, respectively. Our results also suggested that the use of the feature dependency strategy to build multi-labeling models instead of problem transformation is superior considering its higher performance and simplicity in the training process.

• Psychiatric diagnoses have an impact on the treatment and outcomes of patients undergoing elective orthopedic procedures. • Afflicted patients are more likely to have higher costs surgeries, extended length of stays, and death during their admission. 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). [ABSTRACT FROM AUTHOR]

The introduction of pre-trained language models in natural language processing (NLP) based on deep learning and the availability of electronic health records (EHRs) presents a great opportunity to transfer the "knowledge" learned from data in the general domain to enable the analysis of unstructured textual data in clinical domains. This study explored the feasibility of applying NLP to a small EHR dataset to investigate the power of transfer learning to facilitate the process of patient screening in psychiatry. A total of 500 patients were randomly selected from a medical center database. Three annotators with clinical experience reviewed the notes to make diagnoses for major/minor depression, bipolar disorder, schizophrenia, and dementia to form a small and highly imbalanced corpus. Several state-of-the-art NLP methods based on deep learning along with pre-trained models based on shallow or deep transfer learning were adapted to develop models to classify the aforementioned diseases. We hypothesized that the models that rely on transferred knowledge would be expected to outperform the models learned from scratch. The experimental results demonstrated that the models with the pre-trained techniques outperformed the models without transferred knowledge by micro-avg. and macro-avg. F-scores of 0.11 and 0.28, respectively. Our results also suggested that the use of the feature dependency strategy to build multi-labeling models instead of problem transformation is superior considering its higher performance and simplicity in the training process. [ABSTRACT FROM AUTHOR]

The current study examined the relationship between mental illness and recidivism in a sample of 409 men adjudicated for sexual offences who scored higher than average on an established risk assessment tool (Static-99R). Participants were from all provincial correctional systems (except Prince Edward Island) and all regions of the Correctional Service of Canada. Severe mental illness diagnoses, with the exception of some personality disorders, were not associated with recidivism (after an average follow-up of 11 years). While some personality diagnoses were initially related to recidivism, this relationship often disappeared or was attenuated after controlling for substance misuse and risk score on the Static-99R. There were two exceptions: Histrionic and narcissistic personality disorders continued to predict sexual recidivism after controlling for Static-99R and substance misuse history. In sum, the current study suggests that severe mental illness diagnoses are not associated with higher rates of recidivism after accounting for risk score and substance misuse in men with sexual offences, with the exception of histrionic and narcissistic personality disorder diagnoses. For this reason, risk judgements that weigh both known risk factors and severe mental illness may overestimate an individual’s risk to reoffend.

Psychiatric diagnoses, static risk factors, and criminogenic needs at time of admission and release were examined in a mentally ill sample of psychiatrically detained sexual offenders. Although clinically found to be at low or even very low risk at discharge, 12% reoffended sexually over an average follow-up of 7 years. Psychotic disorders were present in only 5% of offenders, whereas 93% had a personality disorder diagnosis and 76% a paraphilic disorder diagnosis. Only exhibitionism and alcohol misuse were associated with relapse. Static risk factors captured by the Static-99 also did not significantly predict recidivism; however, the VRS-SO—a structured risk assessment tool that assesses criminogenic needs and changes in risk from treatment or other change agents, rated retrospectively on the present sample—predicted sexual recidivism as well as any new imprisonment or psychiatric placement. In particular, the sexual deviance factor of the VRS-SO had large in magnitude predictive associations with sexual reoffending, while treatment related changes assessed on this factor were significantly related to non-reoffending. Findings corroborate the advantages of structured risk assessment and structured change monitoring, particularly for complex clientele such as mentally ill sexual offenders.

In this nationwide, register‐based study, we estimated the risk of mental health problems in 2822 individuals diagnosed with cancer in adolescence (13‐19 years). Mental health problems were assessed by psychiatric diagnoses and/or prescribed psychotropic drugs. Cox proportional hazards models estimated hazard ratio (HR) for a psychiatric diagnosis and prescription of psychotropic drug compared to a matched comparison group (n = 28 220). Estimates were adjusted for calendar period and parent characteristics (eg, history of psychiatric diagnosis, education, country of birth). We found an increased risk of a psychiatric diagnosis during the first 5 years after the cancer diagnosis (females: HR 1.23, 95% CI, 1.06‐1.44; males: HR 1.32, 95% CI, 1.11‐1.56), and at >5 years after diagnosis (females: HR 1.31, 95% CI, 1.09‐1.58, males: HR 1.45, 95% CI, 1.18‐1.77). The risk of being prescribed antidepressant (females: HR 1.54, 95% CI, 1.30‐1.84, males: HR 2.06, 95% CI, 1.66‐2.55), antipsychotic (females: HR 2.28, 95% CI, 1.56‐3.34, males: HR 3.07, 95% CI, 2.13‐4.42), anxiolytic (females: HR 1.95, 95% CI, 1.64‐2.31, males: HR 4.02, 95% CI, 3.34‐4.84) and sedative drugs (females: HR 2.24, 95% CI, 1.84‐2.72, males: HR 3.91, 95% CI, 3.23‐4.73) were higher than for comparisons during the first 5 years after diagnosis. Median age at first psychiatric diagnosis and first prescribed psychotropic drug were 18 years. In conclusion, cancer during adolescence is associated with increased risk of mental health problems that may develop in close proximity to treatment. The findings emphasize the need for comprehensive care during treatment and follow‐up. What's new? Survivors of childhood and adolescent cancer often are at increased risk of health conditions later in life, including neurocognitive dysfunction and depression. However, the risk of developing mental health conditions specifically after cancer during adolescence is unclear. In this study, using a matched cohort design and national register data, the authors found that adolescents with cancer are at increased risk of later psychiatric diagnosis and are likely to be prescribed psychotropic drugs, including antidepressants and antipsychotics. The findings suggest that mental health problems develop early following cancer treatment, highlighting the importance of comprehensive care and follow‐up for adolescent cancer patients. [ABSTRACT FROM AUTHOR]

Aims: Children with nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are at risk for behavioral problems, overweight, and obesity. The aim of this study was to analyze the specific behavioral and weight comorbidity in subtypes of incontinence. Methods: A total of 1638 consecutive patients presented to a tertiary incontinence clinic from 2012 to 2018 was examined prospectively according to ICCS criteria. Behavioral symptoms were measured with the Child Behavior Checklist (CBCL). Psychiatric disorders were diagnosed according to ICD‐10 criteria. Weight categories were calculated according to WHO recommendations. Results: The mean age was 7.8 years, 67% of patients were male. Fifty‐seven percent had NE (n = 934), 33% DUI (n = 547), and 40% FI (n = 656). Boys had significantly higher rates of NE and FI than girls. Of all children, 39.2% (n = 539) had a clinically relevant CBCL total score. A total of 28.3% (n = 463) had an ICD‐10 psychiatric diagnosis, mainly ODD and ADHD, and 28.6% (n = 463) were overweight or obese. Boys were more often affected by behavioral symptoms, psychiatric disorders, and overweight/obesity. Children with NE had the highest rate of overweight/obesity. Except for primary nonmonosymptomatic NE, subtypes of incontinence did not differ regarding behavioral symptoms and weight categories. However, overweight/obesity was significantly associated with behavioral and psychiatric parameters. Conclusions: Behavioral symptoms and psychiatric disorders, as well as overweight/obesity are important risk factors associated with incontinence, but the interaction between these factors is complex. In clinical settings, all children with incontinence should be screened with behavioral questionnaires. Also, weight should be measured, and overweight/obesity should be addressed. [ABSTRACT FROM AUTHOR]

Background: The association between incarceration and psychiatric disorders has been noted. Yet, existing studies are cross-sectional or examine the risk of recidivism, which has limited the predictive validity of psychiatric disorders as a risk factor for incarceration. To overcome this limitation, this study used a prospective cohort to examine whether psychiatric diagnoses in early adulthood predicted incarceration throughout a 30-year follow-up. It tested the association between psychiatric diagnoses with future incarcerations, their number and durations, controlling for education and ethnic status. Methods: This study merged data from three sources in Israel: a prospective 10-year birth cohort study of young adults aged 25–34, conducted in the 1980s (N = 4914) that included a psychiatric interview; data from the Prison Service, including the cause, number and duration of incarcerations; and from the Vital Statistics Registry on death records. Results: Multivariate analysis showed that substance-use disorders, antisocial personality and lower levels of education predicted future incarceration, their number and maximum duration. The remainder diagnoses were not significantly associated with future incarceration. Conclusions: Results limited the prediction of future incarcerations to persons diagnosed with substance use and antisocial personality, and do not support an independent predictive association between additional psychiatric diagnoses and future incarceration. [ABSTRACT FROM AUTHOR]

Objectives: Although the prevalence and mental health consequences of childhood maltreatment among adolescents have been studied widely, there are few data addressing these issues in Asian lower middle–income countries. Here, we assessed the prevalence and types of childhood maltreatment and, for the first time, examined their association with current mental health problems in Indian adolescents with a history of child work. Methods: One hundred and thirty-two adolescents (12–18 years; 114 males, 18 females) with a history of child work were interviewed using the Child Maltreatment, Conventional Crime, and Witnessing and Indirect Victimisation modules of the Juvenile Victimization Questionnaire. Potential psychiatric diagnoses and current emotional and behavioural problems were assessed using the culturally adapted Hindi versions of the Youth's Inventory–4R and the Strengths and Difficulties Questionnaire, respectively. Results: A large proportion of the sample reported childhood abuse or neglect (83.36%), direct or indirect victimisation (100%) and experienced symptoms of one or more psychiatric disorders (83.33%). Of the most common maltreatment types, physical abuse was present for 72.73% (extra-familial 56.25%, intra-familial 42.71%), emotional abuse for 47.7% (extra-familial 74.6%, intra-familial 12.9%), general neglect for 17.4% and unsafe home for 45.5% of the adolescents. All these maltreatment types were associated with poor mental health, with emotional abuse showing the strongest and wide-ranging impact. Conclusions: Indian adolescents with a history of child work are at an extremely high risk of extra-familial physical and emotional abuse as well as victimisation. They also experience a range of psychiatric symptoms, especially if they suffered emotional abuse. There is an urgent need for routine mental health screening and to consider emotional abuse in all current and future top-down and bottom-up approaches to address childhood maltreatment, as well as in potential interventions to ameliorate its adverse effects on mental health and well-being, of child and adolescent workers. [ABSTRACT FROM AUTHOR]

Police violence is reportedly common among those diagnosed with mental disorders characterized by the presence of psychotic symptoms or pronounced emotional lability. Despite the perception that people with mental illness are disproportionately mistreated by the police, there is relatively little empirical research on this topic. A cross-sectional general population survey was administered online in 2017 to 1,000 adults in two eastern U.S. cities to examine the relationship between police violence exposure, mental disorders, and crime involvement. Results from hierarchical logistic regression and mediation analyses revealed that a range of mental health conditions are broadly associated with elevated risk for police violence exposure. Individuals with severe mental illness are more likely than the general population to be physically victimized by police, regardless of their involvement in criminal activities. Most of the excess risk of police violence exposure related to common psychiatric diagnoses was explained by confounding factors including crime involvement. However, crime involvement may necessitate more police contact, but does not necessarily justify victimization or excessive force (particularly sexual and psychological violence). Findings support the need for adequate training for police officers on how to safely interact with people with mental health conditions, particularly severe mental illness. [ABSTRACT FROM AUTHOR]

Objective: Psychotic experiences affect more than 10% of children and often co-occur with nonpsychotic mental disorders. However, longitudinal studies of the outcome of psychotic experiences based on unbiased information on mental health service use and psychotropic medications are scarce. The authors investigated whether psychotic experiences at ages 11-12 predicted a psychiatric diagnosis or treatment with psychotropic medications by ages 16-17.Methods: In a longitudinal register-based follow-up study of the Copenhagen Child Cohort 2000, a total of 1,632 children ages 11-12 were assessed for psychotic experiences in face-to-face interviews. The children were also assessed for mental disorders and IQ. National registries provided information on perinatal and sociodemographic characteristics, on psychiatric disorders diagnosed at child and adolescent mental health services, and on prescribed psychotropic medications through ages 16-17.Results: Among children who had not been previously diagnosed, and after adjustment for sociodemographic and perinatal adversities and IQ, psychotic experiences at ages 11-12 predicted receiving a psychiatric diagnosis in child and adolescent mental health services before ages 16-17 (adjusted hazard ratio=3.13, 95% CI=1.93, 5.07). The risk was increased if the child met criteria for a co-occurring mental disorder (not diagnosed in mental health settings) at baseline compared with no psychotic experiences or diagnosis at baseline (adjusted hazard ratio=7.85, 95% CI=3.94, 15.63), but having psychotic experiences alone still marked a significantly increased risk of later psychiatric diagnoses (adjusted hazard ratio=2.76, 95% CI=1.48, 5.13). Similar patterns were found for treatment with psychotropic medications.Conclusions: Psychotic experiences in childhood predict mental health service use and use of psychotropic medications during adolescence. The study findings provide strong evidence that psychotic experiences in preadolescence index a transdiagnostic vulnerability for diagnosed psychopathology in adolescence. [ABSTRACT FROM AUTHOR]

Psychiatric diagnoses, static risk factors, and criminogenic needs at time of admission and release were examined in a mentally ill sample of psychiatrically detained sexual offenders. Although clinically found to be at low or even very low risk at discharge, 12% reoffended sexually over an average follow-up of 7 years. Psychotic disorders were present in only 5% of offenders, whereas 93% had a personality disorder diagnosis and 76% a paraphilic disorder diagnosis. Only exhibitionism and alcohol misuse were associated with relapse. Static risk factors captured by the Static-99 also did not significantly predict recidivism; however, the VRS-SO—a structured risk assessment tool that assesses criminogenic needs and changes in risk from treatment or other change agents, rated retrospectively on the present sample—predicted sexual recidivism as well as any new imprisonment or psychiatric placement. In particular, the sexual deviance factor of the VRS-SO had large in magnitude predictive associations with sexual reoffending, while treatment related changes assessed on this factor were significantly related to non-reoffending. Findings corroborate the advantages of structured risk assessment and structured change monitoring, particularly for complex clientele such as mentally ill sexual offenders. [ABSTRACT FROM AUTHOR]

Abstract Background Despite five decades of increasingly elegant studies aimed at advancing the pathophysiology and treatment of mental illness, the results have not met expectations. Diagnoses are still based on observation, the clinical history, and an outmoded diagnostic system that stresses the historic goal of disease specificity. Psychotropic drugs are still based on molecular targets developed decades ago, with no increase in efficacy. Numerous biomarkers have been proposed, but none have the requisite degree of sensitivity and specificity, and therefore have no usefulness in the clinic. The obvious lack of progress in psychiatry needs exploration. Methods The historical goals of psychiatry are reviewed, including parity with medicine, a focus on diagnostic reliability rather than validity, and an emphasis on reductionism at the expense of socioeconomic issues. Data are used from Thomas Picketty and others to argue that our failure to advance clinical care may rest in part on the rise in social and economic inequality that began in the 1970s, and in part on our inability to move beyond the medical model of specificity of disease and treatment. Results It is demonstrated herein that the historical goal of specificity of disease and treatment has not only impeded the advance of diagnosis and treatment of mental illness, but, in combination with a rapid increase in socioeconomic inequality, has led to poorer outcomes and rising mortality rates in a number of disorders, including schizophrenia, anxiety, and depression. Conclusions It is proposed that Psychiatry should recognize the fact of socioeconomic inequality and its effects on mental disorders. The medical model, with its emphasis on diagnostic and treatment specificity, may not be appropriate for investigation of the brain, given its complexity. The rise of scientific inequality, with billions allocated to connectomics and genetics, may shift attention away from the need for improvements in clinical care. Unfortunately, the future prospects of those suffering from mental illness appear dim.

The aim of this study was to examine alcohol/drug use and problems across psychiatric diagnoses and to what extent associations between each psychiatric diagnosis and alcohol/drug use and problems were independent from the potential confounding effects of psychiatric comorbidity, socioeconomic status, sex and age. We used a dataset comprising a linkage between a large population-based and cross-sectional study among Norwegian adolescents (the youth@hordaland conducted in 2012) and national registry-based data on specialist mental health care use during the 4 years prior to the survey (2008 to 2011). The study sample included 16 to 19 year olds who participated in the youth@hordaland survey and consented to the linkage with patient registry data (n = 9,408). Among these, 853 (9%) had received specialist mental health care and comprised the clinical group, while the rest (n = 8,555) comprised the comparison group. The main outcome variables were several self-reported indicators for alcohol/drug use, including any alcohol use, frequent alcohol intoxication, high-level alcohol consumption, and lifetime illicit drug use, as well as one indicator for potential alcohol/drug-related problems: a positive CRAFFT-score. Adolescents receiving specialist mental health care (n = 853) reported more frequently alcohol/drug use and problems compared to adolescents not receiving these services (Cohens d’s ranging from 0.09 to 0.29, all p ≤ 0.01). Anxiety, depression, conduct disorders, eating disorders, ADHD, and trauma-related disorders were all associated with single measures of alcohol/drug use and problems, with odds ratios (ORs) ranging from 1.58 to 4.63, all p < 0.05) in unadjusted models. Trauma-related disorders, depression and conduct disorders were also positively associated with higher scores on a combined indicator of alcohol/drug use and problems (ORs ranging from 1.89 to 3.15, all p < 0.01), even after the full adjustment from psychiatric comorbidity and sociodemographic variables (adjusted odds ratios ranging from 1.61 to 2.79, p < 0.05). These results suggest that alcohol/drug use and problems were slightly more common among adolescents who received specialist mental health care during the past 4 years compared with the general adolescent population, and adolescents with trauma-related disorders, depression and conduct disorders were high-risk groups for alcohol/drug use and problems.