1
|
Palstra EC, Ferwerda J, van Duin EDA, Ising HK, Nugter MA, Smit F, van der Gaag M, van den Berg D. Psychotic-like experiences and multimorbid psychopathology: The relationship between the 16-item prodromal questionnaire and DSM-IV classifications in a help-seeking population. Early Interv Psychiatry 2024; 18:217-225. [PMID: 37474338 DOI: 10.1111/eip.13454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/25/2023] [Accepted: 07/02/2023] [Indexed: 07/22/2023]
Abstract
AIM Identifying multimorbid psychopathology is necessary to offer more adequate treatment and ultimately reduce the prevalence of persistent mental illnesses. Psychotic symptoms are increasingly seen as a transdiagnostic indicator of multimorbidity, severity and complexity of non-psychotic psychopathology. This study aims to investigate whether psychotic-like experiences and subclinical psychotic symptoms as measured by the 16-item Prodromal Questionnaire are also associated with multimorbid psychopathology. METHODS Participants were help-seeking individuals from outpatient mental healthcare settings and intensive home-treatment teams, aged 17-35. Assessment included the 16-item Prodromal Questionnaire to measure psychotic-like experiences, the Structured Clinical Interview for DSM-IV Axis I, and three sections of the Structured Clinical Interview for DSM-IV Axis II Disorders to determine DSM-IV-TR classifications. The final sample comprised of 160 participants who scored above a cutoff of 6 items on the 16-item Prodromal Questionnaire (HIGH-score) and 60 participants who scored below cutoff (LOW-score). A Poisson Regression was executed to determine the association between the PQ-16 and DSM-IV-TR classifications. RESULTS The HIGH-score group had a mean of 2.76 multimorbid disorders (range 0-7), while the LOW-score group had a mean of 1.45 disorders (range 0-3). Participants with four to seven disorders scored high on the 16-item Prodromal Questionnaire. CONCLUSIONS Our results suggest that psychotic-like experiences are associated with multimorbidity and severity of psychopathology. Screening for psychotic-like experiences via the PQ-16 in a help-seeking population may help prevent under-diagnosis and under-treatment of comorbid psychopathology.
Collapse
Affiliation(s)
- Eline C Palstra
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Academy, The Hague, The Netherlands
| | - Janneke Ferwerda
- Mental Healthcare Organisation GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands
| | - Esther D A van Duin
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Academy, The Hague, The Netherlands
| | | | - M Annet Nugter
- Department of Research and Care Evaluation, Mental Healthcare Organisation GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands
| | - Filip Smit
- Department of Mental Health Prevention, Trimbos Institute, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Academy, The Hague, The Netherlands
| | - David van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Academy, The Hague, The Netherlands
| |
Collapse
|
2
|
Rao V, Lanni S, Yule AM, DiSalvo M, Stone M, Berger AF, Wilens TE. Diagnosing major depressive disorder and substance use disorder using the electronic health record: A preliminary validation study. JOURNAL OF MOOD AND ANXIETY DISORDERS 2023; 2:100007. [PMID: 37693103 PMCID: PMC10486184 DOI: 10.1016/j.xjmad.2023.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background One mechanism to examine if major depressive disorder (MDD) is related to the development of substance use disorder (SUD) is by leveraging naturalistic data available in the electronic health record (EHR). Rules for data extraction and variable construction linked to psychometrics validating their use are needed to extract data accurately. Objective We propose and validate a methodologic framework for using EHR variables to identify patients with MDD and non-nicotine SUD. Methods Proxy diagnoses and index dates of MDD and/or SUD were established using billing codes, problem lists, patient-reported outcome measures, and prescriptions. Manual chart reviews were conducted for the 1-year period surrounding each index date to determine (1) if proxy diagnoses were supported by chart notes and (2) if the index dates accurately captured disorder onset. Results The results demonstrated 100% positive predictive value for proxy diagnoses of MDD. The proxy diagnoses for SUD exhibited strong agreement (Cohen's kappa of 0.84) compared to manual chart review and 92% sensitivity, specificity, positive predictive value, and negative predictive value. Sixteen percent of patients showed inaccurate SUD index dates generated by EHR extraction with discrepancies of over 6 months compared to SUD onset identified through chart review. Conclusions Our methodology was very effective in identifying patients with MDD with or without SUD and moderately effective in identifying SUD onset date. These findings support the use of EHR data to make proxy diagnoses of MDD with or without SUD.
Collapse
Affiliation(s)
- Vinod Rao
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sylvia Lanni
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Amy M. Yule
- Department of Psychiatry, Boston Medical Center, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Maura DiSalvo
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Mira Stone
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Amy F. Berger
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Timothy E. Wilens
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| |
Collapse
|
3
|
Raudales AM, Carosa CL, Weiss NH, Schatten HT, Armey MF. Emotion dysregulation as a mechanism linking posttraumatic stress disorder to subsequent suicidal thoughts and behaviors following inpatient psychiatric discharge. J Psychiatr Res 2023; 161:34-39. [PMID: 36893669 DOI: 10.1016/j.jpsychires.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 02/05/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a well-known risk factor for suicidal thoughts and behaviors (STBs). However, there is a scarcity of longitudinal studies exploring underlying pathways. This study sought to examine the mechanistic role of emotion dysregulation in the relations between PTSD and STBs following discharge from psychiatric inpatient treatment, a particularly high-risk period for suicide. Participants were 362 trauma-exposed psychiatric inpatients (45% female, 77% white, Mage = 40.37). PTSD was assessed via a clinical interview (Columbia Suicide Severity Rating Scale) during hospitalization, emotion dysregulation was assessed via self-report 3-weeks post-discharge, and STBs were assessed via a clinical interview 6-months post-discharge. St'1ructural equation modeling showed that emotion dysregulation significantly mediated the relation between PTSD and suicidal thoughts (β = 0.10, SE = 0.04, p = .01, 95%CI [0.04, 0.39]) but not suicide attempts (β = 0.04, SE = 0.04, p = .29, 95%CI [-0.03, 0.12]) post-discharge. Findings highlight a potential clinical utility of targeting emotion dysregulation among individuals with PTSD to prevent suicidal thoughts following discharge from psychiatric inpatient treatment.
Collapse
Affiliation(s)
- Alexa M Raudales
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | | | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Heather T Schatten
- Butler Hospital, Providence, RI, USA; Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael F Armey
- Butler Hospital, Providence, RI, USA; Alpert Medical School of Brown University, Providence, RI, USA.
| |
Collapse
|
4
|
Alcolado GM, Rowa K, Milosevic I, McCabe RE. Do all obsessions contradict personal values to the same degree? A pilot investigation. Bull Menninger Clin 2023; 87:291-312. [PMID: 37695881 DOI: 10.1521/bumc.2023.87.3.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Although much is known about how intrusive thoughts become obsessions, the factors that determine which particular thoughts do so is not. The degree to which intrusions are personally significant may be such a determinant. Obsessive-compulsive disorder (OCD) is heterogeneous; thus, it is possible that contradictions of personal values may play a varying role in the development of obsessions depending on which OCD symptoms manifest and may change differentially following treatment. Archival data were examined. Patients with a diagnosis of OCD (N = 62) reported their most upsetting obsession and the degree to which it violated values both pre- and postparticipation in group cognitive-behavioral therapy for OCD. At pretreatment, contradiction ratings differed across symptom domains, such that participants with primary symptoms of obsessions/checking exhibited contradiction ratings that were significantly greater than did participants with other primary symptoms. Contradiction ratings did not change posttreatment. Implications for the conceptualization of OCD are discussed.
Collapse
Affiliation(s)
- Gillian M Alcolado
- Assistant professor in the Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Associate Professors in the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Irena Milosevic
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Associate Professors in the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Professor in the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| |
Collapse
|
5
|
Gianoli MO, Meisler AW, Rosen MI. Proposed Changes to the Department of Veterans Affairs Disability Rating Rubric for Mental Disorders. Psychiatr Serv 2022:appips20220377. [PMID: 36510762 DOI: 10.1176/appi.ps.20220377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The U.S. Department of Veterans Affairs (VA) provides disability benefits for general medical and mental health conditions related to military service. Despite advances in conceptualization, assessment, and diagnosis of mental disorders, the current rating rubric used to determine the award amounts received by veterans with posttraumatic stress disorder and other mental disorders has not been substantively revised since 1996. The VA recently proposed sweeping changes to the rating rubric for mental disorders, shifting the focus from a symptom-based algorithm to one based on functional impairment and bringing the rubric more in line with existing disability systems and guidelines. METHODS The authors examined the VA's current symptom-based rating rubric and reviewed and analyzed the proposed changes, including a comparison with other rating systems used for mental disorders. Research on the relationship between psychiatric symptoms and functional impairment is also discussed. RESULTS Bringing examination procedures in line with the new function-based rating schedule will require significant changes to current standard practice for both examiners and Veterans Benefits Administration raters. The new rubric requires more specific definitions, anchors, and operationalization of the domains of function in the rating schedule to improve reliability and validity. CONCLUSIONS The new system reflects an overdue shift away from a symptom-based formula toward real-world functioning. Concept study data suggest that the system may increase ratings for veterans awarded compensation, but the actual impact remains unknown. The authors discuss the implications of the new method for disability determination and offer suggestions for maximizing effective and fair implementation of the new rubric.
Collapse
Affiliation(s)
- Mayumi O Gianoli
- VA Connecticut Healthcare System, West Haven; Department of Psychiatry, Yale School of Medicine, New Haven
| | - Andrew W Meisler
- VA Connecticut Healthcare System, West Haven; Department of Psychiatry, Yale School of Medicine, New Haven
| | - Marc I Rosen
- VA Connecticut Healthcare System, West Haven; Department of Psychiatry, Yale School of Medicine, New Haven
| |
Collapse
|
6
|
Broadbear JH, Beatson JA, Moss F, Jayaram H, George K, Planinic A, Rodrigo K, Rao S. Development and Preliminary Evaluation of a Rapid Screening Tool for Detecting Borderline Personality Disorder in People Aged over 60 Years. Clin Gerontol 2022:1-11. [PMID: 36111819 DOI: 10.1080/07317115.2022.2123727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Screening and diagnostic instruments for Borderline Personality Disorder (BPD) are not validated in people aged over 60. We report a pilot study examining the sensitivity and specificity of a de-novo screening instrument in older adults. METHODS The BPD-OA screening tool incorporates DSM 5 and literature describing the expression of BPD in older adults. This study was conducted using a case control design. The Diagnostic Interview for Borderlines-Revised (DIB-R) and the McLean Screening Instrument for BPD (MSI-BPD) were used as comparators. Comprehensive assessment by psychiatric teams determined participants to be (i) BPD-positive (n = 22) or (ii) BPD-negative (gender matched; n = 21). RESULTS The BPD-OA was the most sensitive instrument for discriminating older adult BPD from non-BPD participants (sensitivity = 0.82). No significant relationship was found between the BPD-OA score and age in BPD-diagnosed participants (r = -0.181, n = 21, p = .432). Participant age explained 3.2% of the variance in BPD-OA scores. Of the 21 BPD-negative participants, eight false positives experienced prominent mood disorders (specificity = 0.62). CONCLUSIONS The BPD-OA screening tool is clearly superior to instruments validated for use in younger people. Further refinement and evaluation will enhance its sensitivity and specificity. CLINICAL IMPLICATIONS Detection of BPD in older adult care settings will improve outcomes for patients, families, and staff through better understanding and appropriate management and treatment strategies.
Collapse
Affiliation(s)
- Jillian H Broadbear
- Spectrum Personality Disorder and Complex Trauma Service, Eastern Health, Richmond, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Josephine A Beatson
- Spectrum Personality Disorder and Complex Trauma Service, Eastern Health, Richmond, Australia
- University of Melbourne, Parkville, Australia
| | - Francine Moss
- St Georges Health Service, St Vincent's Hospital, Kew, Australia
| | | | | | | | - Kulunu Rodrigo
- St Georges Health Service, St Vincent's Hospital, Kew, Australia
| | - Sathya Rao
- Spectrum Personality Disorder and Complex Trauma Service, Eastern Health, Richmond, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| |
Collapse
|
7
|
Ndetei DM, Mutiso VN, Weisz JR, Okoth CA, Musyimi C, Muia EN, Osborn TL, Sourander A, Wasserman D, Mamah D. Socio-demographic, economic and mental health problems were risk factors for suicidal ideation among Kenyan students aged 15 plus. J Affect Disord 2022; 302:74-82. [PMID: 35032509 PMCID: PMC10448955 DOI: 10.1016/j.jad.2022.01.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/09/2021] [Accepted: 01/11/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND About a third of youth with suicidal ideation develop suicidal plans and about 60% of youth with suicidal plans make suicidal attempts. This study aimed to study different types of suicidal ideation and the risk factors in Kenyan youth. METHODS We studied a total of 9742 high school, college and university students using following self-administered instruments: - a researcher design socio-demographic questionnaire, Psychiatric Diagnostic Screening Questionnaire (PDSQ) to document psychiatric disorders and various types of suicidal ideas in previous two weeks, Washington Early Recognition Center Affectivity and Psychosis tool to assess stress, affectivity and psychosis, Wealth index questionnaire to document economic indicators based on household items for the families of the students. We used descriptive statistics, univariate analysis, bivariate logistic regression analysis and variables with a p-value of less than <.05 were entered into generalized linear models using logit links to identify independent predictors. RESULTS The overall prevalence of different types of suicidal ideation was (22.6%), major depression was found in 20.0%, affectivity, psychosis and stress was found in 10.4%, 8.7% and 26.0% respectively. Female gender, major depression, stress, affectivity and psychosis and being in high school were significant (p < 0.05) predictors of suicidal ideation. LIMITATIONS This was a cross sectional study that focused only on suicidal ideas and associated economic factors and mental health disorders. It did not study suicidal behavior. CONCLUSION Future studies are needed to study the progression from suicidal ideas to suicidal attempts and the factors associated with that progression.
Collapse
Affiliation(s)
- David M Ndetei
- Department of Psychiatry, University of Nairobi, Kenya and Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden P.O. Box 48423-00100, Nairobi, Kenya; Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Consolate A Okoth
- Department of Public and Community Health, Machakos University, Kenya
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Esther N Muia
- Department of Public and Community Health, Machakos University, Kenya
| | - Tom L Osborn
- Department of Psychology, Harvard University, Cambridge, MA, USA; Shamiri Institute - Allston, MA, U.S.A. and Nairobi, Kenya
| | - Andre Sourander
- Department of Child Psychiatry, Turku University Hospital, Finland
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Sweden
| | - Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| |
Collapse
|
8
|
Yang TY, Chien TW, Lai FJ. Web-Based Skin Cancer Assessment and Classification Using Machine Learning and Mobile Computerized Adaptive Testing in a Rasch Model: Development Study. JMIR Med Inform 2022; 10:e33006. [PMID: 35262505 PMCID: PMC9282670 DOI: 10.2196/33006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/08/2021] [Accepted: 01/10/2022] [Indexed: 12/03/2022] Open
Abstract
Background Web-based computerized adaptive testing (CAT) implementation of the skin cancer (SC) risk scale could substantially reduce participant burden without compromising measurement precision. However, the CAT of SC classification has not been reported in academics thus far. Objective We aim to build a CAT-based model using machine learning to develop an app for automatic classification of SC to help patients assess the risk at an early stage. Methods We extracted data from a population-based Australian cohort study of SC risk (N=43,794) using the Rasch simulation scheme. All 30 feature items were calibrated using the Rasch partial credit model. A total of 1000 cases following a normal distribution (mean 0, SD 1) based on the item and threshold difficulties were simulated using three techniques of machine learning—naïve Bayes, k-nearest neighbors, and logistic regression—to compare the model accuracy in training and testing data sets with a proportion of 70:30, where the former was used to predict the latter. We calculated the sensitivity, specificity, receiver operating characteristic curve (area under the curve [AUC]), and CIs along with the accuracy and precision across the proposed models for comparison. An app that classifies the SC risk of the respondent was developed. Results We observed that the 30-item k-nearest neighbors model yielded higher AUC values of 99% and 91% for the 700 training and 300 testing cases, respectively, than its 2 counterparts using the hold-out validation but had lower AUC values of 85% (95% CI 83%-87%) in the k-fold cross-validation and that an app that predicts SC classification for patients was successfully developed and demonstrated in this study. Conclusions The 30-item SC prediction model, combined with the Rasch web-based CAT, is recommended for classifying SC in patients. An app we developed to help patients self-assess SC risk at an early stage is required for application in the future.
Collapse
Affiliation(s)
- Ting-Ya Yang
- Department of Family Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Tsair-Wei Chien
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Feng-Jie Lai
- Department of Dermatology, Chi-Mei Medical Center, Tainan, Taiwan
| |
Collapse
|
9
|
Mutiso VN, Ndetei DM, N Muia E, K Alietsi R, Onsinyo L, Kameti F, Masake M, Musyimi C, Mamah D. The prevalance of binge eating disorder and associated psychiatric and substance use disorders in a student population in Kenya - towards a public health approach. BMC Psychiatry 2022; 22:122. [PMID: 35172765 PMCID: PMC8848944 DOI: 10.1186/s12888-022-03761-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/15/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Kenya in particular and Africa in general lack data on Binge Eating Disorder (BED). The overarching objective of this study is to fill that gap. Kenyans may not be aware that BED exists when a "very good" appetite is considered a sign of good health, especially if food is available either at home, in fast food shops or when communally eating together, a very common cultural practice. On the other hand where there is relatively insufficient food, it is not expected that one could be having a problem of eating too much. METHOD We administered the following tools and measurements to 9742 participants (high school, college and university students): 1) Researcher designed socio-demographic and economic indicator questionnaire; 2) An instrument documenting DSM-IV diagnostic criteria for BED and its various symptoms; 3) An instrument to determine DSM-IV psychiatric disorders and substance abuse;4) An instrument measuring high risk for psychosis ,affectivity and stress; 5) A WHO designed instrument measuring the severity of substance abuse for specific substances. We used descriptive and inferential analysis to determine the prevalence and association of the different variables. Independent predictors of BED were generated from a generalized linear model (p<0.05). RESULTS We found a prevalence of 3.2% of BED and a wide range of prevalence for BED and BED related symptoms (8.1% to 19%). The least prevalent was "To prevent weight gain from eating binge did you force yourself to vomit, or used laxatives?". The most common was "Did you often go on eating binges (eating a very large amount of food very quickly over a short period of time)." Major depression, obsessive compulsive disorder, panic disorder, agoraphobia, generalized anxiety disorder ,a positive stress screen and drug abuse were independent predictors of BED (p<0.05). CONCLUSION Our findings on the prevalence of BED and significant associations with various psychiatric disorders and substance use disorders are similar to those obtained in High Income Countries (HIC) using similar large-scale samples in non-clinical populations. Our findings suggest the need fora public health approach to enhance awareness of BED and to promote health-seeking behaviour towards management of BED.
Collapse
Affiliation(s)
- Victoria N. Mutiso
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - David M. Ndetei
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya ,grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Esther N Muia
- grid.493101.e0000 0004 4660 9348Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Rita K Alietsi
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Lydia Onsinyo
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Frida Kameti
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Monicah Masake
- grid.493101.e0000 0004 4660 9348Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Christine Musyimi
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Daniel Mamah
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University Medical School, St. Louis, Missouri USA
| |
Collapse
|
10
|
Kopelovich S, Maura J, Chwastiak L, Towle C, Monroe-DeVita M. Central Assessment of Psychosis Service: A Tele-evaluation Service to Support Early Identification of Psychosis. Psychiatr Serv 2022; 73:112-115. [PMID: 34074141 DOI: 10.1176/appi.ps.202000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Duration of untreated psychosis (DUP) is a reliable predictor of longitudinal psychosis trajectory. The limited availability of specialized assessment needed for early identification contributes to a lengthy average DUP in the United States. This column outlines the development of the Central Assessment of Psychosis Service (CAPS), a novel tele-evaluation service that extends specialized expertise in screening and assessment of psychosis and psychosis risk to publicly funded early psychosis clinics. Preliminary implementation outcomes among the first five CAPS sites suggest that CAPS is acceptable, appropriate, and feasible to implement. Programmatic data collection is underway and will be reported at a future date.
Collapse
Affiliation(s)
- Sarah Kopelovich
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle. Marcela Horvitz-Lennon, M.D., Kenneth Minkoff, M.D., and Esperanza Diaz, M.D., are editors of this column
| | - Jessica Maura
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle. Marcela Horvitz-Lennon, M.D., Kenneth Minkoff, M.D., and Esperanza Diaz, M.D., are editors of this column
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle. Marcela Horvitz-Lennon, M.D., Kenneth Minkoff, M.D., and Esperanza Diaz, M.D., are editors of this column
| | - Cara Towle
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle. Marcela Horvitz-Lennon, M.D., Kenneth Minkoff, M.D., and Esperanza Diaz, M.D., are editors of this column
| | - Maria Monroe-DeVita
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle. Marcela Horvitz-Lennon, M.D., Kenneth Minkoff, M.D., and Esperanza Diaz, M.D., are editors of this column
| |
Collapse
|
11
|
Zimmerman M, Balling C, Chelminski I, Dalrymple K. Patients with borderline personality disorder and bipolar disorder: a descriptive and comparative study. Psychol Med 2021; 51:1479-1490. [PMID: 32178744 DOI: 10.1017/s0033291720000215] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bipolar disorder and borderline personality disorder (BPD) are each significant public health problems. It has been frequently noted that distinguishing BPD from bipolar disorder is challenging. Consequently, reviews and commentaries have focused on differential diagnosis and identifying clinical features to distinguish the two disorders. While there is a burgeoning literature comparing patients with BPD and bipolar disorder, much less research has characterized patients with both disorders. In the current report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compare psychiatric outpatients with both BPD and bipolar disorder to patients with BPD without bipolar disorder and patients with bipolar disorder without BPD. METHODS Psychiatric outpatients presenting for treatment were evaluated with semi-structured interviews. The focus of the current study is the 517 patients with both BPD and bipolar disorder (n = 59), BPD without bipolar disorder (n = 330), and bipolar disorder without BPD (n = 128). RESULTS Compared to patients with bipolar disorder, the patients with bipolar disorder and BPD had more comorbid disorders, psychopathology in their first-degree relatives, childhood trauma, suicidality, hospitalizations, time unemployed, and likelihood of receiving disability payments. The added presence of bipolar disorder in patients with BPD was associated with more posttraumatic stress disorder in the patients as well as their family, more bipolar disorder and substance use disorders in their relatives, more childhood trauma, unemployment, disability, suicide attempts, and hospitalizations. CONCLUSIONS Patients with both bipolar disorder and BPD have more severe psychosocial morbidity than patients with only one of these disorders.
Collapse
Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
| | - Caroline Balling
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
| | - Iwona Chelminski
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
| | - Kristy Dalrymple
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
| |
Collapse
|
12
|
Saunders EFH, Mukherjee D, Waschbusch DA, Liao D, Pearl AM, Aksu E, Bixler EO. Predictors of diagnostic delay: Assessment of psychiatric disorders in the clinic. Depress Anxiety 2021; 38:545-553. [PMID: 33169441 DOI: 10.1002/da.23110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/20/2020] [Accepted: 10/18/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Diagnostic delay contributes to morbidity in psychiatric disorders. METHODS Patients in an ambulatory psychiatry clinic were given patient-reported outcome measures at an initial visit, and a subset (N = 493) were given a structured interview (MINI International Neuropsychiatric Interview, MINI), in addition to the clinical encounter (CLIN). Diagnostic agreement between MINI and CLIN was assessed at an initial and follow-up visit. Diagnostic delay was identified if diagnostic disagreement between MINI and CLIN occurred at the initial visit and changed to an agreement at a follow-up visit. Registry data was compiled by an honest broker. RESULTS Significant agreement occurred between MINI and CLIN diagnoses for major depressive disorder (MDD), bipolar disorder (BD), generalized anxiety disorder, and panic disorder. Diagnostic agreement for MDD occurred at initial visit for 63% of patients, and at follow-up for 87% of those with initial diagnostic disagreement; for BD, 75% at initial visit and 28% at follow-up. No demographic, socioeconomic, symptom severity or functioning measures predicted diagnostic agreement for the MDD group at the first visit, however initial psychopathological symptom complexity predicted diagnostic agreement in the diagnostic delay group. Initial diagnostic agreement for BD was predicted by lower symptom burden and better social, physical, and occupational functioning. No factors predicted additional diagnostic agreement at the second visit in the diagnostic delay group. CONCLUSION Initial assessment by a structured interview aided physicians in identifying MDD by the second visit in patients with complex psychopathology. Patients with high complexity/severity of symptoms and more difficulty with functioning were less commonly identified with BD even with the assistance of a structured interview. Use of structured assessment tools may improve the detection of psychiatric illness by clinicians at the first visit.
Collapse
Affiliation(s)
- Erika F H Saunders
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Dahlia Mukherjee
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Daniel A Waschbusch
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Duanping Liao
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Amanda M Pearl
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Errol Aksu
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Edward O Bixler
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| |
Collapse
|
13
|
The Use of Evidence-Based Assessment for Anxiety Disorders in an Australian Sample. J Anxiety Disord 2020; 75:102279. [PMID: 32777601 DOI: 10.1016/j.janxdis.2020.102279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 06/19/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
Anxiety disorders are common and cause considerable functional impairment. Fortunately, evidence-based treatments are available, however, treatment effectiveness is often reliant on the provision of an accurate diagnosis. Accurate diagnosis requires a multi-method evidence-based assessment (EBA). Assessment techniques available to clinicians include a clinical interview, semi-structured diagnostic interview, self-report/clinician-administered rating scales and direct observation. Research demonstrates that only a small number of therapists utilize EBA, and to date this has not been investigated in an Australian sample. One hundred and two registered Australian psychologists (Mage = 40.98; SD = 12.67; 83.6% female) participated in an online study investigating assessment practices. Participants were asked to indicate EBA frequency of use and the obstacles they face to using EBA. The majority of participants (69% working with adult patients and 51% working with pediatric patients) reported partial use of EBA. Few psychologists (21% working with adult patients and 11% working with child patients) indicated complete use of EBA. Thirty-six percent of participants indicated negative beliefs about the usefulness or helpfulness of EBA. Multiple obstacles to the use of EBA were reported including concerns with the time required to complete assessment (27%), and a lack of access to assessment tools (10%). Implications for training and clinical practice are discussed.
Collapse
|
14
|
The 12-month course of ICD-11 adjustment disorder in the context of involuntary job loss. CLINICAL PSYCHOLOGY IN EUROPE 2020; 2:e3027. [DOI: 10.32872/cpe.v2i3.3027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/18/2020] [Indexed: 11/25/2022] Open
Abstract
Background
After its redefinition in ICD-11, adjustment disorder (AjD) comprises two core symptom clusters of preoccupations and failure to adapt to the stressor. Only a few studies investigate the course of AjD over time and the definition of six months until the remission of the disorder is based on little to no empirical evidence. The aim of the present study was to investigate the course of AjD symptoms and symptom clusters over time and to longitudinally evaluate predictors of AjD symptom severity.
Method
A selective sample of the Zurich Adjustment Disorder Study, N = 105 individuals who experienced involuntary job loss and reported either high or low symptom severity at first assessment (t1), were assessed M = 3.4 (SD = 2.1) months after the last day at work, and followed up six (t2) and twelve months (t3) later. They completed a fully structured diagnostic interview for AjD and self-report questionnaires.
Results
The prevalence of AjD was 21.9% at t1, 6.7% at t2, and dropped to 2.9% at t3. All individual symptoms and symptom clusters showed declines in prevalence rates across the three assessments. A hierarchical regression analysis of symptoms at t3 revealed that more symptoms at the first assessment (β = 0.32, p = .002) and the number of new life events between the first assessment and t3 (β = 0.29, p = .004) significantly predicted the number of AjD symptoms at t3.
Conclusion
Although prevalence rates of AjD declined over time, a significant proportion of individuals still experienced AjD symptoms after six months. Future research should focus on the specific mechanisms underlying the course of AjD.
Collapse
|
15
|
Casey P, Pillay D, Wilson L, Maercker A, Rice A, Kelly B. Pharmacological interventions for adjustment disorders in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd010530.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Patricia Casey
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
| | - Divina Pillay
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
| | - Lorna Wilson
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
| | - Andreas Maercker
- Department of Psychology; University of Zurich; Zurich Switzerland
| | - Angela Rice
- Library and Information Service; Mater Misericordiae University Hospital; Dublin Ireland
| | - Brendan Kelly
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
| |
Collapse
|
16
|
Gander M, Buchheim A, Bock A, Steppan M, Sevecke K, Goth K. Unresolved Attachment Mediates the Relationship Between Childhood Trauma and Impaired Personality Functioning in Adolescence. J Pers Disord 2020; 34:84-103. [PMID: 31990614 DOI: 10.1521/pedi_2020_34_468] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present study investigates the mediating effect of attachment trauma on the relationship between childhood maltreatment and personality functioning in 199 adolescents (12-18 years) using a novel approach of an in-depth analysis of attachment-related traumatic contents during an attachment interview (AAP). Our findings demonstrate that adolescents with a high amount of traumatic attachment-related material show a lower resilience when facing traumatic childhood experiences, resulting in a greater severity of personality dysfunction. In particular, the associations between emotional abuse and neglect and the domains of identity, empathy, self-direction, and intimacy were mediated by the severity of attachment trauma. These results advance our understanding of the different nuances of attachment-related traumatic material and how they might shape personality structure in an adolescent age group.
Collapse
Affiliation(s)
- Manuela Gander
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Austria
| | - Anna Buchheim
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Austria.,Institute of Psychology, University of Innsbruck.,Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Tirol Kliniken, Austria
| | - Astrid Bock
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Austria
| | - Martin Steppan
- Institute of Psychology, University of Basel, Switzerland
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Austria
| | - Kirstin Goth
- Department of Child and Adolescent Psychiatry, Psychiatric University Clinics, Basel, Switzerland
| |
Collapse
|
17
|
Gender Differences in the Utility of the Alcohol Use Disorder Identification Test in Screening for Alcohol Use Disorder Among HIV Test Seekers in South Africa. AIDS Behav 2020; 24:2073-2081. [PMID: 31919618 DOI: 10.1007/s10461-019-02772-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We evaluated the effectiveness of the Alcohol Use Disorder Identification Test (AUDIT) in screening for alcohol use disorder (AUD) among 500 men and women seeking HIV testing. Receiver operating characteristic (ROC) curve analysis was used to determine the utility of the AUDIT in discriminating between AUD caseness and non-caseness. For men, a cut-off score of 10 on the AUDIT predicted AUD with 81% sensitivity and 77% specificity. For women, a cut-off score of 7 yielded optimal sensitivity (82%) and specificity (82%). For men, the AUDIT yielded a positive predictive value (PPV) of 49% and a negative predictive value (NPV) of 94%; for women the PPV and NPV were 49 and 96%, respectively. While the AUDIT can be used to rapidly screen large numbers of men and women seeking HIV testing, the instrument's low PPV indicates that individuals who screen positive may need to undergo further evaluation to detect cases of AUD.
Collapse
|
18
|
Zimmerman M, Balling C, Chelminski I, Dalrymple K. Have Treatment Studies of Depression Become Even Less Generalizable? Applying the Inclusion and Exclusion Criteria in Placebo-Controlled Antidepressant Efficacy Trials Published over 20 Years to a Clinical Sample. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:165-170. [PMID: 31096246 DOI: 10.1159/000499917] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/26/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Antidepressants are amongst the most frequently prescribed medications. More than a decade ago, our clinical research group applied a prototypic set of inclusion/exclusion criteria used in an antidepressant efficacy trial (AET) to patients presenting for treatment in our outpatient practice and found that most patients would not qualify for the trial. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we apply the psychiatric inclusion/exclusion criteria used in 158 placebo-controlled studies to a large sample of depressed patients who presented for outpatient treatment to determine the range and extent of the representativeness of samples treated in AETs and whether this has changed over time. METHOD We applied the inclusion and exclusion criteria used in 158 AETs to 1,271 patients presenting to an outpatient practice who received a principal diagnosis of major depressive disorder. The patients underwent a thorough diagnostic evaluation. RESULTS Across all 158 studies, the percentage of patients that would have been excluded ranged from 44.4 to 99.8% (mean = 86.1%). The percentage of patients that would have been excluded was significantly higher in the studies published in 2010 through 2014 compared to the studies published from 1995 to 2009 (91.4 vs. 83.8%, t(156) = 3.74, p < 0.001). CONCLUSIONS Only a minority of depressed patients seen in clinical practice are likely to be eligible for most AETs. The generalizability of AETs has decreased over time. It is unclear how generalizable the results of AETs are to patients treated in real-world clinical practice.
Collapse
Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island, USA,
| | - Caroline Balling
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Iwona Chelminski
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Kristy Dalrymple
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island, USA
| |
Collapse
|
19
|
Greiner T, Haack B, Toto S, Bleich S, Grohmann R, Faltraco F, Heinze M, Schneider M. Pharmacotherapy of psychiatric inpatients with adjustment disorder: current status and changes between 2000 and 2016. Eur Arch Psychiatry Clin Neurosci 2020; 270:107-117. [PMID: 31440829 DOI: 10.1007/s00406-019-01058-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/13/2019] [Indexed: 01/03/2023]
Abstract
Adjustment disorder is a temporary change in behaviour or emotion as a reaction to a stress factor. Therapy consists of psychotherapy, and pharmacotherapy can be advised. However, data on the real-life pharmacological treatment are sparse. Prescription data for 4.235 psychiatric inpatients diagnosed with adjustment disorder in the time period 2000-2016 were analysed. The data were obtained from the Drug Safety Programme in Psychiatry (AMSP). Data were collected on two reference days per year; prescription patterns and changes over time were analysed. Of all patients, 81.2% received some type of psychotropic drug. Mostly antidepressants (59.8%), antipsychotics (35.5%), and tranquilisers (22.6%) were prescribed. Prescription rates for antidepressants decreased slightly over the years, while rates for antipsychotics increased, especially for atypical antipsychotics. It is important to note that the diagnosis "adjustment disorder" is most likely a working diagnosis that is used for patients in immediate need of psychiatric aid. Overall, pharmacotherapy for inpatients with this diagnosis is mostly symptom-oriented and focuses on depressive moods, agitation and anxiety. Therapy regimes changed over time and show an increased use of atypical antipsychotics with sedative properties. However, for most of the medication, there are neither evidence-based studies nor guidelines, and drugs might be contraindicated in some cases.
Collapse
Affiliation(s)
- Timo Greiner
- Brandenburg Medical School, Immanuel Klinik Rüdersdorf, University Clinic for Psychiatry and Psychotherapy, 15562, Rüdersdorf, Germany.
| | - Beatrice Haack
- Brandenburg Medical School, Immanuel Klinik Rüdersdorf, University Clinic for Psychiatry and Psychotherapy, 15562, Rüdersdorf, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625, Hannover, Germany
| | - Renate Grohmann
- Department of Psychiatry, Ludwig-Maximilians-University, 80336, Munich, Germany
| | - Frank Faltraco
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsmedizin Rostock, 18147, Rostock, Germany
| | - Martin Heinze
- Brandenburg Medical School, Immanuel Klinik Rüdersdorf, University Clinic for Psychiatry and Psychotherapy, 15562, Rüdersdorf, Germany
| | - Michael Schneider
- Brandenburg Medical School, Immanuel Klinik Rüdersdorf, University Clinic for Psychiatry and Psychotherapy, 15562, Rüdersdorf, Germany
| |
Collapse
|
20
|
Asp M, Lindqvist D, Fernström J, Ambrus L, Tuninger E, Reis M, Westrin Å. Recognition of personality disorder and anxiety disorder comorbidity in patients treated for depression in secondary psychiatric care. PLoS One 2020; 15:e0227364. [PMID: 31895938 PMCID: PMC6939935 DOI: 10.1371/journal.pone.0227364] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/17/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Depression is a common illness with substantial economic consequences for society and a great burden for affected individuals. About 30% of patients with depression do not respond to repeated treatments. Psychiatric comorbidity is known to affect duration, recurrence and treatment outcome of depression. However, there is a lack of knowledge on the extent to which psychiatric comorbidity is identified in the clinical setting for depressed patients in secondary psychiatric care. Therefore, the aim of this study was to compare the agreement between traditional diagnostic assessment (TDA) and a structured and comprehensive diagnostic procedure (SCDP) for identification of personality and anxiety disorder comorbidity in depressed patients in secondary psychiatric care. METHODS 274 patients aged 18-77 were referred from four secondary psychiatric care clinics in Sweden during 2012-2017. ICD-10 diagnoses according to TDA (mostly unstructured by psychiatric specialist and residents in psychiatry), were retrieved from medical records and compared to diagnoses resulting from the SCDP in the study. This included the Mini International Neuropsychiatric Interview, the Structured Interview for DSM Axis II Personality Disorders and semi-structured questions on psychosocial circumstances, life-events, psychiatric symptoms, psychiatric treatments, substance use, and suicidal and self-harm behaviour. The assessment was carried out by psychiatric specialists or by residents in psychiatry with at least three years of psychiatric training. RESULTS SCDP identified personality disorder comorbidity in 43% of the patients compared to 11% in TDA (p<0,0001). Anxiety disorder comorbidity was identified in 58% with SCDP compared to 12% with TDA (p<0,0001). CONCLUSIONS Important psychiatric comorbidity seems to be unrecognized in depressive patients when using TDA, which is routine in secondary psychiatric care. Comorbidities are better identified using the proposed model involving structured and semi-structured interviews together with clinical evaluations by clinical experts.
Collapse
Affiliation(s)
- Marie Asp
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
- * E-mail:
| | - Daniel Lindqvist
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| | - Johan Fernström
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| | - Livia Ambrus
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| | - Eva Tuninger
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| | - Margareta Reis
- Department of Clinical Pharmacology, Linköping University, Linköping, Sweden
| | - Åsa Westrin
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| |
Collapse
|
21
|
Nemoto K, Shimokawa T, Fukunaga M, Yamashita F, Tamura M, Yamamori H, Yasuda Y, Azechi H, Kudo N, Watanabe Y, Kido M, Takahashi T, Koike S, Okada N, Hirano Y, Onitsuka T, Yamasue H, Suzuki M, Kasai K, Hashimoto R, Arai T. Differentiation of schizophrenia using structural MRI with consideration of scanner differences: A real-world multisite study. Psychiatry Clin Neurosci 2020; 74:56-63. [PMID: 31587444 PMCID: PMC6972978 DOI: 10.1111/pcn.12934] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/07/2019] [Accepted: 09/13/2019] [Indexed: 12/18/2022]
Abstract
AIM Neuroimaging studies have revealed that patients with schizophrenia exhibit reduced gray matter volume in various regions. With these findings, various studies have indicated that structural MRI can be useful for the diagnosis of schizophrenia. However, multisite studies are limited. Here, we evaluated a simple model that could be used to differentiate schizophrenia from control subjects considering MRI scanner differences employing voxel-based morphometry. METHODS Subjects were 541 patients with schizophrenia and 1252 healthy volunteers. Among them, 95 patients and 95 controls (Dataset A) were used for the generation of regions of interest (ROI), and the rest (Dataset B) were used to evaluate our method. The two datasets were comprised of different subjects. Three-dimensional T1-weighted MRI scans were taken for all subjects and gray-matter images were extracted. To differentiate schizophrenia, we generated ROI for schizophrenia from Dataset A. Then, we determined volume within the ROI for each subject from Dataset B. Using the extracted volume data, we calculated a differentiation feature considering age, sex, and intracranial volume for each MRI scanner. Receiver-operator curve analyses were performed to evaluate the differentiation feature. RESULTS The area under the curve ranged from 0.74 to 0.84, with accuracy from 69% to 76%. Receiver-operator curve analysis with all samples revealed an area under the curve of 0.76 and an accuracy of 73%. CONCLUSION We moderately successfully differentiated schizophrenia from control using structural MRI from differing scanners from multiple sites. This could be useful for applying neuroimaging techniques to clinical settings for the accurate diagnosis of schizophrenia.
Collapse
Affiliation(s)
- Kiyotaka Nemoto
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tetsuya Shimokawa
- Center for Information and Neural Networks, National Institute of Information and Communications Technology, Osaka, Japan
| | - Masaki Fukunaga
- Division of Cerebral Integration, National Institute for Physiological Sciences, Aichi, Japan
| | - Fumio Yamashita
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan
| | - Masashi Tamura
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hidenaga Yamamori
- Department of Pathology of Mental Diseases, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan.,Japan Community Health Care Organization, Osaka Hospital, Osaka, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuka Yasuda
- Department of Pathology of Mental Diseases, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan.,Life Grow Brilliant Mental Clinic, Osaka, Japan
| | - Hirotsugu Azechi
- Department of Pathology of Mental Diseases, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Noriko Kudo
- Department of Pathology of Mental Diseases, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Yoshiyuki Watanabe
- Department of Future Diagnostic Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mikio Kido
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Shinsuke Koike
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan.,Center for Evolutionary Cognitive Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan.,The International Research Center for Neurointelligence (WPI-IRCN), The University of Tokyo Institutes for Advanced Study (UTIAS), Tokyo, Japan.,UTokyo Center for Integrative Science of Human Behavior (CiSHuB), The University of Tokyo, Tokyo, Japan
| | - Naohiro Okada
- The International Research Center for Neurointelligence (WPI-IRCN), The University of Tokyo Institutes for Advanced Study (UTIAS), Tokyo, Japan.,Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoji Hirano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Onitsuka
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidenori Yamasue
- Department of Psychiatry, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Kiyoto Kasai
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan.,The International Research Center for Neurointelligence (WPI-IRCN), The University of Tokyo Institutes for Advanced Study (UTIAS), Tokyo, Japan.,UTokyo Center for Integrative Science of Human Behavior (CiSHuB), The University of Tokyo, Tokyo, Japan.,Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan.,Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuaki Arai
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| |
Collapse
|
22
|
Zimmerman M, Balling C, Chelminski I, Dalrymple K. Applying the inclusion/exclusion criteria in placebo-controlled studies to a clinical sample: A comparison of medications. J Affect Disord 2020; 260:483-488. [PMID: 31539683 DOI: 10.1016/j.jad.2019.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/20/2019] [Accepted: 09/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND We previously compared the inclusion/exclusion criteria in the studies of vortioxetine to other antidepressants and found that they were significantly more restrictive in the vortioxetine studies. In the present study, we tested the hypothesis that the differences in psychiatric inclusion/exclusion criteria used in the studies of some antidepressants resulted in differences in generalizability to clinical samples. METHODS We applied the inclusion and exclusion criteria used in 161 antidepressant efficacy trials to 1,271 patients presenting to an outpatient practice who received a principal diagnosis of major depressive disorder. The patients underwent a thorough diagnostic evaluation. We compared the percentage of patients that would be excluded in studies of different medications. RESULTS The percentage of patients that would have been excluded was significantly higher in the vortioxetine studies than other medications. For the 15 medications that were included in at least 5 trials, we computed the mean percentage of patients that would be excluded. The values ranged from 76.0% (for fluoxetine) to 99.1% (for quetiapine). LIMITATIONS While our calculations were based on the exclusion criteria stated in the published articles, we have no way of knowing how these criteria were actually applied. CONCLUSION Studies of different medications vary in how representative the samples are of patients in clinical practice. The variability in the inclusion/exclusion criteria used to select samples for antidepressant efficacy trials, and the evidence that studies of different medications vary in their generalizability, makes it more difficult to interpret network analyses comparing the relative efficacy of medications.
Collapse
Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, United States.
| | - Caroline Balling
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, United States
| | - Iwona Chelminski
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, United States
| | - Kristy Dalrymple
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, United States
| |
Collapse
|
23
|
Abstract
Associations between subjective maternal bonding recalled from the first 16 years of life and current sleep indices were investigated in a clinical sample of 34 adults with major depressive disorder and 36 normal controls (n = 70) using the self-report parental bonding instrument and wrist actigraphy. Results of multiple linear regression analyses indicated that reports of maternal bonding indices were associated with several sleep indices in adulthood independent of depression status. Higher levels of maternal care were associated with greater time in bed and total sleep time. Higher levels of maternal overprotection were associated with fewer awakenings. Findings indicate that reported maternal bonding characteristics in childhood are related to objectively measured sleep characteristics in adulthood, independent of mood state.
Collapse
|
24
|
Saal WL, Kagee A, Bantjes J. Evaluation of the Beck Anxiety Inventory in predicting generalised anxiety disorder among individuals seeking HIV testing in the Western Cape province, South Africa. S Afr J Psychiatr 2019; 25:1336. [PMID: 31824741 PMCID: PMC6890543 DOI: 10.4102/sajpsychiatry.v25i0.1336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 08/28/2019] [Indexed: 11/16/2022] Open
Abstract
Background Routine anxiety screening is needed among HIV test seekers, given the lack of health-care professionals with the ability to identify individuals with generalised anxiety. Aim The aim of this study was to determine the effectiveness of the Beck anxiety inventory (BAI) in predicting caseness for generalised anxiety disorder (GAD) among persons seeking HIV testing, using the structured clinical interview for the DSM-5 (SCID-5) as the gold standard. Setting Five HIV testing sites in the Western Cape region of South Africa. Method We recruited 500 persons seeking HIV testing from five non-medical testing sites in the Western Cape, South Africa. We used receiver operating curve analysis to determine the optimal cut-off point on the BAI to discriminate between GAD caseness and non-caseness. Results 3.4% of the sample met the DSM-5 criteria for a diagnosis of GAD. Using an optimal cut-off point of 21.5, the sensitivity and specificity of the BAI were 82% and 80%, respectively. The positive predictive value was 13%, while the negative predictive value was 99%. Conclusion Our data suggest that while the BAI may be used to screen for GAD, it is likely to yield a high number of false positives. A two-tiered method may be useful to mitigate against case over-identification. Thus, in a public health setting, persons screening positive on the BAI should receive a diagnostic interview to determine whether they are true cases for GAD. Within resource-constrained communities in South Africa, referral trajectories should be integrated with routine screening and HIV testing.
Collapse
Affiliation(s)
- Wylene L Saal
- Department of Psychology, Arts and Social Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ashraf Kagee
- Department of Psychology, Arts and Social Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jason Bantjes
- Department of Psychology, Arts and Social Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
25
|
Huisman‐van Dijk HM, Matthijssen SJMA, Stockmann RTS, Fritz AV, Cath DC. Effects of comorbidity on Tourette's tic severity and quality of life. Acta Neurol Scand 2019; 140:390-398. [PMID: 31418815 PMCID: PMC6899939 DOI: 10.1111/ane.13155] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/30/2019] [Accepted: 08/04/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study is to gain more insight in the differential contributions of anxiety, depression and obsessive-compulsive (OC) symptom severity to quality of life (QoL) and tic severity in adults with Tourette Disorder (TD). METHODS Self-reported OC symptom, anxiety and depression severity measures were used to investigate their predictive value on QoL and Tic severity in adult TD patients (N = 187), using correlation, regression, and mediation analyses. RESULTS Tic severity has no effect on QoL. Depression severity directly reduces QoL, whereas anxiety and OC symptom severity have an indirect effect on QoL, mediated by depression severity. OC symptom severity directly affects tic severity, whereas depression and anxiety severity do not have a direct effect on tic or OC severity. Finally, anxiety severity indirectly impacts tic severity, with OC symptom severity functioning as a mediator. CONCLUSION In line with and extending previous studies, these findings indicate that OC symptom severity directly influences tic symptom severity whereas depression severity directly influences QoL in TD. Results imply that to improve QoL in TD patients, treatment should primarily focus on diminishing OC and depressive symptom severity rather than focusing on tic reduction.
Collapse
Affiliation(s)
- Hilde M. Huisman‐van Dijk
- Department of Clinical Psychology Faculty of Social Sciences Utrecht University Utrecht The Netherlands
- Altrecht Academic Anxiety Center Utrecht The Netherlands
| | - Suzy J. M. A. Matthijssen
- Department of Clinical Psychology Faculty of Social Sciences Utrecht University Utrecht The Netherlands
- Altrecht Academic Anxiety Center Utrecht The Netherlands
| | - Ruben T. S. Stockmann
- Department of Clinical Psychology Faculty of Social Sciences Utrecht University Utrecht The Netherlands
| | - Anne V. Fritz
- Department of Clinical Psychology Faculty of Social Sciences Utrecht University Utrecht The Netherlands
| | - Danielle C. Cath
- Rob Giel Onderzoekcentrum Groningen The Netherlands
- Department of Psychiatry University Medical Center Groningen and RUG Groningen The Netherlands
- GGZ Drenthe Mental Health Institution Assen The Netherlands
| |
Collapse
|
26
|
Ammerman RT, Scheiber FA, Peugh JL, Messer EP, Van Ginkel JB, Putnam FW. Interpersonal trauma and suicide attempts in low-income depressed mothers in home visiting. CHILD ABUSE & NEGLECT 2019; 97:104126. [PMID: 31473381 PMCID: PMC6773481 DOI: 10.1016/j.chiabu.2019.104126] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/06/2019] [Accepted: 07/29/2019] [Indexed: 05/13/2023]
Abstract
BACKGROUND Risk of suicide is a major concern for depressed mothers in the perinatal period. The strongest predictor of completing suicide is having made a previous attempt. Little is known about the clinical features of low-income, depressed mothers who have attempted suicide in contrast to those who have not. OBJECTIVE This study examined clinical and psychosocial features of 170 low-income, young, depressed mothers with and without previous suicide attempts who were enrolled in an early childhood home visiting program. METHOD Mothers were identified via screening at three months postpartum and diagnosed with major depressive disorder (MDD) using a semi-structured interview. Psychiatric history and presentation, child maltreatment history, intimate partner violence, and social functioning were measured. RESULTS 31.8% of mothers had previous suicide attempts. Mean age of first attempt was 14.38 years (SD = 2.55) and the median number of lifetime attempts was 2. In contrast to no attempts, those who had attempted suicide had more MDD symptoms, earlier age of first MDD episode, and more episodes. A previous attempt was associated with greater childhood trauma, more current MDD symptoms and PTSD diagnosis. No differences were found on intimate partner violence. Mothers who made an attempt reported lower levels of tangible social support and smaller social networks. CONCLUSIONS History of suicide attempts is associated with childhood trauma history and later psychosocial impairments in low income, depressed mothers in home visiting. Implications for addressing the needs of depressed mothers with suicide attempt histories in the context of early childhood programs are discussed.
Collapse
Affiliation(s)
- Robert T Ammerman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229, United States.
| | - Francesca A Scheiber
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229, United States
| | - James L Peugh
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229, United States
| | - Erica Pearl Messer
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229, United States
| | - Judith B Van Ginkel
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229, United States
| | - Frank W Putnam
- Department of Psychiatry, University of North Carolina School of Medicine, 333 S. Columbia Street, Chapel Hill, NC, 27514, United States
| |
Collapse
|
27
|
Larvin H, Peckham E, Prady SL. Case-finding for common mental disorders in primary care using routinely collected data: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1161-1175. [PMID: 31300893 DOI: 10.1007/s00127-019-01744-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/24/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE Case-finding for common mental disorders (CMD) in routine data unobtrusively identifies patients for mental health research. There is absence of a review of studies examining CMD-case-finding accuracy in routine primary care data. CMD-case definitions include diagnostic/prescription codes, signs/symptoms, and free text within electronic health records. This systematic review assesses evidence for case-finding accuracy of CMD-case definitions compared to reference standards. METHODS PRISMA-DTA checklist guided review. Eligibility criteria were outlined prior to study search; studies compared CMD-case definitions in routine primary care data to diagnostic interviews, screening instruments, or clinician judgement. Studies were quality assessed using QUADAS-2. RESULTS Fourteen studies were included, and most were at high risk of bias. Nine studies examined depressive disorders and seven utilised diagnostic interviews as reference standards. Receiver operating characteristic (ROC) planes illustrated overall variable case-finding accuracy across case definitions, quantified by Youden's index. Forest plots demonstrated most case definitions provide high specificity. CONCLUSION Case definitions effectively identify cases in a population with good accuracy and few false positives. For 100 anxiety cases, identified using diagnostic codes, between 12 and 20 will be false positives; 0-47 cases will be missed. Sensitivity is more variable and specificity is higher in depressive cases; for 100 cases identified using diagnostic codes, between 0 and 87 will be false positives; 4-18 cases will be missed. Incorporating context to case definitions may improve overall case-finding accuracy. Further research is required for meta-analysis and robust conclusions.
Collapse
Affiliation(s)
- Harriet Larvin
- Department of Health Sciences, The University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK.
| | - Emily Peckham
- Department of Health Sciences, The University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Stephanie L Prady
- Department of Health Sciences, The University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| |
Collapse
|
28
|
Bullis JR, Boettcher H, Sauer‐Zavala S, Farchione TJ, Barlow DH. What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2019. [DOI: 10.1111/cpsp.12278] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Jacqueline R. Bullis
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
- Division of Depression and Anxiety Disorders Harvard Medical School McLean Hospital Belmont Massachusetts
| | - Hannah Boettcher
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
| | | | - Todd J. Farchione
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
| | - David H. Barlow
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
| |
Collapse
|
29
|
Naismith I, Zarate Guerrero S, Feigenbaum J. Abuse, invalidation, and lack of early warmth show distinct relationships with self-criticism, self-compassion, and fear of self-compassion in personality disorder. Clin Psychol Psychother 2019; 26:350-361. [PMID: 30715768 DOI: 10.1002/cpp.2357] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cultivating self-compassion is increasingly recognized as a powerful method to regulate hyperactive threat processes such as shame and self-criticism, but fear of self-compassion (FSC) can inhibit this. These difficulties are underexplored in personality disorder (PD) despite their prevalence. Furthermore, little evidence exists regarding how these factors relate to adverse childhood experiences (ACEs) and attachment. METHOD Fifty-three participants with a diagnosis of PD completed measures including childhood abuse/neglect, invalidation, early warmth, self-compassion, shame, self-criticism, FSC, and anxious/avoidant attachment. RESULTS Self-compassion was predicted uniquely by low early warmth; self-inadequacy by invalidation and abuse; and FSC by multiple ACEs. FSC and self-compassion were significantly correlated with self-criticism and shame, but not with one another. CONCLUSIONS Low self-compassion and high FSC appear to be distinct problems, substantiating physiological models proposing distinct threat and soothing systems. Results are consistent with theories positing that low self-compassion has distinct origins to shame, self-criticism, and FSC.
Collapse
Affiliation(s)
- Iona Naismith
- Department of Psychology, Universidad de los Andes, Bogota, Colombia
| | | | - Janet Feigenbaum
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| |
Collapse
|
30
|
Danielson M, Månsdotter A, Fransson E, Dalsgaard S, Larsson JO. Clinicians' attitudes toward standardized assessment and diagnosis within child and adolescent psychiatry. Child Adolesc Psychiatry Ment Health 2019; 13:9. [PMID: 30792803 PMCID: PMC6371426 DOI: 10.1186/s13034-019-0269-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 01/31/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is a strong call for clinically useful standardized assessment tools in everyday child and adolescent psychiatric practice. The attitudes of clinicians have been raised as a key-facilitating factor when implementing new methods. An explorative study was conducted aimed to investigate the clinicians' attitudes regarding standardized assessments and usefulness of diagnoses in treatment planning. METHODS 411 mental health service personnel working with outpatient and inpatient assessment and treatment within the specialist child and adolescent mental health services, Stockholm County Council were asked to participate in the study, of which 345 (84%) agreed answer a questionnaire. The questionnaire included questions regarding Attitudes toward Standardized Assessment and Utility of Diagnosis. Descriptive analyses were performed and four subscales were compared with information from a similar study in US using the same instruments. The demographic and professional characteristics (age, working years, gender, education, profession, management position, involvement in assessment, level of service) in terms of prediction of attitudes were studied by univariate and multivariate linear regressions. RESULTS Overall, the clinicians had quite positive attitudes and were more positive compared to a similar study conducted in the US earlier. There were differences in attitudes due to several characteristics but the only characteristic predicting all subscales was type of profession (counselor, nurse, psychiatrist, psychologist, other), with counselors being less positive than other groups. CONCLUSION The overall positive attitudes toward standard assessment are of importance in the development of evidence-based practice and our study implies that clinicians in general value and are willing to use standardized assessment. Nevertheless, there are specific issues such as adequate training and available translated assessment instrument that need to be addressed. When implementing new methods in practice, there are general as well as specific resistances that need to be overcome. Studies in different cultural settings are of importance to further extend the knowledge of what is general and what is specific barriers.
Collapse
Affiliation(s)
- M. Danielson
- 0000 0004 1937 0626grid.4714.6Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden ,0000 0001 2326 2191grid.425979.4Stockholm Child and Adolescent Psychiatry, Stockholm County Council, Box 17914, 118 95 Stockholm, Sweden
| | - A. Månsdotter
- 0000 0004 0623 991Xgrid.412215.1Department of Public Health and Clinical Medicine, 901 87 Umeå, Sweden
| | - E. Fransson
- 0000 0004 1936 9377grid.10548.38Centre for Health Equity Studies, Department of Public Health Sciences, Stockholm University, 106 91 Stockholm, Sweden ,0000 0004 1937 0626grid.4714.6Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - S. Dalsgaard
- 0000 0001 1956 2722grid.7048.bThe National Centre for Register-based Research (NCRR) and Centre for Integrated Register-based Research at AU (CIRRAU), Aarhus University, Fuglesangs Alle 4, 8210 Aarhus V, Denmark
| | - J-O. Larsson
- 0000 0004 1937 0626grid.4714.6Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden ,0000 0001 2326 2191grid.425979.4Stockholm Child and Adolescent Psychiatry, Stockholm County Council, Box 17914, 118 95 Stockholm, Sweden
| |
Collapse
|
31
|
Zettler HR. The Impact of Dual Diagnosis on Drug Court Failure. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2019; 63:357-382. [PMID: 30270702 DOI: 10.1177/0306624x18803832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There is limited research investigating the relationship between dual diagnosis and drug court outcomes. The current study examines the relationship between dual diagnosis and drug court failure by specific failure type. Utilizing data from a large urban drug court in the Southwestern United States, the study finds mixed results regarding the impact of dual diagnosis on drug court failure. Specifically, while there was no evidence that dual diagnosis predicted overall success/failure, dual diagnosis significantly increased the odds of serious program failure (e.g., new offense, absconding, revocation). In contrast, dual diagnosis significantly decreased the odds of less serious failure (e.g., rule violation, relapse).
Collapse
|
32
|
Zimmerman M, Holst CG. Screening for psychiatric disorders with self-administered questionnaires. Psychiatry Res 2018; 270:1068-1073. [PMID: 29908784 DOI: 10.1016/j.psychres.2018.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/06/2018] [Accepted: 05/09/2018] [Indexed: 11/25/2022]
Abstract
Given the time demands of clinical practice it is not surprising that diagnoses are sometimes missed. To improve diagnostic recognition, self-administered screening scales have been recommended. A problem with much of the research effort on screening scales is the confusion between diagnostic testing and screening. It is important for a screening test to have high sensitivity because the more time intensive/expensive follow-up diagnostic inquiry will presumably only occur in patients who are positive on the initial screen. Investigators vary in how they analyze their data in determining the recommended cutoff score on a self-administered screening questionnaire. To illustrate this, in the present report we examined how often each of the different approaches towards determining a cutoff score on bipolar disorder screening scales were used. We reviewed 68 reports of the performance of the 3 most commonly researched bipolar disorder screening scales to determine how the recommended cutoff on the scale was derived. Most studies recommended a cutoff point on the screening scale that optimized the level of agreement with the diagnostic gold standard. Only 11 (16.2%) studies recommended a cutoff that prioritized the scale's sensitivity. It is important for clinicians to understand the difference between screening and diagnostic tests. The results of the present study indicate that most studies of the performance of the 3 most commonly studied bipolar disorder screening measures have taken the wrong approach in deriving the cutoff score on the scale for the purpose of screening.
Collapse
Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, USA; Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.
| | - Carolina Guzman Holst
- Department of Psychiatry and Human Behavior, Brown Medical School, USA; Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| |
Collapse
|
33
|
Limburg K, Dinkel A, Schmid-Mühlbauer G, Sattel H, Radziej K, Becker-Bense S, Henningsen P, Dieterich M, Lahmann C. Neurologists' Assessment of Mental Comorbidity in Patients With Vertigo and Dizziness in Routine Clinical Care-Comparison With a Structured Clinical Interview. Front Neurol 2018; 9:957. [PMID: 30483214 PMCID: PMC6242889 DOI: 10.3389/fneur.2018.00957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/25/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Mental health comorbidities are frequent in patients with vertigo and dizziness. The current study was conducted in a specialized interdisciplinary university center for vertigo and dizziness. Clinical routines consist of a structured work-up in which neuro-otological and neurological tests are performed to first detect possible organic vestibular deficits. In addition, psychiatric disorders and comorbidities are considered. The study aimed to evaluate neurologists' awareness of psychiatric next to somatic disorders within patients' first examination in terms of diagnostic congruence between neurologists' diagnoses and structured clinical assessment of mental disorders. Methods: The study involved 392 patients. Diagnostic evaluation included (a) structured history-taking (including psychosocial anamnesis), neurological, and neuro-otological diagnostics conducted by neurologists and (b) a structured clinical interview for mental disorders (SCID-I) conducted by psychologists and final-year medical or psychology students. Cohen's Kappa was calculated to determine agreement rates regarding depression and anxiety disorders; additionally, sensitivity and specificity were evaluated. Results: Neurologists' assessments led to at least one psychiatric diagnosis among the main diagnoses in 40 (10.2 %) patients, whereas the structured clinical interview led to at least one DSM-IV psychiatric diagnosis in 174 (44.4%) of the patients. Agreement was low (κ < 0.2); sensitivity was low (15%) but specificity was high (98%). Conclusions: Agreement between the diagnosis of neurologists and structured clinical interviews for psychiatric disorders is low. Since psychiatric disorders are frequent in vertigo and dizziness and tend to take a chronic course, improving early recognition and implementing appropriate care concepts is vital.
Collapse
Affiliation(s)
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | | | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Katharina Radziej
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,Department of Neurology, University Hospital, Ludwig-Maximilians University, Munich, Germany.,Cluster of Systems Neurology-SyNergy, Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| |
Collapse
|
34
|
Which mental disorders are associated with the greatest impairment in functioning? Soc Psychiatry Psychiatr Epidemiol 2018; 53:1265-1276. [PMID: 29959451 DOI: 10.1007/s00127-018-1554-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective of this study is to estimate the comparative associations of mental disorders with three measures of functional impairment: the Global Assessment of Functioning (GAF); the number of days in the past 12 months of total inability to work or carry out normal activities because of emotions, nerves, or mental health (i.e., days out of role); and a modified version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). METHODS Secondary data analysis of the linked Mental Health Surveillance Study and the National Survey on Drug Use and Health (n = 5653), nationally representative population surveys conducted in the United States. Generalized linear models assessed the independent effects of mental disorders on each measure of functional impairment, controlling for mental disorder comorbidity, physical health disorders, and sociodemographic factors. RESULTS The results varied across measures of functional impairment. However, mood disorders generally tended to be associated with the greatest functional impairment, anxiety disorders with intermediate impairment, and substance use disorders with the least impairment. All 15 disorders were significantly associated with the GAF score in multiple regression models, eight disorders were significantly associated with the WHODAS score, and three disorders were significantly associated with days out of role. CONCLUSIONS Our results highlight the value of complementary measures of functional impairment.
Collapse
|
35
|
Rouco V, Paz C, Winter D, Feixas G. On the Measurement of Implicative Dilemmas. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2018. [DOI: 10.1080/10720537.2018.1499159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Clara Paz
- Universidad de Las Américas, Quito, Ecuador
| | | | | |
Collapse
|
36
|
Gander M, Sevecke K, Buchheim A. Disorder-specific attachment characteristics and experiences of childhood abuse and neglect in adolescents with anorexia nervosa and a major depressive episode. Clin Psychol Psychother 2018; 25:894-906. [PMID: 30216616 PMCID: PMC6585713 DOI: 10.1002/cpp.2324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/15/2018] [Accepted: 07/31/2018] [Indexed: 11/08/2022]
Abstract
For the first time, the present study investigates disorder‐specific attachment characteristics and childhood trauma in adolescent inpatients with anorexia nervosa (n = 30, girls/boys: 28/2, age: M = 14.84, SD = 1.20), a major depressive episode (n = 30, girls/boys: 27/3, age: M = 15.14, SD = 1.50), and controls (n = 60, girls/boys: 44/16, age: M = 16.10, SD = 1.20). We used the Structured Clinical Interview to diagnose Axis I disorders, the Adult Attachment Projective Picture System to classify attachment representations, and the Childhood Trauma Questionnaire to assess child maltreatment. Our findings demonstrate an overrepresentation of the unresolved attachment status in the patient samples. A one‐way analysis of variance succeeded by Bonferroni post hoc tests indicated that adolescents with anorexia nervosa show more isolation and dissolution of boundaries between life and death when confronted with situations of solitude. Although they report moderate to severe levels of traumatic childhood experiences, they tend to minimize those. Adolescents with a major depressive episode report higher levels of emotional abuse and neglect in their childhood, leaving them in a state of failed protection and danger during attachment distress. Integrating these attachment‐related characteristics into specific psychotherapeutic interventions might be associated with a better outcome in that age group.
Collapse
Affiliation(s)
- Manuela Gander
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
37
|
Bram AD, Gottschalk KA, Leeds WM. Chronic fatigue syndrome and the somatic expression of emotional distress: Applying the concept of illusory mental health to address the controversy. J Clin Psychol 2018; 75:116-131. [PMID: 30152867 DOI: 10.1002/jclp.22692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/28/2018] [Accepted: 07/13/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The process of somatization in chronic fatigue syndrome (CFS) was investigated using the concept of illusory mental health (IMH). IMH involves self-reporting low emotional distress alongside performance-based assessment of distress. METHOD We studied IHM and physical symptoms in 175 women across four groups: (a) CFS plus depression; (b) CFS with no depression (CFS-ND); (c) depressive disorder without CFS; and (d) healthy controls (HC). IMH was assessed using a self-report measure plus the performance-based Early Memory Index (EMI). RESULTS CFS-NDs were no more likely to have IMH compared with HCs. Among the CFS-NDs, IMH was associated with more physical symptoms. For CFS-NDs, EMI added meaningfully beyond self-reported mental health in predicting physical symptoms. CONCLUSION Findings refute reducing CFS to somatization, but there is a subgroup of CFS whose lacking access to emotional distress is associated with heightened physical symptomatology.
Collapse
Affiliation(s)
- Anthony D Bram
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts.,Boston Psychoanalytic Society and Institute, Newton, Massachusetts.,Veritas Foundation for Clinical Research, Topeka, Kansas
| | - Kiley A Gottschalk
- Department of Counseling Services, Human Relations Service, Wellesley, Massachusetts
| | - William M Leeds
- Veritas Foundation for Clinical Research, Topeka, Kansas.,Pulmonary & Sleep Associates, Topeka, Kansas
| |
Collapse
|
38
|
Bram AD, Gottschalk KA, Leeds WM. Emotional Regulation in Women with Chronic Fatigue Syndrome and Depression: Internal Representations and Adaptive Defenses. J Am Psychoanal Assoc 2018; 66:701-741. [PMID: 30249136 DOI: 10.1177/0003065118798043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic fatigue syndrome (CFS) presents challenges in differential diagnosis and treatment. Complicating diagnosis is that its symptoms overlap with those of depression. This study applies psychoanalytic concepts to understand emotional regulation (ER) in women with CFS and/or depression. One hundred eighty-six women were assigned to four groups and compared: (a) CFS plus high er depression (CFS-HD); (b) CFS plus lower depression (CFS-LD); (c) depressive disorder (DD); and (d) healthy controls (HC). ER was operationalized by measures of capacity to form internal representations and adaptive defenses. The study's premise was that difficulties metabolizing emotions psychologically would be associated with their greater somatic expression. Some support was found for the hypothesis that CFS participants would exhibit more impairment in representing emotions and in adaptive defenses compared to the DD and HC groups, but this held only for the CFS-HD group. Although CFS-LD participants were expected to be more purely somatizing than the CFS-HD group, they instead showed more sophisticated capacities for ER than that group and recalled less distressing early relationships, revealing more resilience. Still, however, we found support for somatization in some CFS sufferers: Within both the CFS-HD and the CFS-LD groups, weaknesses in representing emotions and in defensive functioning were associated with more severe physical symptoms. Clinically, the heterogeneity of CFS and those who suffer from it indicates the need for individual assessment and depression treatment.
Collapse
|
39
|
Nagar M, Westen D, Nakash O. Reliability of DSM and empirically derived prototype diagnosis for mood, anxiety and personality disorders. Compr Psychiatry 2018; 85:8-14. [PMID: 29933136 DOI: 10.1016/j.comppsych.2018.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/11/2018] [Accepted: 06/02/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prominent psychiatric diagnostic systems such as the DSM-IV and ICD-10 have shown low reliability in clinical practice. An alternative approach to classification of psychiatric disorders is prototype matching. In the current study, we examined reliability of assessing mood, anxiety and personality disorders using a multi-method multi informant approach. More specifically, we examined diagnosis made by treating clinician and independent expert clinical interviewer, using three different diagnostic systems (DSM symptom count, DSM-IV prototype diagnosis and empirically derived prototype diagnosis). METHODS A convenience sample of clinicians (N = 80) and patients (N = 170) from eight community mental health clinics in Israel participated in the study. RESULTS Our findings show fair to excellent interrater reliability for prototype dimensional diagnostic systems (ranged from 0.40 to 0.79) for most mood and anxiety disorders examined. Overall, dimensional diagnostic systems, yielded better interrater reliability for mood, anxiety and personality disorders, as compared with categorical diagnosis. There were no significant differences between dimensional systems. CONCLUSIONS Our findings provide further support to the advantages of dimensional over categorical models in increasing reliability.
Collapse
Affiliation(s)
- Maayan Nagar
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, P.O. Box 167, Herzliya 46150, Israel.
| | - Drew Westen
- Department of Psychology and Psychiatry, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA.
| | - Ora Nakash
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, P.O. Box 167, Herzliya 46150, Israel.
| |
Collapse
|
40
|
Vallejo-Sánchez B, Pérez-García AM. Contribución del Neuroticismo, Rasgos Patológicos de Personalidad y Afrontamiento en la Predicción de la Evolución Clínica: Estudio de Seguimiento a los 5 Años de una Muestra de Pacientes con Trastorno Adaptativo. CLÍNICA Y SALUD 2018. [DOI: 10.5093/clysa2018a9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
41
|
Brodey B, Purcell SE, Rhea K, Maier P, First M, Zweede L, Sinisterra M, Nunn MB, Austin MP, Brodey IS. Rapid and Accurate Behavioral Health Diagnostic Screening: Initial Validation Study of a Web-Based, Self-Report Tool (the SAGE-SR). J Med Internet Res 2018; 20:e108. [PMID: 29572204 PMCID: PMC5889494 DOI: 10.2196/jmir.9428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/29/2018] [Accepted: 02/13/2018] [Indexed: 11/26/2022] Open
Abstract
Background The Structured Clinical Interview for DSM (SCID) is considered the gold standard assessment for accurate, reliable psychiatric diagnoses; however, because of its length, complexity, and training required, the SCID is rarely used outside of research. Objective This paper aims to describe the development and initial validation of a Web-based, self-report screening instrument (the Screening Assessment for Guiding Evaluation-Self-Report, SAGE-SR) based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the SCID-5-Clinician Version (CV) intended to make accurate, broad-based behavioral health diagnostic screening more accessible within clinical care. Methods First, study staff drafted approximately 1200 self-report items representing individual granular symptoms in the diagnostic criteria for the 8 primary SCID-CV modules. An expert panel iteratively reviewed, critiqued, and revised items. The resulting items were iteratively administered and revised through 3 rounds of cognitive interviewing with community mental health center participants. In the first 2 rounds, the SCID was also administered to participants to directly compare their Likert self-report and SCID responses. A second expert panel evaluated the final pool of items from cognitive interviewing and criteria in the DSM-5 to construct the SAGE-SR, a computerized adaptive instrument that uses branching logic from a screener section to administer appropriate follow-up questions to refine the differential diagnoses. The SAGE-SR was administered to healthy controls and outpatient mental health clinic clients to assess test duration and test-retest reliability. Cutoff scores for screening into follow-up diagnostic sections and criteria for inclusion of diagnoses in the differential diagnosis were evaluated. Results The expert panel reduced the initial 1200 test items to 664 items that panel members agreed collectively represented the SCID items from the 8 targeted modules and DSM criteria for the covered diagnoses. These 664 items were iteratively submitted to 3 rounds of cognitive interviewing with 50 community mental health center participants; the expert panel reviewed session summaries and agreed on a final set of 661 clear and concise self-report items representing the desired criteria in the DSM-5. The SAGE-SR constructed from this item pool took an average of 14 min to complete in a nonclinical sample versus 24 min in a clinical sample. Responses to individual items can be combined to generate DSM criteria endorsements and differential diagnoses, as well as provide indices of individual symptom severity. Preliminary measures of test-retest reliability in a small, nonclinical sample were promising, with good to excellent reliability for screener items in 11 of 13 diagnostic screening modules (intraclass correlation coefficient [ICC] or kappa coefficients ranging from .60 to .90), with mania achieving fair test-retest reliability (ICC=.50) and other substance use endorsed too infrequently for analysis. Conclusions The SAGE-SR is a computerized adaptive self-report instrument designed to provide rigorous differential diagnostic information to clinicians.
Collapse
Affiliation(s)
| | | | - Karen Rhea
- Centerstone, Nashville, TN, United States
| | | | - Michael First
- Department of Psychiatry, Columbia University, New York City, NY, United States
| | | | | | | | | | - Inger S Brodey
- Department of English and Comparative Literature, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
42
|
von Glischinski M, Willutzki U, Stangier U, Hiller W, Hoyer J, Leibing E, Leichsenring F, Hirschfeld G. Liebowitz Social Anxiety Scale (LSAS): Optimal cut points for remission and response in a German sample. Clin Psychol Psychother 2018; 25:465-473. [DOI: 10.1002/cpp.2179] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | - U. Willutzki
- Department of Psychology; Witten/Herdecke University; Witten Germany
| | - U. Stangier
- Clinical Psychology and Psychotherapy; Goethe University Frankfurt; Frankfurt Germany
| | - W. Hiller
- Institute of Psychology; University of Mainz; Mainz Germany
| | - J. Hoyer
- Institute of Clinical Psychology and Psychotherapy; Technische Universität Dresden; Dresden Germany
| | - E. Leibing
- Center of Psychosocial Medicine; University of Goettingen; Goettingen Germany
| | - F. Leichsenring
- Clinic of Psychosomatics and Psychotherapy; Justus-Liebig-University Giessen; Giessen Germany
| | - G. Hirschfeld
- Department of Quantitative Methods; Osnabrück University of Applied Sciences; Osnabrück Germany
| |
Collapse
|
43
|
Goldstein LA, Mehling WE, Metzler TJ, Cohen BE, Barnes DE, Choucroun GJ, Silver A, Talbot LS, Maguen S, Hlavin JA, Chesney MA, Neylan TC. Veterans Group Exercise: A randomized pilot trial of an Integrative Exercise program for veterans with posttraumatic stress. J Affect Disord 2018; 227:345-352. [PMID: 29145076 DOI: 10.1016/j.jad.2017.11.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/30/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is prevalent among military veterans and is associated with significant negative health outcomes. However, stigma and other barriers to care prevent many veterans from pursuing traditional mental health treatment. We developed a group-based Integrative Exercise (IE) program combining aerobic and resistance exercise, which is familiar to veterans, with mindfulness-based practices suited to veterans with PTSD. This study aimed to evaluate the effects of IE on PTSD symptom severity and quality of life, as well as assess the feasibility and acceptability of IE. METHODS Veterans (N = 47) were randomized to either IE or waitlist control (WL). Veterans in IE were asked to attend three 1-h group exercise sessions for 12 weeks. RESULTS Compared with WL, veterans randomized to IE demonstrated a greater reduction in PTSD symptom severity (d = -.90), a greater improvement in psychological quality of life (d = .53) and a smaller relative improvement in physical quality of life (d = .30) Veterans' ratings of IE indicated high feasibility and acceptability. LIMITATIONS The sample was relatively small and recruited from one site. The comparison condition was an inactive control. CONCLUSIONS This initial study suggests that IE is an innovative approach to treating veterans with symptoms of PTSD that reduces symptoms of posttraumatic stress and improves psychological quality of life. This approach to recovery may expand the reach of PTSD treatment into non-traditional settings and to veterans who may prefer a familiar activity, such as exercise, over medication or psychotherapy.
Collapse
Affiliation(s)
- Lizabeth A Goldstein
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Department of Psychiatry, University of California, San Francisco, CA, United States.
| | - Wolf E Mehling
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States; Osher Center for Integrative Medicine, University of California, San Francisco, CA, United States
| | - Thomas J Metzler
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States
| | - Beth E Cohen
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States; Department of Medicine, University of California, San Francisco, CA, United States
| | - Deborah E Barnes
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Department of Psychiatry, University of California, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
| | - Gerard J Choucroun
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States
| | - Aliza Silver
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States
| | - Lisa S Talbot
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Shira Maguen
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Department of Psychiatry, University of California, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States
| | - Jennifer A Hlavin
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States
| | - Margaret A Chesney
- Osher Center for Integrative Medicine, University of California, San Francisco, CA, United States
| | - Thomas C Neylan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Department of Psychiatry, University of California, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States
| |
Collapse
|
44
|
Gormley MJ, Pinho T, Pollack B, Puzino K, Franklin MK, Busch C, DuPaul GJ, Weyandt LL, Anastopoulos AD. Impact of Study Skills and Parent Education on First-Year GPA Among College Students With and Without ADHD: A Moderated Mediation Model. J Atten Disord 2018; 22:334-348. [PMID: 26187415 PMCID: PMC4715995 DOI: 10.1177/1087054715594422] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To test if the relationship between ADHD and academic achievement is mediated by service utilization and/or study skills, and if these mediation effects are moderated by parental education level. METHOD A bootstrapping method within structural equation modeling was used with data from 355 first year college students meeting strict criteria for ADHD or clearly without ADHD to test the mediation and moderation effects. RESULTS Study skills, but not service utilization, significantly mediated the relationship between ADHD status and GPA; however, this relationship was not significant among students with at least one parent holding a master's degree or higher. CONCLUSION Among first year college students study skills may be a more salient predictor of educational outcomes relative to ADHD status. Additional research into support services for college students with ADHD is needed, however, results suggest interventions targeting study skills may hold particular promise for these students.
Collapse
|
45
|
Bachem R, Casey P. Adjustment disorder: A diagnosis whose time has come. J Affect Disord 2018; 227:243-253. [PMID: 29107817 DOI: 10.1016/j.jad.2017.10.034] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/06/2017] [Accepted: 10/19/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adjustment disorder is among the most frequently diagnosed mental disorders in clinical practice although it has received little academic attention and been the subject of substantial criticism over the past decades. While those suffering with adjustment disorders are often treated by mental health professionals, research interest in the origin of the disorder or the effectiveness of psychotherapeutic and medical interventions has only recently begun to emerge. This article summarizes the empirical literature published on adjustment disorder and points out current diagnostic developments in DSM-5 and ICD-11. METHODS Literature for this review was identified through established online search tools, including publications in English, German, and Spanish. RESULTS This paper reviews literature on the evolution of adjustment disorder, and highlights the current state of research with regard to genesis and treatment. Importantly, for the first time ICD-11 intends to define adjustment disorder by explicit symptom groups, unlike DSM-5. LIMITATIONS Publications without an English abstract were not included. CONCLUSIONS Key directions for future research include investigating the concordance of the ICD-11 and DSM-5 concepts and the effect that the diverging conceptualizations may have. Risk and protective factors specific to AD should be identified and the biological underpinnings of the disorder should be explored. Finally, given the high prevalence of AD in certain clinical settings effective disorder-specific interventions should be developed and evaluated.
Collapse
Affiliation(s)
- Rahel Bachem
- Bob Shapell School of Social Work, Tel Aviv University, Chaim Levanon 30, Tel Aviv 699780, Israel.
| | - Patricia Casey
- University College Dublin, School of Medicine, Mater Misericordiae Hospital, 62/63 Eccles Street, Dublin 7, Ireland
| |
Collapse
|
46
|
Zander E, Wyder L, Holtforth MG, Schnyder U, Hepp U, Stulz N. Validity of routine clinical diagnoses in acute psychiatric inpatients. Psychiatry Res 2018; 259:482-487. [PMID: 29154169 DOI: 10.1016/j.psychres.2017.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 10/26/2017] [Accepted: 11/01/2017] [Indexed: 11/26/2022]
Abstract
AIM To examine the validity of diagnoses obtained by clinicians during routine clinical examination on acute psychiatric inpatient wards. METHODS N=100 inpatients with a broad spectrum of major mental disorders were randomly selected in a mental hospital's department of general psychiatry. Patients were diagnosed by independent assessors within Md = 5 (Range: 1-18) days of admission using the SCID I in order to examine the validity of the diagnoses given by the clinical staff based on routine assessments. RESULTS The commonly used clinical examination technique had good overall agreement with the SCID I assessments regarding primary diagnoses at the level of ICD-10 main categories (F2, F30-31, F32-F33, F4; κ = 0.65). However, agreement between routine clinical diagnoses and the SCID I diagnoses tended to be low for some specific mental disorders (e.g., depressive disorders) and for secondary diagnoses. CONCLUSIONS The validity of routine clinical diagnoses established in acute inpatient settings is limited and should be improved.
Collapse
Affiliation(s)
- Eduard Zander
- Psychiatric Services Aargau, P.O. Box 432, CH-5201 Brugg, Switzerland
| | - Lea Wyder
- Psychiatric Services Aargau, P.O. Box 432, CH-5201 Brugg, Switzerland; University of Berne, Department of Psychology, Fabrikstrasse 8, CH-3012 Berne, Switzerland
| | - Martin Grosse Holtforth
- University of Berne, Department of Psychology, Fabrikstrasse 8, CH-3012 Berne, Switzerland; Inselspital, Psychosomatic Competence Center, Haus C.L. Lory, CH-3010 Berne, Switzerland
| | - Ulrich Schnyder
- University Hospital Zurich, Department of Psychiatry and Psychotherapy, University of Zurich, Culmannstrasse 8, CH-8091 Zurich, Switzerland
| | - Urs Hepp
- Integrated Psychiatric Services Winterthur - Zurcher Unterland, Wieshofstrasse 102, P.O. Box 144, CH-8408 Winterthur, Switzerland
| | - Niklaus Stulz
- Psychiatric Services Aargau, P.O. Box 432, CH-5201 Brugg, Switzerland; University of Berne, Department of Psychology, Fabrikstrasse 8, CH-3012 Berne, Switzerland
| |
Collapse
|
47
|
Naismith I, Mwale A, Feigenbaum J. Inhibitors and facilitators of compassion-focused imagery in personality disorder. Clin Psychol Psychother 2017; 25:283-291. [PMID: 29251381 DOI: 10.1002/cpp.2161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 08/25/2017] [Accepted: 10/30/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Compassion-focused therapy (CFT) has potential to benefit clients with a personality disorder (PD), given the inflated levels of shame and self-criticism in this population. However, clinical observation indicates that clients with PD may find techniques from this approach challenging. AIMS The aim of this study is to trial one aspect of CFT, compassion-focused imagery (CFI), with this population, and identify factors that predict clients' ability to generate CFI and experience self-compassion during the task, including type of CFI exercise and, second, to establish whether CFI outcomes increase with practice. METHOD In Study 1, 53 participants with a diagnosis of PD completed measures of self-compassion, self-reassurance, shame, self-criticism, fear of self-compassion, affect, anxious and avoidant attachment, and mental imagery abilities. Participants were assigned to trial CFI from memory (n = 25) or from imagination (n = 28), then rated their image's vividness, its compassionate traits, and ease of experiencing compassion. A negative mood manipulation was carried out, and CFI tasks and outcome measures were repeated. For Study 2, self-compassion and self-criticism were measured before and after 1 week of daily CFI practice. RESULTS Study 1 found that negative mood and low mental imagery ability are significant inhibitors to generating compassionate images and affect. The 2 CFI exercises were equally effective. Study 2 suffered from high attrition, but regular practice was associated with significant improvement in self-compassion (though not self-criticism). CONCLUSIONS CFI appears to be effective in improving self-compassion for some clients. However, it is less effective in the presence of negative affect. Clients with low mental imagery ability may benefit more from alternative CFT techniques.
Collapse
Affiliation(s)
| | - Amanda Mwale
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Janet Feigenbaum
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| |
Collapse
|
48
|
Economou M, Souliotis K, Peppou LE, Agapidaki I, Tzavara C, Stefanis CN. Major depression in Cyprus amid financial crisis: prevalence and correlates. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/17542863.2017.1364283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Marina Economou
- Community Mental Health Centre, University Mental Health Research Institute (UMHRI), Athens, Greece
- First Department of Psychiatry, Medical School, National & Kapodistrian University, Athens, Greece
| | - Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National & Kapodistrian University, Athens, Greece
| | - Lily Evangelia Peppou
- Community Mental Health Centre, University Mental Health Research Institute (UMHRI), Athens, Greece
| | - Irene Agapidaki
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National & Kapodistrian University, Athens, Greece
| | - Chara Tzavara
- Community Mental Health Centre, University Mental Health Research Institute (UMHRI), Athens, Greece
| | - Costas N. Stefanis
- Community Mental Health Centre, University Mental Health Research Institute (UMHRI), Athens, Greece
| |
Collapse
|
49
|
Neuschwander M, In-Albon T, Meyer AH, Schneider S. Acceptance of a structured diagnostic interview in children, parents, and interviewers. Int J Methods Psychiatr Res 2017; 26:e1573. [PMID: 28730663 PMCID: PMC6877120 DOI: 10.1002/mpr.1573] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 04/23/2017] [Accepted: 04/28/2017] [Indexed: 11/11/2022] Open
Abstract
The objective of this study was to investigate the satisfaction and acceptance of a structured diagnostic interview in clinical practice and in a research setting. Using the Structured Diagnostic Interview for Mental Disorders in Children and Adolescents (Kinder-DIPS), 28 certified interviewers conducted 202 interviews (115 with parents, 87 with children). After each interview, children, parents, and interviewers completed a questionnaire assessing the overall satisfaction (0 = not at all satisfied to 100 = totally satisfied) and acceptance (0 = completely disagree to 3 = completely agree) with the interview. Satisfaction ratings were highly positive, all means >82. The mean of the overall acceptance for children was 2.43 (standard deviation [SD] = 0.41), 2.54 (SD = 0.33) of the parents, 2.30 (SD = 0.43) of the children's interviewers, and 2.46 (SD = 0.32) of the parents' interviewers. Using separate univariate regression models, significant predictors for higher satisfaction and acceptance with the interview are higher children's Global Assessment of Functioning, fewer number of children's diagnoses, shorter duration of the interview, a research setting, female sex of the interviewer, and older age of the interviewer. Results indicate that structured diagnostic interviews are highly accepted by children, parents, and interviewers. Importantly, this is true for different treatment settings.
Collapse
Affiliation(s)
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy, University Koblenz-Landau, Landau, Germany
| | - Andrea H Meyer
- Department of Psychology, University of Basel, Basel, Switzerland
| | - Silvia Schneider
- Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Bochum, Germany
| |
Collapse
|
50
|
Arditte Hall KA, De Raedt R, Timpano KR, Joormann J. Positive memory enhancement training for individuals with major depressive disorder. Cogn Behav Ther 2017; 47:155-168. [DOI: 10.1080/16506073.2017.1364291] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kimberly A. Arditte Hall
- National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, 150 S. Huntington Ave. (116B), Boston, MA 02130, USA
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL 33146, USA
| | - Rudi De Raedt
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, B-9000, Ghent, Belgium
| | - Kiara R. Timpano
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL 33146, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT 06511, USA
| |
Collapse
|