Mental Disorder-The Need for an Accurate Definition

Biosensors for psychiatric biomarkers in mental health monitoring

Psychiatric disorders are associated with serve disturbances in cognition, emotional control, and/or behavior regulation, yet few routine clinical tools are available for the real-time evaluation and early-stage diagnosis of mental health. Abnormal levels of relevant biomarkers may imply biological, neurological, and developmental dysfunctions of psychiatric patients. Exploring biosensors that can provide rapid, in-situ, and real-time monitoring of psychiatric biomarkers is therefore vital for prevention, diagnosis, treatment, and prognosis of mental disorders. Recently, psychiatric biosensors with high sensitivity, selectivity, and reproducibility have been widely developed, which are mainly based on electrochemical and optical sensing technologies. This review presented psychiatric disorders with high morbidity, disability, and mortality, followed by describing pathophysiology in a biomarker-implying manner. The latest biosensors developed for the detection of representative psychiatric biomarkers (e.g., cortisol, dopamine, and serotonin) were comprehensively summarized and compared in their sensitivities, sensing technologies, applicable biological platforms, and integrative readouts. These well-developed biosensors are promising for facilitating the clinical utility and commercialization of point-of-care diagnostics. It is anticipated that mental healthcare could be gradually improved in multiple perspectives, ranging from innovations in psychiatric biosensors in terms of biometric elements, transducing principles, and flexible readouts, to the construction of 'Big-Data' networks utilized for sharing intractable psychiatric indicators and cases.

Operational criteria application does not change clinicians' opinion on the diagnosis of mental disorder: a pre- and post-intervention validity study

Objective

Our objective was to check if the ICD-10 operational criteria application changes non-operational, prototype-based diagnoses obtained in a real-life scenario.

Methods

Psychiatry residents applied the diagnostic criteria of the ICD-10 as a "diagnostic test" to five outpatient patients they were already following who had a prototype-based diagnosis. Tests were used to ascertain whether changes in opinion were significant and if any of the diagnostic groups were more prone to change than others. The present paper is part of the study with UTN U1111-1260-1212.

Results

Seventeen residents reviewed their last five case files, retrieving 85 diagnostic pairs of non-operational-based vs. operational-based diagnoses. The Stuart-Maxwell test did not indicate a significant opinion change (χ2 = 5.25, p = 0.39; power = 0.94) besides 30% of diagnostic changes. Despite not being statistically significant, 20.2% of all evaluations resulted in a change that would affect treatment choices. Using ICD-10 operational criteria slightly increased the number of observed diagnoses, but probably without clinical relevance. None of the non-operational diagnoses have a higher tendency to change with operational criteria application (χ2 = 11.6, p = 0.07). The female gender was associated with a higher diagnostic change tendency.

Conclusion

Applying ICD-10 operational criteria as a diagnostic test does not induce a statistically significant diagnostic opinion change in residents and no diagnostic group seems more sensible to diagnostic change. Gender-related differences in diagnostic opinion changes might be evidence of sunk cost bias. Although not statistically significant, using operational criteria after diagnostic elaboration might help to deal with subjects without adequate treatment response.

A close look at sociality in DSM criteria

PURPOSE

The importance of sociality in psychology and psychotherapy is quite undisputed; however, this construct risks being underestimated in psychiatric nosography. The aim of the review was to assess the relevance of sociality in DSM 5 criteria.

METHOD

Sociality-laden criteria of 192 selected DSM categories have been identified through a textual grid. Second, the criteria have been classified into 6 categories, i.e., (1) Affiliation and Attachment (AA), (2) Social Communication (SC), (3) Perception and Understanding of Others (PUO), (4) Culture, (5) Clinical Significance Criterion (CSC) (6), and No Specific Construct (NSC).

RESULTS

13% of all mental disorders mention AA in their criteria. 8.8% of all mental disorders mention SC; 8.8% of all mental disorders mention PUO in their criteria. 15% of all mental disorders mention culture in their criteria (exclusively ex negativo though). 40% of mental disorders mention non-specific sociality (NSC) in their criteria. CSC is mentioned in 85% of mental disorders. Personality disorders have the highest "concentration" of sociality mentions throughout the DSM categories.

CONCLUSIONS

The overall results suggest that DSM criteria offer a confused account of sociality. We believe that the descriptive approach is the underlying reason. We suggest that in the long run a theory-laden approach to sociality, informed by evolutionary insights about motivations, could be of help.

Understanding the medication safety challenges for patients with mental illness in primary care: a scoping review

BACKGROUND

Mental illness and medication safety are key priorities for healthcare systems around the world. Despite most patients with mental illness being treated exclusively in primary care, our understanding of medication safety challenges in this setting is fragmented.

METHOD

Six electronic databases were searched between January 2000-January 2023. Google Scholar and reference lists of relevant/included studies were also screened for studies. Included studies reported data on epidemiology, aetiology, or interventions related to medication safety for patients with mental illness in primary care. Medication safety challenges were defined using the drug-related problems (DRPs) categorisation.

RESULTS

Seventy-nine studies were included with 77 (97.5%) reporting on epidemiology, 25 (31.6%) on aetiology, and 18 (22.8%) evaluated an intervention. Studies most commonly (33/79, 41.8%) originated from the United States of America (USA) with the most investigated DRP being non-adherence (62/79, 78.5%). General practice was the most common study setting (31/79, 39.2%) and patients with depression were a common focus (48/79, 60.8%). Aetiological data was presented as either causal (15/25, 60.0%) or as risk factors (10/25, 40.0%). Prescriber-related risk factors/causes were reported in 8/25 (32.0%) studies and patient-related risk factors/causes in 23/25 (92.0%) studies. Interventions to improve adherence rates (11/18, 61.1%) were the most evaluated. Specialist pharmacists provided the majority of interventions (10/18, 55.6%) with eight of these studies involving a medication review/monitoring service. All 18 interventions reported positive improvements on some medication safety outcomes but 6/18 reported little difference between groups for certain medication safety measures.

CONCLUSION

Patients with mental illness are at risk of a variety of DRPs in primary care. However, to date, available research exploring DRPs has focused attention on non-adherence and potential prescribing safety issues in older patients with dementia. Our findings highlight the need for further research on the causes of preventable medication incidents and targeted interventions to improve medication safety for patients with mental illness in primary care.

Anxiolytic-like Effect of Quercetin Possibly through GABA Receptor Interaction Pathway: In Vivo and In Silico Studies

Scientific evidence suggests that quercetin (QUR) has anxiolytic-like effects in experimental animals. However, the mechanism of action responsible for its anxiolytic-like effects is yet to be discovered. The goal of this research is to assess QUR's anxiolytic effects in mouse models to explicate the possible mechanism of action. After acute intraperitoneal (i.p.) treatment with QUR at a dose of 50 mg/kg (i.p.), behavioral models of open-field, hole board, swing box, and light-dark tests were performed. QUR was combined with a GABAergic agonist (diazepam) and/or antagonist (flumazenil) group. Furthermore, in silico analysis was also conducted to observe the interaction of QUR and GABA (α5), GABA (β1), and GABA (β2) receptors. In the experimental animal model, QUR had an anxiolytic-like effect. QUR, when combined with diazepam (2 mg/kg, i.p.), drastically potentiated an anxiolytic effect of diazepam. QUR is a more highly competitive ligand for the benzodiazepine recognition site that can displace flumazenil (2.5 mg/kg, i.p.). In all the test models, QUR acted similar to diazepam, with enhanced effects of the standard anxiolytic drug, which were reversed by pre-treatment with flumazenil. QUR showed the best interaction with the GABA (α5) receptor compared to the GABA (β1) and GABA (β2) receptors. In conclusion, QUR may exert an anxiolytic-like effect on mice, probably through the GABA-receptor-interacting pathway.

Values in mental and medical disorder concepts: Their presence is not the point, being aware of them is

BACKGROUND

Both in medicine and in psychiatry, it's essential to find a general definition for medical and mental disorders. For this we have to analyze the concepts behind these definitions. In this article, we intend to review the proximity between the concepts of mental and medical disorders regarding the presence of values, and to propose a way to deal with the different kinds of values that might be present.

METHODS

The method used in this paper was a conceptual review/analysis.

RESULTS

Regarding the concept of medical disorder, it has resorted to different sub-concepts such as dysfunction and harm (distress disability). The concept of dysfunction, apparently being less value-laden, has been prioritized in relation to the harm component although several authors have already proved that implicitly and explicitly this concept is value laden. In medical-surgical disorder it is very unlikely to find any diagnostic information that includes moral values. In this type of disorder, the values in question are universally non-moral: pain, disability, distress (or risk for these) and risk of death. On the other hand, in several mental disorders, moral values have often been included in their diagnostic criteria.

CONCLUSION

It is concluded that values are present in the main concepts that have been used to define medical or mental disorder. What is essential is to understand what is descriptive and what is value and to try to avoid moral values in this context.

Common psychological disorders in elderly and their correlations with social support, Shiraz, Iran, 2018†

Objective

To recognize and screen common mental disorders in elderlies and determine their relationship with social support in Shiraz, Iran.

Methods

In this cross-sectional analytical study, 400 elderlies aged >60 years from Shiraz were selected through stratified random sampling. Data collection was done by 3 demographic data, Medical Outcome Study (MOS), social support, and standardization of mental disorders symptoms checklist 90 (SCL-90) questionnaires. The collected data were analyzed with SPSS 22, using descriptive statistics, Pearson correlation coefficient, and univariate and multivariate linear regression analyses. A P value <0.05 was regarded as statistically significant.

Results

A total of 400 elderlies (mean age = 67.39 ± 6.89), among whom 204 individuals were female (51%), participated in the study. Somatization and phobic anxiety were the most (68.9%) and least (14.2%) prevalent disorders, respectively. The average total score of social support was 85.59 + 3.5. Social support and its 5 subscales showed statistically significant negative correlation with SCL-90 total scores and its 9 domains (P < 0.05). A 1-point increase in social support score results in reduction in the psychological disorders score by 0.35 point (P < 0.001).

Conclusions

It seems necessary to plan and make policies by the authorities to increase social support and reduce the burden of common mental disorders in the elderly.

Circadian Influences on the Habenula and Their Potential Contribution to Neuropsychiatric Disorders

The neural circadian system consists of the master circadian clock in the hypothalamic suprachiasmatic nuclei (SCN) communicating time of day cues to the rest of the body including other brain areas that also rhythmically express circadian clock genes. Over the past 16 years, evidence has emerged to indicate that the habenula of the epithalamus is a candidate extra-SCN circadian oscillator. When isolated from the SCN, the habenula sustains rhythms in clock gene expression and neuronal activity, with the lateral habenula expressing more robust rhythms than the adjacent medial habenula. The lateral habenula is responsive to putative SCN output factors as well as light information conveyed to the perihabenula area. Neuronal activity in the lateral habenula is altered in depression and intriguingly disruptions in circadian rhythms can elevate risk of developing mental health disorders including depression. In this review, we will principally focus on how circadian and light signals affect the lateral habenula and evaluate the possibility that alteration in these influences contribute to mental health disorders.

Social network interventions in mental healthcare: a protocol for an umbrella review

INTRODUCTION

Social networks (SNs) can play a crucial role in the process of recovery from mental illness. Yet there is no standard best practice for involving SNs to optimise patient recovery. It is therefore critical to explore the diversity of SN approaches in mental health, highlight gaps in the evidence and suggest future directions for research and practice. This protocol describes the methods for an umbrella review of SN interventions for the care and/or treatment of mental illness.

METHODS AND ANALYSIS

Nine electronic databases will be searched for the relevant journal articles: CINAHL, PubMed, Scopus, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Library, Web of Science, Scopus and Ovid PsycINFO. We will include reviews which extracted information about the quantity, structure and quality of patient's SNs as well as frequency of contact. The range of publication dates of the included articles will be from 2010 and 2021, as recommended by Joanna Briggs Institute guidelines. The Assessment of Multiple Systematic Reviews 2 tool and ratings of the quality of evidence will be used to assess the quality of the included reviews. The results will be presented in accordance with guidelines in the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Findings will inform the development of an SN framework to guide the design and evaluation of psychosocial interventions.

ETHICS AND DISSEMINATION

This umbrella review will involve secondary data analysis and ethical approval is not required. The target audience includes clinicians, researchers and service users, who will be reached with tailored materials through journal publications, conference presentations and social media. The presentation of the results will provide a more complete picture of relevant evidence and explicit basis from which to improve psychosocial well-being for people diagnosed with a mental illness.

PROSPERO REGISTRATION NUMBER

This protocol was registered with the International Prospective Register of Systematic Reviews (http:/ /www.crd.york.ac.uk/PROSPERO), registration number CRD42020192873.

Testing the Differential Impact of an Internet-Based Mental Health Intervention on Outcomes of Well-being and Psychological Distress During COVID-19: Uncontrolled Intervention Study

BACKGROUND

During COVID-19, the psychological distress and well-being of the general population has been precarious, increasing the need to determine the impact of complementary internet-based psychological interventions on both positive mental health as well as distress states. Psychological distress and mental well-being represent distinct dimensions of our mental health, and congruent changes in outcomes of distress and well-being do not necessarily co-occur within individuals. When testing intervention impact, it is therefore important to assess change in both outcomes at the individual level, rather than solely testing group differences in average scores at the group level.

OBJECTIVE

This study set out to investigate the differential impact of an internet-based group mental health intervention on outcomes of positive mental health (ie, well-being, life satisfaction, resilience) and indicators of psychological distress (ie, depression, anxiety, stress).

METHODS

A 5-week mental health intervention was delivered to 89 participants using the Zoom platform during 2020. Impact on outcomes of distress, well-being, and resilience was assessed at the start and end of the program with multiple analysis of variance (MANOVA) and reliable change indices (RCIs) being used to determine program impact at the group and individual levels, respectively.

RESULTS

The intervention significantly improved all mental health outcomes measured, (F6,83=5.60, P<.001; Wilks Λ=.71; partial η2=.29) showing small to moderate effect sizes on individual outcomes. The largest effect sizes were observed for life satisfaction and overall well-being (η2=.22 and η2=.2, respectively). Larger effect sizes were noted for those with problematic mental health scores at baseline. A total of 92% (82/89) of participants demonstrated reliable change in at least one mental health outcome. Differential response patterns using RCI revealed that more than one-half of the participants showed improvement in both mental well-being and psychological distress, over one-quarter in outcomes of well-being only, and almost one-fifth in distress only.

CONCLUSIONS

The results provide evidence for the significant impact of an internet-based mental health intervention during COVID-19 and indicate the importance of assessing dimensions of both well-being and distress when determining mental health intervention effectiveness.

Reintroducing Consciousness in Psychopathology: Review of the Literature and Conceptual Framework

Alterations in consciousness are among the most common transdiagnostic psychopathological symptoms. Therefore clinical practice would benefit from a clear conceptual framework that guides the recognition, comprehension, and treatment of consciousness disorders. However, contemporary psychopathology lacks such a framework. We describe how pathology of consciousness is currently being addressed in clinical psychology and psychiatry so far, and how the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and International Classification of Diseases, Tenth Edition (ICD-10) refer to this subject. A brief review of the literature on consciousness is then given. After describing psychological perspectives on consciousness and discussing theoretical issues involved in exploring consciousness, we offer a practical clinical working definition of consciousness and we illustrate its connections with a variety of diagnoses. Making use of Jean-Paul Sartre’s distinctions among: states, functions, qualities, and structure, provide a conceptual framework to understand consciousness, to refine diagnostics and to guide the development of therapeutic possibilities in clinical practice.

The role of gender as a moderator in the relationship between disease perception and coping with stress strategies among psychiatric patients

Introduction: The perception of disease depends on the patient’s beliefs related to the nature of the illness, the previous personal or family experiences and his/her attitude to them. Patients try to understand and cope with health problems. The purpose of the present study was to answer the question which components of the relationship between the strategies for coping with stress and mental disease perception are moderated by gender.

Material and Methods: The study involved 98 patients with depressive disorders, anxiety disorders, schizophrenia, alcohol related disorders. The research of the variables was carried out using the COPE Inventory and Disease Perception Questionnaire.

Results: It has been noticed that in men, when their perception of the mental disorder as beneficial increases, the religious strategies for coping with stress become more frequent. Furthermore, the opposite sex pattern emerged. In the situation when an individual’s perception of the illness as a threat increased, female patients less frequently employed religious coping and planning. Furthermore, in women, when the perception of the mental disease as a weakness increases, the frequency of using emotional social support and acceptance decreases.

Conclusions: The result indicated that there are opposite patterns of gender specific coping strategy dependent on the mental illness perception.

Disease perception and coping strategies for stress in Polish patients with various mental disorders

Introduction: Nowadays more and more people struggle with mental problems associated with fast pace of life and overpowering stress. Individuals affected by mental disorders frequently apply ineffective methods of coping with stress, and their attitudes towards the disease in fact strengthen the psychopathological symptoms. The purpose of the present study was to compare disease perception and coping strategies for stress in Polish patients with various types of mental disorders.

Material and Methods: The study involved 123 patients with depressive disorders, anxiety disorders, schizophrenia, alcohol related disorders, subjects detained due to psychoactive substance-induced psychotic disorders and amnestic syndromes, staying at Mental Healthcare Centre. Measurements of the variables were carried out using COPE Inventory and Disease Perception Questionnaire.

Results: The type of mental disorder differentiated the group with respect to the use of strategies aimed at seeking instrumental and emotional support, planning, positive reinterpretation, focus on emotions and substance use. There are significant differences between patients in the approach to illness as a task, weakness and threat.

Conclusions: The results show that the type of mental disorder is important in the context of the strategies used for coping with stress and the patients' approach to their condition.

Lateral Habenula Gone Awry in Depression: Bridging Cellular Adaptations With Therapeutics

Depression is a highly heterogeneous disease characterized by symptoms spanning from anhedonia and behavioral despair to social withdrawal and learning deficit. Such diversity of behavioral phenotypes suggests that discrete neural circuits may underlie precise aspects of the disease, rendering its treatment an unmet challenge for modern neuroscience. Evidence from humans and animal models indicate that the lateral habenula (LHb), an epithalamic center devoted to processing aversive stimuli, is aberrantly affected during depression. This raises the hypothesis that rescuing maladaptations within this nucleus may be a potential way to, at least partially, treat aspects of mood disorders. In this review article, we will discuss pre-clinical and clinical evidence highlighting the role of LHb and its cellular adaptations in depression. We will then describe interventional approaches aiming to rescue LHb dysfunction and ultimately ameliorate depressive symptoms. Altogether, we aim to merge the mechanistic-, circuit-, and behavioral-level knowledge obtained about LHb maladaptations in depression to build a general framework that might prove valuable for potential therapeutic interventions.