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1.
Psychiatr Danub ; 32(Suppl 3): 311-315, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33030445

RESUMO

INTRODUCTION: The eleventh revision of the International Classification of Diseases (ICD-11) is planned to be published in 2018. So called, "beta version" of the chapter of mental and behavioral disorders (ICD-11) is already available and it is considered that there will be no significant deviations in the final version. The DSM-5 was released in 2013. Changes related to mental disorders in child and adolescent psychiatry have been made in both of these classifications. To identify changes in the classifications of mental disorders in childhood and adolescent age in beta version of ICD-11 and DSM-5. METHODS: Review of mental disorders in childhood and adolescent age and their classification in ICD-11 and DSM-5. RESULTS: For disorders that are classified as "mental retardation" in ICD-10, a new term "intellectual development disorders" has been introduced in ICD-11, ie "intellectual disabilities" in DSM-5. Hyperactivity disorders and attention deficit is a separate entity in relation to ICD-10, in which it is classified as a hyperkinetic disorder. Asperger's syndrome, which is isolated from autism spectrum disorders in DSM-5, does not appear under that name in ICD-11 either. Elimination disorders are in a separate block MKB-11 and DSM-5. Speech and language disorders are classified as communication disorders in the DSM-5 classification. Selective mutism and anxiety separation disorder in childhood are in the block of anxiety and fear-related disorders in ICD-11, and among anxiety disorders in DSM-5, respectively. Reactive emotional disorder and disinhibited attachment disorder of childhood are classified as stress-related disorders in ICD-11 and DSM-5. CONCLUSIONS: The new classifications (ICD-11 and DSM-5) classify mental disorders in child and adolescent psychiatry somewhat differently from their antecedents. New entities have also been formed.


Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Classificação Internacional de Doenças , Transtornos Mentais/classificação , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/classificação , Criança , Humanos , Distúrbios da Fala/classificação
2.
Medicine (Baltimore) ; 99(35): e21595, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871875

RESUMO

BACKGROUND: Delirium is a frequent form of acute brain dysfunction in mechanically ventilated patients. Screening tools have been developed to identify delirium, but it is unclear which tool is the most accurate. Therefore, we provide a protocol of systematic evaluation to assess the accuracy of delirium screening tools in mechanically ventilated patients. METHODS: PubMed, PsycINFO, EMBASE, and the Cochrane Library will be searched. Studies involving mechanically ventilated patients which compared diagnostic tools with the Diagnostic and Statistical Manual of Mental Disorders criteria as a reference standard will be included. We will use MetaDiSC and STATA 15.1 to analyze carefully when a network meta-analysis is allowed. RESULTS: This study will provide a high-quality synthesis to assess the accuracy of different screening methods in mechanically ventilated patients. CONCLUSION: The conclusion of our systematic review will provide evidence to judge which screening method is the best for mechanically ventilated patients.


Assuntos
Encéfalo/fisiopatologia , Delírio/etiologia , Programas de Rastreamento/métodos , Respiração Artificial/efeitos adversos , Delírio/diagnóstico , Delírio/prevenção & controle , Testes Diagnósticos de Rotina/estatística & dados numéricos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Metanálise em Rede
3.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32938777

RESUMO

BACKGROUND AND OBJECTIVES: Genetic testing is recommended for individuals with autism spectrum disorder (ASD). Pathogenic yield varies by clinician and/or patient characteristics. Our objectives were to determine the pathogenic yield of genetic testing, the variability in rate of pathogenic results based on subject characteristics, and the percentage of pathogenic findings resulting in further medical recommendations in toddlers with a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of ASD. METHODS: We conducted a retrospective chart review of 500 toddlers, 18 to 36 months, diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ASD (mean age: 25.8 months, 79% male). Subject demographics, medical and neuropsychological characteristics, and genetic test results were abstracted. Genetic results were divided into negative or normal, variants of unknown significance, and pathogenic. Subject characteristics were compared across results. Manual chart review determined if further recommendations were made after pathogenic results. RESULTS: Over half of subjects (59.8%, n = 299) completed genetic testing, and of those, 36 (12.0%) had pathogenic findings. There were no significant differences in Bayley Scales of Infant Development cognitive (P = .112), language (P = .898), or motor scores (P = .488) among children with negative or normal findings versus a variant of unknown significance versus pathogenic findings. Medical recommendations in response to the genetic finding were made for 72.2% of those with pathogenic results. CONCLUSIONS: Our findings reinforce the importance of genetic testing for toddlers diagnosed with ASD given the 12% yield and lack of phenotypic differences between subjects with and without pathogenic findings. The majority of pathogenic results lead to further medical recommendations.


Assuntos
Transtorno do Espectro Autista/genética , Testes Genéticos/estatística & dados numéricos , Transtorno do Espectro Autista/diagnóstico , Transtornos Dismórficos Corporais/diagnóstico , Transtornos Dismórficos Corporais/genética , Pré-Escolar , Cromossomos Humanos 13-15 , Cognição , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Proteína do X Frágil de Retardo Mental/genética , Deleção de Genes , Duplicação Gênica , Testes Genéticos/métodos , Humanos , Lactente , Desenvolvimento da Linguagem , Masculino , Análise em Microsséries , Mosaicismo , Destreza Motora , Mutação , Fenótipo , Encaminhamento e Consulta , Estudos Retrospectivos
4.
FP Essent ; 495: 11-16, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32757561

RESUMO

Personality disorders (PDs) have a prevalence of approximately 9% in the United States. Patients with these disorders frequently are encountered in the family medicine setting. It is thought that a combination of unknown genetic factors and life experiences, particularly adverse childhood experiences, contribute to PD development. The diagnosis of patients with PD is complex and should be performed by a psychiatry or psychology subspecialist. The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) divides the 10 PDs into three clusters based on descriptive commonalities. Individuals with cluster A PDs often are described as odd or eccentric. Individuals with cluster B PDs often appear dramatic and emotional and exhibit erratic behavior. Individuals with cluster C PDs often appear anxious and fearful. Family physicians should be able to recognize patients with characteristics suggestive of PDs who should be considered for screening. Management consists mainly of psychotherapy. Use of pharmacotherapy is recommended in some specific situations. Patients with PDs can have significant disabilities, medical comorbidities, and high rates of health care use. They have a higher incidence of sleep disorders, chronic pain, chronic health conditions, and obesity than patients in the general population.


Assuntos
Transtornos da Personalidade , Criança , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Transtornos da Personalidade/diagnóstico , Prevalência , Estados Unidos
5.
FP Essent ; 495: 17-22, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32757562

RESUMO

Obsessive-compulsive disorder (OCD) is characterized by recurrent intrusive thoughts, images, or urges (ie, obsessions) and repetitive mental acts or behaviors (ie, compulsions). Body dysmorphic disorder (BDD) is a chronic preoccupation with perceived flaws in physical appearance that leads to repetitive behaviors (ie, rituals). The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) places both disorders under a new category, obsessive-compulsive and related disorders, along with hoarding disorder, excoriation disorder, and trichotillomania. Both OCD and BDD cause marked distress and functional impairment in patients. They share similarities in terms of risk factors and comorbid conditions. Management of these disorders involves a thorough assessment of symptoms, suicidal ideation, and comorbid medical and mental health conditions. Cognitive behavioral therapy (CBT) is the most effective therapy option for OCD. Pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) can be added for patients who do not improve with CBT only, or used as an initial treatment with or without CBT for patients with severe symptoms. For patients with BDD, initial treatments for monotherapy or combination therapy are SSRIs and/or CBT tailored to BDD. For patients with severe BDD or signs of suicidality, combination therapy should be used.


Assuntos
Transtornos Dismórficos Corporais , Transtorno Obsessivo-Compulsivo , Transtornos Dismórficos Corporais/diagnóstico , Transtornos Dismórficos Corporais/terapia , Terapia Cognitivo-Comportamental , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/terapia
6.
Lancet Psychiatry ; 7(9): 801-812, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32828168

RESUMO

Persistent depressive disorder is a chronic mood disorder that is common and often more disabling than episodic major depression. In DSM-5, the term subsumes several chronic depressive presentations, including dysthymia with or without superimposed major depressive episodes, chronic major depression, and recurrent major depression without recovery between episodes. Dysthymia can be difficult to detect in psychiatric and primary care settings until it intensifies in the form of a superimposed major depressive episode. Although information is scarce concerning the cause of persistent depressive disorder including dysthymia, the causation is likely to be multifactorial. In this narrative Review, we discuss current knowledge about the nosology and neurobiological basis of dysthymia and persistent depressive disorder, emphasising a dimensional perspective based on course for further research. We also review new developments in psychotherapy and pharmacotherapy for persistent depressive disorder, and propose a tailored, modular approach to accommodate its multifaceted nature.


Assuntos
Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/terapia , Transtorno Distímico/diagnóstico , Transtorno Distímico/terapia , Antidepressivos/uso terapêutico , Doença Crônica , Terapia Combinada , Comorbidade , Transtorno Depressivo Maior/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtorno Distímico/epidemiologia , Humanos , Psicoterapia/métodos , Recidiva
7.
PLoS One ; 15(8): e0237698, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842139

RESUMO

With brief psychiatric hospitalizations, the extent to which symptoms change is rarely characterized. We sought to understand symptomatic changes across Research Domain Criteria (RDoC) dimensions, and the extent to which such improvement might be associated with risk for readmission. We identified 3,634 individuals with 4,713 hospital admissions to the psychiatric inpatient unit of a large academic medical center between 2010 and 2015. We applied a natural language processing tool to extract estimates of the five RDoC domains to the admission note and discharge summary and calculated the change in each domain. We examined the extent to which symptom domains changed during admission, and their relationship to baseline clinical and sociodemographic features, using linear regression. Symptomatic worsening was rare in the negative valence (0.4%) and positive valence (5.1%) domains, but more common in cognition (25.8%). Most diagnoses exhibited improvement in negative valence, which was associated with significant reduction in readmission risk. Despite generally brief hospital stays, we detected reduction across multiple symptom domains, with greatest improvement in negative symptoms, and greatest probability of worsening in cognitive symptoms. This approach should facilitate investigations of other features or interventions which may influence pace of clinical improvement.


Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos Mentais/diagnóstico , Readmissão do Paciente/estatística & dados numéricos , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Processamento de Linguagem Natural , Admissão do Paciente/estatística & dados numéricos , Sumários de Alta do Paciente Hospitalar/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Tempo , Resultado do Tratamento
8.
Epidemiol Psychiatr Sci ; 29: e153, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32782057

RESUMO

AIMS: Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise lifetime comorbidity across a range of common mental disorders based on a diverse range of population-based surveys. METHODS: The WHO World Mental Health (WMH) surveys assessed 145 990 adult respondents from 27 countries. Based on retrospectively-reported age-of-onset for 24 DSM-IV mental disorders, associations were examined between all 548 logically possible temporally-ordered disorder pairs. Overall and time-dependent hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Absolute risks were estimated using the product-limit method. Estimates were generated separately for men and women. RESULTS: Each prior lifetime mental disorder was associated with an increased risk of subsequent first onset of each other disorder. The median HR was 12.1 (mean = 14.4; range 5.2-110.8, interquartile range = 6.0-19.4). The HRs were most prominent between closely-related mental disorder types and in the first 1-2 years after the onset of the prior disorder. Although HRs declined with time since prior disorder, significantly elevated risk of subsequent comorbidity persisted for at least 15 years. Appreciable absolute risks of secondary disorders were found over time for many pairs. CONCLUSIONS: Survey data from a range of sites confirms that comorbidity between mental disorders is common. Understanding the risks of temporally secondary disorders may help design practical programs for primary prevention of secondary disorders.


Assuntos
Transtornos Mentais/epidemiologia , Adolescente , Adulto , Idoso , Comorbidade , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Transtornos Mentais/classificação , Pessoa de Meia-Idade , Prevalência , Modelos de Riscos Proporcionais , Transtornos Psicóticos/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
9.
Clin Nurse Spec ; 34(5): 208-216, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32796381

RESUMO

PURPOSE/OBJECTIVES: The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) with Criterion A was universally used in admission screening to pilot a trauma-informed care process for quality improvement. DESCRIPTION OF THE PROJECT: All adult inpatient behavioral health patients at a Mid-Atlantic county hospital were screened for trauma exposure on admission. Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with Criterion A was provided to all adults admitted to a 27-bed inpatient behavioral health unit for 8 weeks. Quantitative descriptive statistics were calculated based on self-report PCL-5 scores; qualitative data were gathered from staff and stakeholders. OUTCOME: During the pilot period, there was a 49.2% response rate. Fifty respondents (53.8%) screened positive for trauma as recorded on the Criterion A portion. Seventeen (18.3%) were negative for trauma self-report, and 26 (30.0%) did not complete this portion. Fifty-six (60.2%) completed screens scored 33 or greater on the PCL-5 portion. Staff found the timing of administration convenient but expressed concern over emotional cost to patient. CONCLUSIONS: Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with Criterion A served as guidepost for trauma-informed assessment, treatment, and referrals. Future considerations may include timing of presentation to patient, electronic translation of the tool to facilitate interdisciplinary collaboration, and tracking of screening completion.


Assuntos
Programas de Rastreamento/métodos , Serviços de Saúde Mental/organização & administração , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/enfermagem , Adulto , Lista de Checagem , Manual Diagnóstico e Estatístico de Transtornos Mentais , Unidades Hospitalares , Hospitalização , Humanos , Mid-Atlantic Region , Enfermeiras Clínicas , Projetos Piloto , Melhoria de Qualidade
10.
Artigo em Russo | MEDLINE | ID: mdl-32678554

RESUMO

OBJECTIVE: To investigate the prevalence and symptoms of separation anxiety (SA) and separation anxiety disorder (SAD) in adult outpatients with non-psychotic mental disorders. MATERIAL AND METHODS: Five hundred and fifty-seven outpatients over 18 years of age with nonpsychotic mental disorders were examined. Clinical, psychopathological, psychometric (the Adult Separation Anxiety Questionnaire (ASA-27), the Structured Clinical Interview for Anxiety Symptoms (SCI-SAS), the Mini-International Neuropsychiatric Interview (MINI), the Quality of Life Enjoyment and Satisfaction Questionnaire (QLES-Q) methods were used. RESULTS AND CONCLUSION: SAD and SA accompany a wide range of nonpsychotic mental disorders, predominantly anxious and affective, and are highly prevalent among outpatients (24.8% and 5.4%, respectively). Patients with SAD are characterized by a high level of SA; the symptoms specific to SAD predominate in the structure of the disorder. It has been shown that during the manifestation of the disorder in childhood, the range of attachment objects widens with age, and the quality of life in such patients is lower.


Assuntos
Ansiedade de Separação , Pacientes Ambulatoriais , Adolescente , Adulto , Ansiedade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Prevalência , Qualidade de Vida
11.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(6. Vyp. 2): 5-12, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32729685

RESUMO

The concepts of schizophrenia and other primary psychotic disorders have been changed a lot since their beginnings more than century ago due to many factors such as the dominance of a certain hypothesis during a particular period of time, the development of new clinical research and specific treatments as well as different understanding of the boundaries between mental disorders. It was appeared the diagnosis of schizophrenia spectrum disorders which still based only on clinical symptoms. Whether psychotic disorders can be better represented dimensionally or categorically remains a challenging question. Regarding schizophrenia and other primary psychotic disorders, there are some important changes in DSM-5 and ICD-11 concerning the use of quantitative assessment of psychopathological domains, course of psychosis and remission as well as giving more attention to cognitive issues. The main differences between these classifications are the structure of corresponding sections and different criteria of some disorders. Before the ICD-11 implementation in 2022 into clinical practice, it is highly recommended to conduct a set of trainings for clinicians along with the comments to Diagnostic guidelines for Schizophrenia and other primary psychotic disorders.


Assuntos
Transtornos Psicóticos , Esquizofrenia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Classificação Internacional de Doenças , Psicopatologia
12.
Psychopathology ; 53(2): 103-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32610320

RESUMO

BACKGROUND: The diagnostic weight of the first-rank symptoms was deemphasized in DSM-5 and a similar change is expected in ICD-11. This change was motivated by a lack of solid, empirical evidence of the diagnostic significance of first-rank symptoms for schizophrenia. Yet, it seems that Schneider's original concept of first-rank symptoms was overly simplified when it was introduced in DSM-III. Specifically, it was overlooked that first-rank symptoms, in Schneider's understanding, fundamentally involve a disorder of the self. The aim here is to empirically test Schneider's claim that first-rank symptoms involve self-disorders. METHODS: In a modified, cross-sectional study of 98 first-admission patients, the relation between lifetime presence of first-rank symptoms and self-disorders was examined. Self-disorders were examined with the EASE (Examination of Anomalous Self-Experiences). RESULTS: We found an odds ratio of 1.56 (95% CI 1.10-2.21) for having first-rank symptoms for each 5-point increase in the EASE (measuring self-disorder) using a generalized linear mixed model regression. We did not find first-rank symptoms in the absence of self-disorders. CONCLUSION: The close relation between first-rank symptoms and self-disorders seems to support Schneider's original concept of first-rank symptoms. We suggest that first-rank symptoms occurring without the pervasively altered self-experiences might not be different from other psychotic phenomena in terms of their diagnostic significance. Awareness of self-disorders can help clinicians in assessing and detecting first-rank symptoms.


Assuntos
Transtornos Psicóticos/diagnóstico , Adulto , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino
13.
Psychopathology ; 53(2): 111-118, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645704

RESUMO

The presence of hoarding behavior among patients with schizophrenia has been known for more than a century. Nevertheless, only a few studies have examined the hoarding phenomenon among patients with schizophrenia, and no studies have examined the potential motivation. Hoarding disorder became a separate diagnosis in DSM-5. Studies about hoarding disorder use primarily quantitative approaches (e.g., scales, self-administered questionnaires, and structured interviews) when assessing the patients. The main objectives of this study were to examine the meaning of hoarding for patients with schizophrenia spectrum disorders and to explore associated psychopathology which may motivate the hoarding. We have examined 13 patients diagnosed with schizophrenia spectrum disorders showing hoarding behavior. The patients underwent semistructured, narrative interviews about the following domains: the time of onset of hoarding, the meaning of hoarding and associated psychopathology, the presence of insight into hoarding, and problematic issues about discarding. The study shows that hoarding begins very early in life for these patients and can be motivated by various psychopathologies. Diminished sense of basic self and transitivistic experiences were mentioned by several patients as motivations for collecting objects. Furthermore, the difficulty with discarding reflected a huge ambivalence and ruminations. Our findings suggest that thorough and comprehensive assessments of people with hoarding symptoms are necessary to assure the correct diagnosis and to understand the patient. An increased knowledge of the patients' motivations for hoarding behavior may also be useful for the treating personnel and may prevent social adversities. We think it is questionable that in the DSM-5 hoarding is not mentioned in the description of schizophrenia but has been elevated to a separate disorder.


Assuntos
Transtorno de Acumulação/psicologia , Esquizofrenia/complicações , Adulto , Idoso , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
PLoS One ; 15(6): e0233153, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32492037

RESUMO

Body dysmorphic disorder (BDD), together with its subtype muscle dysmorphia (MD), has been relocated from the Somatoform Disorders category in the DSM-IV to the newly created Obsessive-Compulsive and Related Disorders category in the DSM-5. Both categorizations have been criticized, and an empirically derived classification of BDD is lacking. A community sample of N = 736 participants completed an online survey assessing different psychopathologies. Using a structural equation modeling approach, six theoretically derived models, which differed in their allocation of BDD symptoms to various factors (i.e. general psychopathology, somatoform, obsessive-compulsive and related disorders, affective, body image, and BDD model) were tested in the full sample and in a restricted sample (n = 465) which indicated primary concerns other than shape and weight. Furthermore, measurement invariance across gender was examined. Of the six models, only the body image model showed a good fit (CFI = 0.972, RMSEA = 0.049, SRMR = 0.027, TLI = 0.959), and yielded better AIC and BIC indices than the competing models. Analyses in the restricted sample replicated these findings. Analyses of measurement invariance of the body image model showed partial metric invariance across gender. The findings suggest that a body image model provides the best fit for the classification of BDD and MD. This is in line with previous studies showing strong similarities between eating disorders and BDD, including MD. Measurement invariance across gender indicates a comparable presentation and comorbid structure of BDD in males and females, which also corresponds to the equal prevalence rates of BDD across gender.


Assuntos
Transtornos Dismórficos Corporais/classificação , Adolescente , Adulto , Idoso , Transtornos Dismórficos Corporais/epidemiologia , Transtornos Dismórficos Corporais/psicologia , Imagem Corporal , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Alemanha/epidemiologia , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Transtornos do Humor/psicologia , Transtorno Obsessivo-Compulsivo/psicologia , Prevalência , Psicopatologia , Transtornos Somatoformes/psicologia , Inquéritos e Questionários , Adulto Jovem
15.
Artigo em Russo | MEDLINE | ID: mdl-32490615

RESUMO

OBJECTIVE: To evaluate the level of adaptive functioning in patients with attention deficit hyperactivity disorder (ADHD). MATERIALS AND METHODS: One hundred children and adolescents with ADHD (79 male and 21 female) were examined using M. Weiss functional impairment rating scale (WFIRS). The total score on the ADHD-DSM-IV was at least 24 and ADHD severity was rated as «Moderately ill¼ or «Markedly ill¼ on CGI-S-ADHD scale. RESULTS: Typical for ADHD difficulties with adaptive functioning in «Family¼, «Learning and school¼, «Life skills¼, «Social activities¼ domains are more pronounced in «Markedly ill¼ patients compared to «Moderately ill¼ and increase during the transition from childhood to adolescence. Comorbid disorders (oppositional defiant disorder and anxiety disorders) lead to a significant increase in adaptive functioning impairments in most domains of daily life, including «Family¼, «Learning and school¼, «Child's self concept¼, «Social activities¼ and «Risky activities¼. CONCLUSION: It is necessary not only to assess core symptoms in the follow-up of patients with ADHD, but also evaluate comorbid disorders and the level of functional impairment across the main domains of daily life.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Adolescente , Transtornos de Ansiedade , Criança , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino
16.
Artigo em Inglês | MEDLINE | ID: mdl-32532077

RESUMO

Since December 2019, the COVID-19 pandemic has attracted worldwide attention for its rapid and exponential diffusion. The long-term psychological impact, of both the spread of the virus and the restrictive policies adopted to counteract it, remains uncertain. However, recent studies reported a high level of psychological distress and Post-Traumatic Stress Disorder (PTSD) symptoms. The purpose of this study is to assess the psychometric properties of a new questionnaire, to evaluate PTSD risk related to the COVID-19 emergency. A total of Italian people completed a web-based cross-sectional survey broadcasted through different social-media. Demographic data and some psychological dimensions, such as general distress and sleep disturbance, were collected. A new self-report questionnaire (COVID-19-PTSD), consisting of 19 items, was developed starting from the PTSD Check List for DSM-5 (PCL-5) questionnaire, and it was administered in order to analyze its psychometric properties. The results highlighted the adequate psychometric properties of the COVID-19-PTSD questionnaire. The confirmatory factor analysis indicated that a seven-factor model (Intrusion, Avoidance, Negative Affect, Anhedonia, Dysphoric arousal, Anxious arousal and Externalizing behavior) best fits the data. Significant correlations were found among COVID-19-PTSD scores, general distress and sleep disturbance. A high percentage of PTSD symptomatology (29.5%) was found in the Italian population. COVID-19-PTSD appears to be effective in evaluating the specific stress symptoms related to the COVID-19 pandemic in the Italian population. These results are relevant from a clinical point of view because they suggest that the COVID-19 pandemic could be considered as a traumatic event. Psychological interventions to counteract short- and long-term psychopathological effects, consequent to the COVID-19 pandemic, appear to be necessary.


Assuntos
Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Análise Fatorial , Humanos , Itália/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Prevalência , Transtornos de Estresse Pós-Traumáticos/classificação , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários
17.
PLoS One ; 15(6): e0233657, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32502221

RESUMO

BACKGROUND: Studies comparing prevalence of alcohol use disorder (AUD) using DSM-IV and DSM-5 diagnostic criteria in college students are limited. This study examines changes in AUD prevalence estimates using DSM-IV versus DSM-5 and characterizes the profile of DSM-5 "diagnostic orphans." METHODS AND FINDINGS: A college student sample (n = 1,155; mean age: 21 ±1.97) selected conveniently from six large private and public universities in Greater Beirut, Lebanon completed an anonymous survey in May 2016. The study response rate was 83.1%. Data on DSM-IV and DSM-5 AUD criteria were gathered from 582 past-year drinkers, of which 377 (65%) were screened to have DSM-IV abuse/dependence, and 203 (35%) to have any DSM-5 AUD (58% mild, 21% moderate, and 21% severe). Overall percent agreement between measures was 68% (kappa = 0.41). One hundred and ninety-one students met one DSM-5 AUD criterion only (i.e. "diagnostic orphans," herein DOs), of which the majority (82%) endorsed "hazardous use." Compared to past-year drinkers with zero-endorsed DSM-5 criteria, DOs were more likely to be aged 21 or above [OR = 1.57(1.21-2.03)], less likely to perceive their socioeconomic status (SES) as poorer vs. same as others [OR = 0.17(0.07-0.43)], more likely to drink 1-2 times/week vs. ≤3 times per month [OR = 2.24(1.44-3.49)], and more likely to report past-year cigarette smoking [OR = 2.16(1.10-4.24)]. When compared to past-year drinkers with DSM-5 AUD, DOs were more likely to be pursuing a graduate or medical degree (vs. undergraduate degree) [2.06 (1.09-3.89)], and to be living with parents most of the time vs. not [OR = 2.68(1.14-6.31)]. DOs (versus drinkers with AUD) were less likely to drink at a high frequency (3-4 times /week or more vs.≤3 times per month) [OR = 0.15(0.05-0.48)], and to report past-year waterpipe smoking [OR = 0.54(0.34-0.85)], but more likely to report past-year marijuana use [1.89(1.10-3.23)]. The findings are subject to recall bias and under-reporting and the study could not infer causality because temporality of associations cannot be established in a cross-sectional study design. CONCLUSIONS: DSM-IV abuse/dependence prevalence rate was higher than DSM-5 AUD prevalence mainly due to the high percentage of students who engaged in "hazardous use". The DO screen might capture a young person in transition between non-drinking/occasional drinking to drinking frequently/developing an AUD. The prevention, identification, and management of DOs may be critical components of a national alcohol harm-reduction policy.


Assuntos
Alcoolismo/classificação , Alcoolismo/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Política de Saúde , Humanos , Líbano/epidemiologia , Masculino , Prevalência , Estudantes , Adulto Jovem
19.
Compr Psychiatry ; 100: 152177, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360141

RESUMO

BACKGROUND: To prevent negative effects of early-onset psychiatric disorders on children's development, structured diagnostics are needed. However, validated diagnostic instruments (based on DSM-5) for children aged 7 years and younger are scarce. The Diagnostic Infant and Preschool Assessment (DIPA) is a diagnostic interview developed in the USA for measuring 16 psychiatric disorders in young children. The psychometric properties of the American version of the DIPA have been validated. Here we determined the accuracy of the psychometric properties of the Dutch DSM-5 based version of the DIPA for the corresponding population. MATERIAL AND METHODS: Psychometric properties of the DSM-5 based version of the DIPA were determined based on a sample of 136 biological, foster, therapeutic foster and adoptive parents of clinically referred children and children involved in a serious accident (aged 1-7 years). In line with the American validation study, we included the following seven DIPA modules: posttraumatic stress disorder (PTSD), major depressive disorder (MDD), attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), separation anxiety disorder (SAD), generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD). We administered the DIPA, Trauma Symptom Checklist for Young Children (TSCYC) and Child Behavior Checklist (CBCL). Analyses were conducted with continuous outcomes (number of symptoms) and categorical outcomes (diagnoses). RESULTS: The Dutch DSM-5 based version of the DIPA showed good internal consistency and interrater reliability with both continuous and categorical variables. The concurrent validity was good; we found a good concordance between the DIPA and corresponding questionnaires on both the symptom and diagnoses level. In addition, the divergence on symptom level between the DIPA and non-corresponding questionnaires was adequate, which indicated adequate divergent validity. Due to a limited number of positive cases, we could not draw conclusions regarding its psychometric properties in the GAD and OCD modules. CONCLUSIONS: Our study shows promising initial results regarding the reliability and validity of the Dutch version of the DIPA, that is based on the DSM-5. Therefore, we recommend the use of the DIPA in research and clinical practice.


Assuntos
Transtornos Mentais/diagnóstico , Escalas de Graduação Psiquiátrica/normas , Psicometria/estatística & dados numéricos , Inquéritos e Questionários/normas , Criança , Pré-Escolar , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Lactente , Entrevista Psicológica , Estudos Longitudinais , Masculino , Psiquiatria/métodos , Reprodutibilidade dos Testes
20.
Lancet Psychiatry ; 7(6): 515-527, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32445690

RESUMO

BACKGROUND: Several small studies suggest that the adjunctive use of anti-inflammatory agents might improve depressive symptoms in bipolar disorder. However, there are few well designed, appropriately powered clinical trials assessing the efficacy of these novel treatment strategies. We aimed to assess the efficacy of adjunctive minocycline or celecoxib in this setting. METHODS: This double-blind, 12-week, randomised, placebo-controlled trial was done in four outpatient psychiatric clinics in Pakistan. Eligible participants were adults (aged 18-65 years) with DSM-5 bipolar disorder (type I or II) and a major depressive episode. In a 2 × 2 factorial design, participants were randomly assigned (1:1:1:1) to receive either active minocycline plus active celecoxib, active minocycline plus placebo celecoxib, placebo minocycline plus active celecoxib, or placebo minocycline plus placebo celecoxib. The primary outcome was the mean change from baseline to week 12 in score on the 17-item Hamilton Depression Rating Scale (HAMD-17), assessed in all randomised participants (missing data were imputed and assumed to be missing at random). The trial was registered with ClinicalTrials.gov, NCT02703363. FINDINGS: 266 (17%) of 1542 patients assessed between May 1, 2016, and March 31, 2019, were randomly assigned to receive minocycline plus celecoxib (n=68), minocycline plus placebo (n=66), celecoxib plus placebo (n=66), or placebo plus placebo (n=66). From baseline to week 12, depressive symptoms as per HAMD-17 reduced in all four groups (from 24·5-25·2 to 11·3-12·8), but these reductions did not differ significantly between the groups. In terms of main effects, reductions in HAMD-17 did not differ for patients treated with minocycline (mean adjusted difference vs non-minocycline 1·48 [95% CI -0·41 to 3·36]; p=0·123) or for celecoxib (mean adjusted difference vs non-celecoxib -0·74 [-2·61 to 1·14]; p=0·443). Rates of serious adverse effects did not differ between groups (31 participants had a manic switch, two self-harmed, and one died in a motor vehicle accident). INTERPRETATION: We found no evidence that minocycline or celecoxib was superior to placebo for the treatment of bipolar depression. This large trial casts doubt on the potential therapeutic benefits of adjunctive anti-inflammatory drugs for the acute management of bipolar depression. FUNDING: Stanley Medical Research Institute.


Assuntos
Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Celecoxib/uso terapêutico , Minociclina/uso terapêutico , Adulto , Antibacterianos/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Transtorno Bipolar/psicologia , Estudos de Casos e Controles , Celecoxib/administração & dosagem , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minociclina/administração & dosagem , Paquistão/epidemiologia , Placebos/administração & dosagem , Escalas de Graduação Psiquiátrica , Resultado do Tratamento
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