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1.
Adv Exp Med Biol ; 1192: 17-25, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705488

RESUMO

Because of the poor link between psychiatric diagnosis and neurobiological findings, it is difficult to classify mental disorders. The changes made to psychiatric diagnostic systems over the years can be understood in terms of "practical conservatism." The Diagnostic and Statistical Manual of Mental Disorders (DSM)-I and DSM-II were theoretically supported by the psychoanalytic and psychodynamic approach. Subsequently, psychiatric diagnoses of this kind were opposed by the anti-psychiatry movement, as well as by the findings of the Rosenhan experiment. Thus, the DSM-III revolution contained more empiricism, aligning psychiatry with biomedicine. Psychiatric diagnoses are classified and defined in terms of Kraepelinian dualism, using a categorical approach. The empirical trend was continued in the DSM-IV. To overcome the limitations of current psychiatric diagnostic systems and integrate fundamental genetic, neurobiological, behavioral, environmental, and experimental components into psychiatry, the Research Domain Criteria (RDoC) were established. To overcome the limitations of the categorical approach, psychiatrists have considered adopting a dimensional approach. However, their efforts were frustrated in the DSM-5 revision process. Thus, the DSM-5 is characterized by the rearrangement of psychiatric diagnoses, the partial adoption of a dimensional approach, the introduction of new diagnoses, and harmonization with the International Classification of Diseases.


Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos Mentais/classificação , Transtornos Mentais/psicologia , Psiquiatria , Humanos , Classificação Internacional de Doenças , Neurobiologia
4.
Lancet Psychiatry ; 6(9): 778-785, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31296444

RESUMO

Developed in collaboration with WHO Department of Mental Health and Substance Abuse, this study (conducted in India, the UK, and the USA) integrated feedback from mental health service users into the development of the chapter on mental, behavioural, and neurodevelopmental disorders for ICD-11. The ICD-11 will be used for health reporting from January, 2022. As a reporting standard and diagnostic classification system, ICD-11 will be highly influential by informing policy, clinical practice, and research that affect mental health service users. We report here the first study to systematically seek and collate service user perspectives on a major classification and diagnostic guideline. Focus groups were used to collect feedback on five diagnoses: depressive episode, generalised anxiety disorder, schizophrenia, bipolar type 1 disorder, and personality disorder. Participants were given the official draft diagnostic guidelines and a parallel lay translation. Data were then thematically analysed, forming the basis of co-produced recommendations for WHO, which included features that could be added or revised to better reflect lived experience and changes to language that was confusing or objectionable to service users. The findings indicated that an accessible lay language version of the ICD-11 could be beneficial for service users and their supporters.


Assuntos
Grupos Focais/métodos , Classificação Internacional de Doenças/normas , Transtornos Mentais/diagnóstico , Serviços de Saúde Mental/organização & administração , Organização Mundial da Saúde/organização & administração , Transtornos de Ansiedade/classificação , Transtornos de Ansiedade/diagnóstico , Transtorno Bipolar/classificação , Transtorno Bipolar/diagnóstico , Transtorno Depressivo/classificação , Transtorno Depressivo/diagnóstico , Estudos de Avaliação como Assunto , Feminino , Guias como Assunto , Humanos , Índia/epidemiologia , Masculino , Transtornos Mentais/classificação , Transtornos Mentais/psicologia , Serviços de Saúde Mental/normas , Transtornos da Personalidade/classificação , Transtornos da Personalidade/diagnóstico , Esquizofrenia/classificação , Esquizofrenia/diagnóstico , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
6.
BMC Psychol ; 7(1): 46, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291999

RESUMO

BACKGROUND: A taxonomy of the objects of study, theory, assessment, and intervention is critical to the development of all clinical sciences. Clinical psychology has been conceptually and administratively dominated by the taxonomy of an adjacent discipline - psychiatry's Diagnostic and statistical manual of mental disorders (DSM). Many have called for a 'paradigm shift' away from a medical nosology of diseases toward clinical psychology's own taxonomy of clinical psychological problems (CPPs), without being able to specify what is to be listed and classified. MAIN TEXT: An examination of DSM's problems for clinical psychology, especially its lack of clinical utility, and a search for the essence of CPPs in what clinical psychologists actually do, leads to the proposal that: The critical psychological-level phenomenon underlying CPPs is the occurrence of 'problem-maintaining circles' (PMCs) of causally related cognitions, emotions, behaviours, and/or stimuli. This concept provides an empirically-derived, theory-based, treatment-relevant, categorical, essentialist, parsimonious, and nonstigmatizing definition of CPPs. It distinguishes psychological problems in which PMCs have not (yet?) formed, and which may respond to 'counseling', clinical psychological problems in which active PMCs require clinical intervention, and psychopathological problems which are unlikely to be 'cured' by PMC-breaking alone. CONCLUSION: A subsequent classification and coding system of PMCs is proposed, and expected benefits to research, communication, and the quality of case formulation in clinical psychology are described, reliant upon a development effort of some meaningful fraction of that which has been devoted to the DSM.


Assuntos
Transtornos Mentais/classificação , Transtornos Mentais/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Classificação Internacional de Doenças , Transtornos Mentais/psicologia , Psiquiatria/normas
7.
Rev. pesqui. cuid. fundam. (Online) ; 11(4): 1096-1102, jul.-set. 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1005467

RESUMO

Objetivo: Compreender os riscos e os mecanismos de enfrentamento apresentados pelas puérperas diante dos transtornos mentais no pós-parto. Métodos: Pesquisa qualitativa, de caráter descritivo, realizada com 12 puérperas, na faixa etária de 16 a 35 anos, que fizeram o acompanhamento do pré-natal na unidade de Atendimento Multiprofissional Especializado em Petrolina/PE, por meio de entrevista semiestruturada e observação dos conteúdos implícitos no comportamento das puérperas. A coleta dos dados ocorreu em novembro e dezembro de 2016. Resultados: Identificou-se que fatores como gravidez precoce ou não planejada, carência de apoio do companheiro, instabilidade familiar e baixas condições socioeconômicas podem contribuir como agentes facilitadores no surgimento de algum transtorno mental na puérpera. Conclusão: Considerando que os transtornos mentais são comuns no puerpério, quanto mais precocemente detectar os fatores de risco, melhor assistência poderá ser oferecida à puérpera


Objective: To understand the risks and coping mechanisms presented by puerperal women in the face of postpartum mental disorders. Methods: A descriptive qualitative study was carried out with twelve puerperae, in the age group of 16 to 35 years old who underwent prenatal follow-up at the Multiprofessional Specialized Care Unit in Petrolina-PE, through a semi-structured interview and observation of the contents implicit in the behavior of puerperal women. Data collection took place in November and December 2016. Results: It was identified that factors such as early or unplanned pregnancy, lack of support from the partner, family instability and low socioeconomic conditions can contribute as facilitating agents in the emergence of some mental disorder in the puerpera. Conclusion: Considering that chronic disorders are common in the puerperium, the earlier the risk factors are detected, the better care can be given to the woman


Objetivo: Comprender los riesgos y mecanismos de enfrentamiento presentados por las puérperas ante los trastornos mentales en el posparto. Métodos: Investigación cualitativa, de carácter descriptivo, realizada con doce puérperas, en el grupo de edad de 16 a 35 años que hicieron el seguimiento del prenatal en la unidad de Atención Multiprofesional Especializado en Petrolina-PE, por medio de entrevista semiestructurada y observación de los contenidos implícitos en el comportamiento de las puérperas. La recolección de los datos ocurrió en noviembre y diciembre de 2016. Resultados: Se identificó que factores como embarazo precoz o no planificado, carencia de apoyo del compañero, inestabilidad familiar y bajas condiciones socioeconómicas pueden aportar como agentes facilitadores en el surgimiento de algún trastorno mental en la puérpera. Conclusión: Considerando que los trastornos mentales son comunes en el puerperio, cuanto más precozmente detecte los factores de riesgo, mejor asistencia podrá ser ofrecida a la puérpera


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adolescente , Adulto , Depressão Pós-Parto/prevenção & controle , Depressão Pós-Parto/psicologia , Período Pós-Parto/psicologia , Transtornos Mentais/classificação , Transtornos Mentais/etiologia
8.
Tijdschr Psychiatr ; 61(5): 305-316, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31180569

RESUMO

BACKGROUND: Severe mental illnesses (SMI) are associated with high mental healthcare and other healthcare costs. In 2012, mental healthcare labels were developed to create more transparency between insurance companies, municipalities, and mental healthcare. The labels are based on care intensity, and should provide a regional overview of the present groups of patients with SMI.
AIM: Explore the functionality and validity of the used labels in relation to needs for care and psychosocial functioning.
METHOD: The ROM data (needs for care, functioning) from 706 patients were tested per label by Chi-square tests and ANOVAs. For two high complex labels (alarming care avoiders and persons with safety risks), repeated measures ANOVAs and McNemar tests were used to analyse changes in functioning and needs over time.
RESULTS: To a limited extent, the labels were distinctive in care needs and functioning. The most restrictions in functioning and (unfulfilled) needs were present in the labels 'alarming care avoiders' and 'avoiding danger'. These findings were stable over time.
CONCLUSION: The labels are not sufficiently distinctive. To enhance regional care planning, it is desirable to combine existing information on healthcare labels with information on care needs and functioning. KEY WORDS functioning, mental healthcare labels, needs for care, routine outcome monitoring, severe mental illness.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Reembolso de Seguro de Saúde , Transtornos Mentais/classificação , Humanos , Escalas de Graduação Psiquiátrica
10.
J Med Syst ; 43(7): 204, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31139933

RESUMO

A psychological disorder is a mutilation state of the body that intervenes the imperative functioning of the mind or brain. In the last few years, the number of psychological disorders patients has been significantly raised. This paper presents a comprehensive review of some of the major human psychological disorders (stress, depression, autism, anxiety, Attention-deficit hyperactivity disorder (ADHD), Alzheimer, Parkinson, insomnia, schizophrenia and mood disorder) mined using different supervised and nature-inspired computing techniques. A systematic review methodology based on three-dimensional search space i.e. disease diagnosis, psychological disorders and classification techniques has been employed. This study reviews the discipline, models, and methodologies used to diagnose different psychological disorders. Initially, different types of human psychological disorders along with their biological and behavioural symptoms have been presented. The racial effects on these human disorders have been briefly explored. The morbidity rate of psychological disordered Indian patients has also been depicted. The significance of using different supervised learning and nature-inspired computing techniques in the diagnosis of different psychological disorders has been extensively examined and the publication trend of the related articles has also been comprehensively accessed. The brief details of the datasets used in mining these human disorders have also been shown. In addition, the effect of using feature selection on the predictive rate of accuracy of these human disorders is also presented in this study. Finally, the research gaps have been identified that witnessed that there is a full scope for diagnosis of mania, insomnia, mood disorder using emerging nature-inspired computing techniques. Moreover, there is a need to explore the use of a binary or chaotic variant of different nature-inspired computing techniques in the diagnosis of different human psychological disorders. This study will serve as a roadmap to guide the researchers who want to pursue their research work in the mining of different psychological disorders.


Assuntos
Encefalopatias/diagnóstico , Encefalopatias/fisiopatologia , Transtornos Mentais/diagnóstico , Transtornos Mentais/fisiopatologia , Aprendizado de Máquina Supervisionado , Comportamento , Encefalopatias/classificação , Mineração de Dados , Emoções , Humanos , Relações Interpessoais , Transtornos Mentais/classificação
11.
Med Hypotheses ; 126: 69-77, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31010503

RESUMO

The current diagnostic classification systems in psychiatry have been developed primarily for evidence-based clinical decision making with both categorical and dimensional approaches having their own advantages and disadvantages. Efforts have been made to improve these classification systems, and we are now at the point where we must expand beyond the one-dimensionality of these systems. In this paper, we propose that psychiatric disorders can be arranged in a three-dimensional classification system according to the degree of dysfunctions on three specific axes in a way that is similar to the arrangement of chemical elements according to their atomic weights in Mendeleyev's periodic table. For the three axes, we chose externalization, drive, and attention to represent the three-dimensional descriptions of mental health, namely, well-being in social, motivational, and cognitive areas, respectively. Throughout the paper, we explain our reasons for choosing these three axes and compare our hypothesis with categorical diagnostic systems as well as Cloninger's dimensional diagnostic system using personality disorders, affective disorders, and schizophrenia as the specific diagnostic samples.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Transtornos Mentais/classificação , Transtornos Mentais/diagnóstico , Transtornos Mentais/fisiopatologia , Mães , Psiquiatria/normas , Adulto , Algoritmos , Atenção , Cognição , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Homeostase , Humanos , Lactente , Recém-Nascido , Saúde Mental , Transtornos do Humor/diagnóstico , Motivação , Relações Pais-Filho , Personalidade , Transtornos da Personalidade/classificação , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/fisiopatologia , Psiquiatria/métodos , Esquizofrenia/diagnóstico , Comportamento Social
14.
Int J Radiat Oncol Biol Phys ; 104(4): 748-755, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-30904707

RESUMO

PURPOSE: The impact of psychiatric comorbidities on the cost of cancer care in radiation oncology practices is not well studied. We assessed the acute and 24-month follow-up costs for patients with and without pre-existing psychiatric comorbidities undergoing radiation therapy. METHODS AND MATERIALS: Patients with cancer undergoing radiation therapy at our institution from 2009 to 2014 were denoted as having pre-existing psychiatric conditions (Psych group) if they had associated billing codes for any of the 422 International Classification of Diseases, 9th revision psychiatric conditions during the 12 months before their cancer diagnosis. The Elixhauser comorbidity index was calculated, excluding psychiatric categories. Medicare reimbursement was assigned to professional services, and Medicare departmental cost-to-charge ratios were applied to service line hospital charges and adjusted for inflation to create 2017 standardized costs. Acute (0-6 month) and follow-up (6-24 month) costs were subcategorized into clinic, emergency department, hospital inpatient, and outpatient costs. RESULTS: Among 1275 patients, 126 (9.9%) had at least 1 pre-existing psychiatric diagnosis. On univariate analysis, both acute and long-term costs were higher in the Psych group. The largest significant differences in costs were follow-up hospital inpatient costs ($5861 higher; 95% confidence interval [CI], $687-$11,035; P = .002), follow-up hospital outpatient costs ($2086 higher; 95% CI, -$142 to $4,314; P = .040), and follow-up emergency department costs ($396 higher; 95% CI, $149-$643; P < .001). Age, race, sex, and treatment modalities were comparable, but the Psych group patients had more median comorbidities (2 vs 1) and had more respiratory cancer diagnoses than the nonpsychiatric group (31% vs 17%). On multivariate analysis adjusted for age, sex, cancer diagnosis, and comorbidities, global follow-up costs remained 150% higher in the Psych group (P < .001). Acute costs were similar after adjustment (P = .63). CONCLUSIONS: Psychiatric comorbidities independently predict elevated healthcare costs in patients treated for cancer. Radiation oncology payment models should consider adjustments to account for psychiatric comorbidities because addressing these may mitigate cost differential.


Assuntos
Assistência ao Convalescente/economia , Custos de Cuidados de Saúde , Transtornos Mentais/economia , Neoplasias/radioterapia , Cobertura de Condição Pré-Existente/economia , Idoso , Análise de Variância , Comorbidade , Intervalos de Confiança , Custos e Análise de Custo , Feminino , Custos Hospitalares , Humanos , Estimativa de Kaplan-Meier , Masculino , Medicare/economia , Transtornos Mentais/classificação , Transtornos Mentais/mortalidade , Neoplasias/economia , Neoplasias/mortalidade , Cobertura de Condição Pré-Existente/classificação , Taxa de Sobrevida , Estados Unidos
15.
Perspect Psychol Sci ; 14(3): 419-436, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30844330

RESUMO

For more than a century, research on psychopathology has focused on categorical diagnoses. Although this work has produced major discoveries, growing evidence points to the superiority of a dimensional approach to the science of mental illness. Here we outline one such dimensional system-the Hierarchical Taxonomy of Psychopathology (HiTOP)-that is based on empirical patterns of co-occurrence among psychological symptoms. We highlight key ways in which this framework can advance mental-health research, and we provide some heuristics for using HiTOP to test theories of psychopathology. We then review emerging evidence that supports the value of a hierarchical, dimensional model of mental illness across diverse research areas in psychological science. These new data suggest that the HiTOP system has the potential to accelerate and improve research on mental-health problems as well as efforts to more effectively assess, prevent, and treat mental illness.


Assuntos
Transtornos Mentais/classificação , Projetos de Pesquisa , Heurística , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/prevenção & controle , Transtornos Mentais/terapia , Modelos Teóricos , Terminologia como Assunto
16.
Isr J Health Policy Res ; 8(1): 9, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30704513

RESUMO

BACKGROUND: Restraint or seclusion measures in acute psychiatric care are used as a last resort when all other methods for removal of physical threat have failed. The purpose of this study is to find a correlation between coercive measures, demographic characteristics within this patient group, and factors associated with shortened periods of restriction. METHODS: This is a one-year retrospective study conducted in a male acute closed ward of a psychiatric hospital in Israel. The data from January 1, 2014 to December 31, 2014 were retrieved from the records of patients who underwent restraint and/or seclusion interventions during this period. The analyzed data included age, psychiatric diagnosis, marital status, education, race, ethnicity, length of hospital stay, legal status during admission, type of coercive measure (mechanical restraint, seclusion), number and duration of coercive episodes, reasons for coercion, time of event, number of previous hospitalizations, aggression in past and present treatment, and treatment during events. RESULTS: During this time period, there were 563 admissions in the study ward. Over this period, 176 subjects (31.3%) underwent 488 restraints and/or seclusions. 98% were aggressive in the past. (Although some results reached statistical significance, we prefer to emphasize here only the most important results, while the others will be presented in the text.) Patients with personality disorders were physically limited for the longest time, while schizophrenia patients were restricted for the shortest time compared with other diagnoses (p = 0.007). A negative correlation was found between the length of coercion and the number of academic female nurses on duty (p = 0.005), as well as the administration of sedative medications during the restricting procedure. CONCLUSIONS: We believe that the presence of registered, academic female nurses on duty and medication administration during coercive measures can reduce the length of restriction.


Assuntos
Transtornos Mentais/classificação , Isolamento de Pacientes/estatística & dados numéricos , Restrição Física/estatística & dados numéricos , Adolescente , Adulto , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Israel/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Estatísticas não Paramétricas
18.
Occup Environ Med ; 76(4): 230-235, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30674604

RESUMO

OBJECTIVE: This study examined the associations between changes in common mental disorders (CMD) and subsequent diagnosis-specific sickness absence (SA) among midlife and ageing municipal employees. METHODS: Data from the Helsinki Health Study phase I (2000-2002) and phase II (2007) surveys among employees of the City of Helsinki, Finland, were linked with prospective register data from the Social Insurance Institution of Finland on diagnosis-specific (mental, musculoskeletal, other causes) SA (n=3890). Associations between change in CMD (General Health Questionnaire 12) from phase I to phase II and the first SA event in 2007-2014 were analysed using Cox regression modelling. Sociodemographic, work and health-related covariates from phase I, and SA from the year preceding phase I were controlled for. RESULTS: Having CMD at one or two time points, that is, favourable and unfavourable change in CMD and repeated CMD, were all associated with a higher risk of SA due to mental, musculoskeletal and other diagnoses compared with women and men with no CMD. Favourable change in CMD reduced the risk of SA when compared with repeated CMD. The strongest associations were observed for repeated CMD (HR range: 1.44 to 5.05), and for SA due to mental diagnoses (HR range: 1.15 to 5.05). The associations remained after adjusting for the covariates. CONCLUSIONS: Changing and repeated CMD increased the risk of SA due to mental, musculoskeletal and other diagnoses. CMD should be tackled to prevent SA and promote work-ability among ageing employees.


Assuntos
Absenteísmo , Empregados do Governo/psicologia , Transtornos Mentais/classificação , Adulto , Feminino , Finlândia , Seguimentos , Empregados do Governo/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Inquéritos e Questionários
19.
Eur Psychiatry ; 57: 58-60, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30677549

RESUMO

In this article we aim at conceptual reconstruction of the historical background behind RDoC project. It incorporates some elements that have not heretofore been included in frameworks for psychopathology research. At the same time, however, RDoC - like any approach to mental illness - must grapple with longstanding challenges in addressing issues about the roles and relationships of mind, brain, and patients' reports in considering the nature of disorder. In this respect, the historical roots of psychopathology remain as relevant as ever.


Assuntos
Transtornos Mentais/classificação , Psiquiatria/normas , Psicopatologia/normas , Humanos , National Institute of Mental Health (U.S.) , Projetos de Pesquisa , Estados Unidos
20.
Pharmacopsychiatry ; 52(4): 175-179, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29791934

RESUMO

INTRODUCTION: While the current nomenclature of psychotropic drugs is disease-based, their approved indications do not always match their classifications. METHODS: Information on approved indications of "second-generation antipsychotics" and "newer antidepressants" that are available in the United States (US), the United Kingdom (UK), France, Germany, and Japan were extracted from their packet inserts. RESULTS: A significant proportion of "atypical antipsychotics" were approved for psychiatric conditions other than psychotic disorders (i. e., bipolar disorder, major depressive disorder, and autistic disorder) as follows: 76.9% in the US, 66.7% in the UK, 66.7% in France, 60.0% in Germany, and 44.4% in Japan. Likewise, more than half of "newer antidepressants" had approved indications for psychiatric conditions other than depression (e. g., panic disorder, obsessive compulsive disorder, social anxiety disorder, general anxiety disorder, and post-traumatic stress disorder): 56.3% in the US, 69.2% in the UK, 69.2% in France, 50.0% in Germany, and 62.5% in Japan. CONCLUSIONS: Our results raise concerns regarding generic terminologies of "antipsychotics" and "antidepressants" since the conventional indication-based nomenclature does not fit well with the official indication.


Assuntos
Antidepressivos/classificação , Antipsicóticos/classificação , Transtornos Mentais/classificação , Transtornos Mentais/tratamento farmacológico , Terminologia como Assunto , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Aprovação de Drogas , Humanos , Uso Off-Label
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