The unintended consequences following what we thought was a small wording change provide a cautionary tale for DSM-V The mistake arose from the decision to add the following criterion to most ...disorders in DSM-IV: "the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning."
Saving PTSD from itself in DSM-V Spitzer, Robert L; First, Michael B; Wakefield, Jerome C
Journal of anxiety disorders,
01/2007, Letnik:
21, Številka:
2
Journal Article
Recenzirano
Abstract Papers in this special issue of the Journal of Anxiety Disorders concern critical issues and core assumptions that underlie the diagnostic construct of posttraumatic stress disorder. Rather ...than addressing specific points raised in these papers, we consider the issues and their implications for redefining PTSD and associated disorders in the DSM-V. Specific proposals are advanced to tighten definitional criteria for traumatic events and posttraumatic symptoms. We believe the more stringent criteria express the intent of the PTSD category and will promote more effective research on whether that intent was legitimate or based on misconceptions.
We report on a global survey of diagnosing mental health professionals, primarily psychiatrists, conducted as a part of the development of the ICD‐11 mental and behavioural disorders classification. ...The survey assessed these professionals' use of various components of the ICD‐10 and the DSM, their attitudes concerning the utility of these systems, and usage of “residual” (i.e., “other” or “unspecified”) categories. In previous surveys, most mental health professionals reported they often use a formal classification system in everyday clinical work, but very little is known about precisely how they are using those systems. For example, it has been suggested that most clinicians employ only the diagnostic labels or codes from the ICD‐10 in order to meet administrative requirements. The present survey was conducted with clinicians who were members of the Global Clinical Practice Network (GCPN), established by the World Health Organization as a tool for global participation in ICD‐11 field studies. A total of 1,764 GCPN members from 92 countries completed the survey, with 1,335 answering the questions with reference to the ICD‐10 and 429 to the DSM (DSM‐IV, DSM‐IV‐TR or DSM‐5). The most frequent reported use of the classification systems was for administrative or billing purposes, with 68.1% reporting often or routinely using them for that purpose. A bit more than half (57.4%) of respondents reported often or routinely going through diagnostic guidelines or criteria systematically to determine whether they apply to individual patients. Although ICD‐10 users were more likely than DSM‐5 users to utilize the classification for administrative purposes, other differences were either slight or not significant. Both classifications were rated to be most useful for assigning a diagnosis, communicating with other health care professionals and teaching, and least useful for treatment selection and determining prognosis. ICD‐10 was rated more useful than DSM‐5 for administrative purposes. A majority of clinicians reported using “residual” categories at least sometimes, with around 12% of ICD‐10 users and 19% of DSM users employing them often or routinely, most commonly for clinical presentations that do not conform to a specific diagnostic category or when there is insufficient information to make a more specific diagnosis. These results provide the most comprehensive available information about the use of diagnostic classifications of mental disorders in ordinary clinical practice.
•Early childhood adversities are linked with PD symptoms in adulthood.•Malnutrition is linked with paranoid, schizoid, avoidant, and dependent PDs.•Maltreatment is linked with paranoid, schizoid, ...avoidant, and schizotypal PDs.•Overall, those exposed to both adversities had even higher PD scores.•Interventions should focus on immediate and long-term outcomes.
Both childhood malnutrition and maltreatment are associated with mental health problems that can persist into adulthood. Previously we reported that in Barbados, those with a history of infant malnutrition were more likely to report having experienced childhood maltreatment. Few studies, however, address the long-term outcomes of those who have been exposed to both. We assessed the unique and combined associations of a history of early malnutrition and childhood maltreatment with personality pathology in mid-adulthood in participants of the 47-year longitudinal Barbados Nutrition Study. We used the Structured Clinical Interview for DSM-IV-TR Axis II Personality Disorders Personality Questionnaire (SCID-II-PQ) and NEO Personality Inventory-Revised derived Five-Factor Model (NEO PI-R FFM) personality disorder (PD) scores to assess personality pathology, the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to assess childhood maltreatment, and clinical documentation of malnutrition in infancy. We tested the associations of malnutrition and maltreatment with PD scores using linear regression models, unadjusted and adjusted for other childhood adversities. We found increased scores for paranoid, schizoid, avoidant, and dependent PDs among those who had been malnourished and increased scores for paranoid, schizoid, schizotypal, and avoidant PDs among those with higher childhood maltreatment scores. Overall, those exposed to both adversities had even greater PD scores.
ABSTRACTThe novel coronavirus pandemic and the resulting expanded use of telemedicine have temporarily transformed community-based care for individuals with serious mental illness (SMI), challenging ...traditional treatment paradigms. We review the rapid regulatory and practice shifts that facilitated broad use of telemedicine, the literature on the use of telehealth and telemedicine for individuals with SMI supporting the feasibility/acceptability of mobile interventions, and the more limited evidence-based telemedicine practices for this population. We provide anecdotal reflections on the opportunities and challenges for telemedicine drawn from our daily experiences providing services and overseeing systems for this population during the pandemic. We conclude by proposing that a continued, more prominent role for telemedicine in the care of individuals with SMI be sustained in the post-coronavirus landscape, offering future directions for policy, technical assistance, training, and research to bring about this change.
Objectives
Lifetime DSM‐5 diagnoses generated by the lay‐administered Composite International Diagnostic Interview for DSM‐5 (CIDI) in the World Mental Health Qatar (WMHQ) study were compared to ...diagnoses based on blinded clinician‐administered reappraisal interviews.
Methods
Telephone follow‐up interviews used the non‐patient edition of the Structured Clinician Interview for DSM‐5 (SCID) oversampling respondents who screened positive for five diagnoses in the CIDI: major depressive episode, mania/hypomania, panic disorder, generalized anxiety disorder, and obsessive‐compulsive disorder. Concordance was also examined for a diagnoses of post‐traumatic stress disorder based on a short‐form versus full version of the PTSD Checklist for DSM‐5 (PCL‐5).
Results
Initial CIDI prevalence estimates differed significantly from the SCID for most diagnoses (χ12 ${\chi }_{1}^{2}$ = 6.6–31.4, p = 0.010 < 0.001), but recalibration reduced most of these differences and led to consistent increases in individual‐level concordance (AU‐ROC) from 0.53–0.76 to 0.67–0.81. Recalibration of the short‐form PCL‐5 removed an initially significant difference in PTSD prevalence with the full PCL‐5 (from χ12 ${\chi }_{1}^{2}$ = 610.5, p < 0.001 to χ12 ${\chi }_{1}^{2}$ = 2.5, p = 0.110) while also increasing AU‐ROC from 0.76 to 0.81.
Conclusions
Recalibration resulted in valid diagnoses of common mental disorders in the Qatar National Mental Health Survey, but with inflated prevalence estimates for some disorders that need to be considered when interpreting results.
PURPOSE OF REVIEWThe Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 revision is underway. The review examines draft proposals for changes in mood disorders (posted February 2010 on ...DSM-5 web site), explains their rationale, and considers relative costs vs. benefits.
RECENT FINDINGSProposals covered include recommendation for a comorbid anxiety dimension; addition of a new disorder, mixed anxiety depression; replacement of mixed manic episodes with a ‘mixed features’ specifier applicable to manic, hypomanic, and major depressive episodes; addition of severity dimensions for manic and major depressive episodes; and removal of the bereavement exclusion in major depressive episode. Although some proposals (particularly the anxiety dimension and the use of Patient Health Questionnaire-9 (PHQ-9) as depression severity dimension) may improve clinical and research utility, others have a high potential for false positives (e.g., addition of mixed anxiety depression, removal of bereavement exclusion), unclear clinical utility (e.g., mixed features specifier for depressive episodes), or problematic implementation (e.g., use of Clinical Global Impression (CGI), which requires prior experience of treating bipolar patients, for rating manic episode severity).
SUMMARYA cost–benefit analysis of mood proposals yields mixed results, with some having significant benefits and others carrying the risk of significant problems. Only proposals in which benefits outweigh costs should be included in the final DSM-5.
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