American Psychiatric Association Diagnostic Research Articles

Major considerations in neurotic skin excoriations and psychiatric disorders: a systematic review

Introduction: Among psychiatric dermatoses, neurotic excoriation is characterized by the patient's confession of causing lesions on the skin itself, without presenting a basic dermatological disease. The theme has been gaining prominence since the incorporation of the diagnosis in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5, APA 2014). Objective: The present study addressed the main clinical findings in research studies on neurotic excoriation, in addition to valuing the importance of psychological aspects in etiopathogenesis. Methods: The research and development of the work were carried out from June to July 2024 in the Scopus, PubMed, Science Direct, and Scielo databases, using the main scientific articles on nutrigenomics, and following the PRISMA rules. The quality of the studies was based on the GRADE and AMSTAR-2 instruments, and the risk of bias by the Cochrane instrument (Funnel Plot). Results and Conclusion: 18 studies were included out of a total of 115. According to the GRADE instrument, most studies presented homogeneity in their results, with X2=89.5%>50%. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 26 studies with a high risk of bias and 25 studies that did not meet the GRADE and AMSTAR-2 criteria. it was found that the subject has been scarcely addressed in the literature since not all cases are diagnosed and this pathology has more than one denomination (excoriation disorder, pathological palpation of the skin, neurodermatitis, dermatothilomania, and psychogenic excoriation). Therefore, the present study addressed the main clinical findings in research studies, through a systematic review, on neurotic excoriation, in addition to valuing the importance of psychological aspects in etiopathogenesis.

Posttraumatic Stress Disorder Among Adults in Communities With Mass Violence Incidents

Mass violence incidents (MVIs) are prevalent in the US and can have profound and long-lasting psychological consequences on direct survivors, but their outcomes among the broader communities where the MVI occurred are unknown. To investigate the prevalence of and factors associated with past-year and current posttraumatic stress disorder (PTSD) among adults in communities that experienced an MVI. This cross-sectional survey was completed between February and September 2020 with a household probability sample of adults from 6 communities that had experienced an MVI between 2015 and 2019: Dayton, Ohio; El Paso, Texas; Parkland, Florida; Pittsburgh, Pennsylvania; San Bernadino, California; and Virginia Beach, Virginia. Address-based sampling was used to identify randomly selected households, mail invitations, and select 1 adult per household to complete a self-administered paper or online survey. Data analysis was performed from September to November 2023. The primary outcome was presumptive diagnostic-level past-year PTSD and current (past month) PTSD determined using American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) PTSD criteria. A total of 6867 adults aged 18 years or older accessed the website with a description of the study and consent materials. Of these, 5991 (87.2%) agreed to participate and completed the survey, 343 (6.3%) partially completed the survey, and 443 (6.5%) did not meet eligibility criteria or refused to participate. Most of the 5991 respondents were female (3825 individuals [53.5%]) and had a mean (SD) age of 45.56 (17.58) years. A total of 1261 of 5931 individuals (21.0%) reported high exposure to the MVI (either they or a close friend and/or family member was on site during the shooting). Nearly one-quarter (23.7%; 1417 of 5977 participants reporting PTSD) met presumptive DSM-5 diagnostic criteria for past-year PTSD, with 8.9% (530 participants) meeting the criteria for current PTSD. Regression analyses found that being female (odds ratio, 2.32; 95% CI, 2.01-2.68) and having a history of both physical or sexual assault and other potentially traumatic events (odds ratio, 9.68; 95% CI, 7.48-12.52) were associated with the greatest risk of past-year PTSD. In this survey study of 5991 participants, presumptive PTSD was quite prevalent long after the MVI among adults in communities that have experienced an MVI, suggesting that MVIs have persistent and pervasive public health impacts on communities, particularly among those with prior exposure to physical or sexual assault and other potentially traumatic events. Focusing exclusively on direct exposure to MVIs is not sufficient. Incorporating these findings into screening should improve efforts to identify the individuals most in need of prevention or mental health service after MVIs.

Sensory Modulation Challenges: One Missing Piece in the Diagnosis and Treatment of Veterans with PTSD

Veterans with and without a post-traumatic stress disorder (PTSD) diagnosis were evaluated for presence of Sensory Modulation Challenges (SMC) using the Adolescent/Adult Sensory Profile and other measures. Those with PTSD showed significant SMC symptoms. Presence of SMC can contribute to explaining the PTSD symptoms of hyperarousal, avoidance/numbing, and Criterion E cited in the American Psychiatric Association Diagnostic and statistical manual of mental disorders (5th ed.) (DSM-5-TR). Participants also received a consultation and handout explaining sensory diet, the occupational therapy self-treatment for their issues, especially hyperarousal. Despite the small sample size of the non-PTSD group, findings indicate that veterans with PTSD should be tested and treated for Sensory Modulation Challenges.

Successive clinical application of vitamin D and bumetanide in children with autism spectrum disorder

Rationale:Autism spectrum disorder (ASD) is a common neurodevelopmental disorder caused by complex interactions between genetic and environmental factors. Recent studies suggest that Vitamin D3 or bumetanide therapy may improve the core symptoms of ASD in some individuals. However, there are no guidelines that provide clinicians with evidence-based treatment regimens for the use of these therapies in ASD.Patient concerns:A 30-month-old female was referred to our department because she did not respond when her name was called.Diagnosis:The patient was diagnosed with ASD by a team of autism experts according to American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria.Interventions:The patient was administered Vitamin D3 150,000 IU intramuscularly once a month and Vitamin D3 800 IU orally each day. After 6 months, Vitamin D3 supplementation was discontinued because of lack of effectiveness. Subsequently, oral bumetanide 0.5 mg twice daily was initiated.Outcomes:The patient's symptoms remained unchanged after 6 months of Vitamin D3 supplementation, and her serum 25 (OH) D levels had reached 52.4 ng/mL. At the parent's request, Vitamin D3 supplementation was discontinued because of lack of effectiveness. Thereafter, bumetanide was initiated. After 1 month of bumetanide, the patient's Childhood Autism Rating Scale score was 26, which is below the cutoff score for ASD. This case report suggests that Vitamin D3 and bumetanide target different mechanisms in the pathogenesis of ASD.Lessons:Based on these observations, we discuss three possible scenarios for Vitamin D3 supplementation and propose that bumetanide should be initiated if Vitamin D3 supplementation is ineffective (identifier ChiCTR-CCC-13004498).

La distimia femenina y los fenómenos de amor y desamor.

Aunque el término distimia fue acuñado por Kahlbaum, su significado actual se inició en 1980, cuando aparece en el Manual Diagnóstico de la Asociación Americana de Psiquiatría (DSM) designando una depresión crónica de leve intensidad, distinguible de la depresión mayor. Objetivo: En este trabajo se estudian los casos de dos mujeres con este diagnóstico (según CIE-10) y se examinan los “componentes subjetivos” que sustentan los síntomas depresivos y que habitualmente no se mencionan en las publicaciones. Material y métodos: Se emplea el “Método de Abordaje de la Subjetividad” (MAS), consistente en realizar entrevistas no-directivas y registrar las expresiones verbales de modo fiel, al tiempo que se prescinde de cualquier alusión a teorías, creencias particulares, juicios de valor, etc. Resultados: Se reconoce en estas pacientes una desinserción sentimental respecto al objeto de amor, un convivir desencantado con sus parejas e imposibilidad de separación, al tiempo que aparecen insidiosamente los síntomas depresivos. Este fenómeno tiene como base la caída del “ideal romántico” al que aspiran, que sostiene sus vidas y que funciona como una “agarradera” o “ancla de personalidad”, razones por las que no mejoran su sintomatología. Estas originales apreciaciones cuestionan la noción clásica sobre el duelo. Conclusiones: Para que este tipo de pacientes mejoren sintomáticamente hace falta que hablen y se den cuenta de lo que realmente les está sucediendo. El estudio aquí descrito muestra las coordenadas subjetivas que se requiere conocer para poder conducir una adecuada intervención psicoterapéutica.

Measuring Trauma Symptoms in Paramedicine

Background The trauma experienced as a paramedic can have a devastating psychological impact on both professionals and students in training, and increases the risk of developing post-traumatic stress disorder (PTSD). Paramedics are often placed in high-risk situations involving multiple or sustained trauma and also experience high levels of occupational stress, which can produce adverse psychological and physiological responses. Despite these risks, understanding trauma and its various manifestations in paramedicine has not been well documented. Methods This narrative review describes the history and changes in diagnostic criteria, and contrasts the methods of measuring PTSD symptomology with the current criteria. Results PTSD was first defined in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) in 1980, however the diagnostic criteria and associated measurement tools failed to reflect the repeated and vicarious traumatic events experienced by paramedics. Currently, the majority of the measurement tools used to assess post-traumatic stress are still aligned with superseded diagnostic criteria and many only classify the symptoms of PTSD as present or absent with little consideration given to symptom severity. Consequently, these existing measurements of PTSD are out dated and inefficient in their ability to identify and measure PTSD using the revised criteria. Conclusion The development of a more specific measurement tool, which reflects the DSM-5 diagnostic criteria of trauma-related stressors within this population, will allow for a more comprehensive measurement of symptoms. Future research undertaken in this specific field will also help to inform education and training programs to assist with the negative impacts of trauma and aid in management and treatment of PTSD in paramedics.

Pediatric Bipolar Disorder: A Case Presentation and Discussion

Bipolar disorder is a mood disorder characterized by periods of mania, hypomania, and depression that interfere with the child's daily functioning ( American Psychiatric Association, 2013 American Psychiatric Association Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Publishing, Washington, DC2013 Crossref Google Scholar , Birmaher, 2013 Birmaher B. Bipolar disorder in children and adolescents. Child and Adolescent Mental Health. 2013; 18: 140-148 Crossref Scopus (39) Google Scholar ). There are subtypes of bipolar disorder, such as bipolar I disorder, bipolar II disorder, cyclothymic disorder, and other specified bipolar and related disorders ( American Psychiatric Association, 2013 American Psychiatric Association Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Publishing, Washington, DC2013 Crossref Google Scholar , Birmaher, 2013 Birmaher B. Bipolar disorder in children and adolescents. Child and Adolescent Mental Health. 2013; 18: 140-148 Crossref Scopus (39) Google Scholar ). Pediatric bipolar disorder has a more tenuous disease course compared with adult onset disorder with many associated comorbidities ( Frías et al, 2015 Frías Á. Palma C. Farriols N. Comorbidity in pediatric bipolar disorder: Prevalence, clinical impact, etiology and treatment. Journal of Affective Disorders. 2015; 174: 378-389 Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar , Post et al, 2017 Post R.M. Altshuler L.L. Kupka R. McElroy S.L. Frye M.A. Rowe M. Nolen W.A. More childhood onset bipolar disorder in the United States than Canada or Europe: Implications for treatment and prevention. Neuroscience & Biobehavioral Reviews. 2017; 74: 204-213 Crossref PubMed Scopus (45) Google Scholar ). Therefore, early recognition of the disorder using diagnostic criteria is paramount. Criteria for diagnosis of the different types of bipolar disorder are outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5; American Psychiatric Association, 2013 American Psychiatric Association Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Publishing, Washington, DC2013 Crossref Google Scholar ). A pediatric bipolar case is discussed in relation to these criteria.

The mental health community: An underserved and undertreated population: Insomnia management paramount to mental health

The mental health community: An underserved and undertreated population: Insomnia management paramount to mental health

24 In sickness and in power

24 In sickness and in power

Perioperative management of patients with dementia

### Key points The most recent estimate suggests that up to 850 000 people in the UK are currently living with dementia, and this number is set to increase to 1 million by 2025.1 As the incidence of dementia approximately doubles for every 5 yr increase in age, and older patients are increasingly presented for anaesthesia and surgery, anaesthetists are likely to encounter this group of patients with their unique set of challenging problems2 in everyday clinical practice. This article will outline some of the diagnostic and clinical features which characterize dementia, and the implications this condition and its treatment can have when planning perioperative care. Dementia is a slowly progressive loss of cognitive abilities, which exceeds the normal age-related decline in brain efficiency and is therefore classified as a disease. While dementia is still considered acceptable nomenclature, and will be used throughout this article, the most recent American Psychiatric Association Diagnostic and Statistical Manual (DSM-V, 2013) has now grouped it with delirium and amnestic disorder under the encompassing term of neurocognitive disorder (NCD).3 A diagnosis requires a decline in cognitive function across domains including attention, executive function, memory, language, and perception, which is not attributable to another mental disorder …

Impact of Alcohol Dependency on Oral Health - A Cross-sectional Comparative Study.

Alcoholism is a chronic and progressive psychiatric illness characterised by a loss of control over alcohol consumption. Consumption of alcohol inevitably affects the oral cavity, oral mucosa and teeth. Literature indicates that alcohol dependents may have increased risk of dental caries, probing pocket depth and mucosal lesions. To assess the impact of alcohol dependency on oral health status among alcoholics in comparison with non alcoholics. A total 76 alcoholic patients visiting Psychiatric Department were compared with matched non alcoholics. Subjects were categorised as alcohol dependents based on American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria. Non alcoholic subjects were selected by controlling for potentially confounding variables such as for cigarette, smoking and age. Data was collected by interview and clinical examination. Oral health status of subjects was assessed using a modified WHO proforma and salivary pH and plaque pH were assessed. Chi-square test was used for assessing socio demographic details and Mann-whitney U test was used for prevalence of dental caries and periodontal diseases, Unpaired t-test was used for plaque and salivary pH. There was no statistically significant difference noted among alcoholic and nonalcoholic control group with respect to socio demographic details. Prevalence of dental caries was higher in alcohol dependent subjects with a mean DMFT of 5.92 compared to nonalcoholic subjects (4.51). Prevalence of periodontitis was higher (89.61%) in alcohol dependent subjects compared to controls (78.67%). Prevalence of mucosal lesions among alcohol dependent subjects was 31.5% which was higher than the controls (25%). Subjects who were categorised as alcoholics showed a lower plaque and salivary pH compared to non alcoholics. Subjects categorised as alcohol dependent subjects had slightly lower mean plaque and salivary pH and a higher prevalence of dental caries, periodontitis and mucosal lesions compared with non alcoholic subjects.

Book review: The Logic of Madness: A New Theory of Mental Illness

Book review: The Logic of Madness: A New Theory of Mental Illness

Spatiotemporal Neural Dynamics of Enhanced Attention to Danger Cues in Posttraumatic Stress Disorder

We all know that the world can be a dangerous place. This sense of danger might be reinforced by experiencing or witnessing traumatic events that involve actual or threatened death or serious injury. For individuals who develop posttraumatic stress disorder (PTSD) after such traumatic events, danger sensitivity is amplified to the extent that it permanently alters how they attend and perceive the world around them, leading to severe impairments in their daily functioning ( 1 American Psychiatric AssociationDiagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association, Washington, DC2013 Crossref Google Scholar ). Indeed, behavioral studies have repeatedly demonstrated that PTSD is associated with heightened vigilance for danger cues and increased attention to threat-related information, collectively referred to as threat-related attentional biases ( 2 Bar-Haim Y. Lamy D. Pergamin L. Bakermans-Kranenburg M.J. van IJzendoorn M.H. Threat-related attentional bias in anxious and nonanxious individuals: A meta-analytic study. Psychol Bull. 2007; 133: 1-24 Crossref PubMed Scopus (2589) Google Scholar ). Why some individuals exhibit threat-related attention facilitation after trauma and others do not is unclear. Similarly, the spatiotemporal dynamics of the neural mechanisms associated with this selective modulation of attention are largely unknown. Soldiers With Posttraumatic Stress Disorder See a World Full of Threat: Magnetoencephalography Reveals Enhanced Tuning to Combat-Related CuesBiological PsychiatryVol. 78Issue 12PreviewPosttraumatic stress disorder (PTSD) is linked to elevated arousal and alterations in cognitive processes. Yet, whether a traumatic experience is linked to neural and behavioral differences in selective attentional tuning to traumatic stimuli is not known. The present study examined selective awareness of threat stimuli and underlying temporal-spatial patterns of brain activation associated with PTSD. Full-Text PDF

Alcohol Dependence and Mortality: Implications for Treatment

Alcohol use disorders are the most common mental disorder worldwide with an estimated 3.6% prevalence among adults aged 15–65 (Rehm et al., 2009). They are associated with significant morbidity as well as negative social consequences for both the sufferer and those around them. The categorization of alcohol use disorders is complicated and the subject of much debate. Within the current World Health Organisation International Classification of Disease (ICD 10) alcohol dependence syndrome is a separate diagnosis characterised by a cluster of behavioural, cognitive and physiological phenomena including a strong desire to drink alcohol, difficulty in controlling use, tolerance (need to consume greater amounts to get the same effect) and withdrawal symptoms on stopping alcohol use distinct from the diagnosis “harmful alcohol use” (World Health Organisation, 1997). Until recently this distinction was also reflected in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM IV) but within the DSM V updated in 2013 the previous diagnoses of “alcohol dependence” and “alcohol abuse” were merged to one diagnosis of “Alcohol Use Disorder” due to concern that these are not two distinct phenomena but represent a spectrum of severity of the same underlying disorder (National Institute on Alcohol Abuse and Alcoholism, 2015). In their systematic literature review and meta-analysis Laramee and colleagues have shown that those with alcohol dependence (using broad criteria not limited to clinical diagnoses by either ICD 10 or DSM IV criteria) are at approximately 3.5 times higher risk of death than the general population (Laramee et al., 2015). This finding is similar to a previous systematic review of the association between all alcohol use disorders and mortality which found that mortality risk was 3 times higher in men and over 4 times higher in women with alcohol use disorders (Roerecke and Rehm, 2013). Interestingly however Laramee et al. also showed an increase in mortality of 25% among those with alcohol dependence compared to those with criteria for the diagnosis alcohol abuse suggesting an increased severity of this diagnosis in terms of health risk, even if the two conditions represent an underlying continuum. Roerecke and Rehm have previously shown that this increased risk in those with alcohol use disorders is found for all causes of death with particularly high standardised mortality ratios for digestive disease, especially liver cirrhosis, and mental disorders (Roerecke and Rehm, 2014). Risk from unintentional injuries and suicides was also substantially higher. Cause-specific mortality from alcohol dependence has not been investigated in this way but similarities between findings for both alcohol use disorders and alcohol dependence and all-cause mortality suggest that this pattern is likely to be similar. In addition to showing the substantial increased mortality risk found in those with alcohol dependence Laramee et al. also consider whether mortality risk differed among those with alcohol dependence who continue to drink heavily versus those who are abstinent and those who have reduced their alcohol consumption. The results show a dose–response with lowest mortality in those who are abstinent but also reduced mortality in those who reduce their drinking. The authors use this finding to justify reducing drinking as a valid treatment outcome alongside total abstinence, but further than this these results add to body of evidence that effective treatment outcome which actually leads to decreases in drinking can save lives. If reducing alcohol consumption even among those in treatment, who are likely to have the most severe disease, results in lower mortality then it is clear that the health effects of heavy alcohol use are at least to some extent reversible and it is never too late to intervene. The findings from Laramee et al. are consistent with findings for alcohol use disorder that decreasing alcohol consumption substantially reduces the increased mortality risk associated with this illness (Roerecke et al., 2013). However despite the high prevalence of alcohol use disorders and the high cost associated with morbidity and mortality the treatment gap for alcohol use disorders is larger than for any other mental disorder (Kohn et al., 2004). The majority of people with alcohol use disorders receive no treatment at all (Kohn et al., 2004, Drummond et al., 2011). Reasons for this low level of treatment are multi-factorial and diverse but stigma (Schomerus et al., 2011), lack of recognition by medical professionals and low levels of funding (Kohn et al., 2004) are likely to be key factors. The paper from Laramee et al. showing the substantial increased mortality among those with alcohol dependence emphasises the need for both better prevention and treatment of this harmful disease.

Nonsuicidal Self-Injury among Youth

Following the 2007 definitional consensus of nonsuicidal self-injury (NSSI), there have been significant advances in our understanding of the behavior, particularly among children, adolescents, and young adults. 1 International Society for the Study of Self-injury. [homepage on the Internet]. http://www.isssweb.org. Accessed July 15, 2013. Google Scholar Given the tremendous growth of the field, in 2013 the American Psychiatric Association incorporated NSSI into their diagnostic manual as a disorder warranting further research. 2 American Psychiatric Association Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Association, Arlington (VA)2013 Crossref Google Scholar NSSI is defined as the deliberate immediate destruction of one's own body tissue (eg, self-cutting, bruising, burning) in the absence of conscious suicidal intent. This definition excludes socially accepted practices such as tattooing and body piercing. 1 International Society for the Study of Self-injury. [homepage on the Internet]. http://www.isssweb.org. Accessed July 15, 2013. Google Scholar Stereotypic and repetitive self-injurious behavior by youth with developmental disabilities and neuropsychiatric disorders as well as major forms of NSSI (eg, bone breaking, amputation) are subsumed under the broad umbrella of NSSI behaviors 3 Nock M.K. Favazza A.R. Nonsuicidal self-injury: definition and classification. in: Nock M.K. Understanding nonsuicidal self-injury: origins, assessment and treatment. American Psychological Association, Washington (DC)2009: 9-18 Crossref Google Scholar ; however, the current review focuses on NSSI that occurs in typically developing youth, which is consistent with current conceptualizations in the field. 3 Nock M.K. Favazza A.R. Nonsuicidal self-injury: definition and classification. in: Nock M.K. Understanding nonsuicidal self-injury: origins, assessment and treatment. American Psychological Association, Washington (DC)2009: 9-18 Crossref Google Scholar , 4 Klonsky E.D. Muehlenkamp J.J. Lewis S.P. Walsh B. Nonsuicidal self-injury. Hogrefe Publishers, Cambridge (MA)2011 Google Scholar , 5 Nixon M.K. Heath N.L. Self-injury in youth: the essential guide to assessment and intervention. Routledge, New York (NY)2008 Google Scholar

Are subsyndromal symptomatic depression and major depressive disorder distinct disorders?

Depressive conditions that do not meet full symptomatic or duration criteria for a major depressive disorder (MDD) are of considerable interest to both clinicians and researchers. [1-4] The fourth edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) provides descriptions of several types of subthreshold depressive states including dysthymia, minor depression and recurrent brief depression; but many individuals with subthreshold depression and associated impaired functioning do not meet DSM-IV diagnostic criteria for any of these disorders. [3] To cover these cases Judd and colleagues [4] proposed the concept of ‘Subsyndromal Symptomatic Depression’ (SSD) for individuals without depressed affect or anhedonia who have two or more (but less than five) of the other seven symptoms of depression that have been present for most of the time for at least two weeks and that are associated with impaired social functioning. [3,4] The appropriate diagnosis and treatment of individuals with this type of subthreshold depression will require a better understanding of the relationship between SSD and MDD. Are they independent disorders or is SSD a transitional state on the road to MDD? SSD is a relatively common condition. Based on the Epidemiological Catchment Area study in the United States, Judd and colleagues estimated a 12-month prevalence of SSD of 8.4% in the general population; the prevalence in women was double that in men and was particularly high in women who were unmarried and unemployed. [5] A study in Australia reported a 12.9% prevalence in the general population and found that the quality of life for persons with SDD was intermediate, between that for persons without any depressive symptoms and that for persons who met criteria for MDD. [6] A survey of people aged 60 and above in Singapore found that SSD was more common in individuals with a lower socioeconomic status and was often associated with cognitive impairment, anxiety, poor physical health, and poor social functioning. [7] The clinical presentation of SSD is similar to that for other types of depressive disorders. [5] Common symptoms include sleep disturbances (44.7%), prolonged fatigue (42.1%), repetitive thoughts of death (31%), and difficulty concentrating (22.7%). Atypical symptoms such as weight gain, slowed thinking and hypersomnia are somewhat more common in individuals with SSD than in those with minor depression. Risk of suicide is lower among SSD patients than in patients with minor depression or major depressive disorder. [5]

Efficacy of guanfacine extended release in the treatment of combined and inattentive only subtypes of attention-deficit/hyperactivity disorder.

Extended-release guanfacine (GXR) is approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents aged 6-17 years. This post-hoc analysis further examines the effects of GXR on hyperactivity-impulsivity and inattentiveness. Data from two large double-blind placebo-controlled pivotal trials of GXR in the treatment of ADHD were analyzed. Using the pooled population to provide sufficient sample size and associated statistical power, the impact of GXR treatment on core ADHD symptoms was examined by comparing ADHD Rating Scale IV (ADHD-RS-IV) total scores in the overall GXR and placebo groups in subjects with each of the three ADHD subtypes. ADHD-RS-IV Hyperactivity-Impulsivity and Inattentiveness subscale scores in the overall study population by randomized dose group (vs. placebo) were also examined. The full analysis set included 631 subjects aged 6-17 years (GXR: n=490; placebo: n=141). Among subjects with the predominantly inattentive subtype of ADHD, differences in least squares (LS) mean reductions from baseline in ADHD-RS-IV total scores were significantly greater in GXR-treated subjects (n=127) than in placebo-treated subjects (n=38) at treatment weeks 3 through 5 and end point (p≤0.020). Among subjects with combined type ADHD, differences in LS mean ADHD-RS-IV total score reductions from baseline were significantly greater in the GXR group (n=354) than in the placebo group (n=100) at treatment weeks 1 through 5 and end point (p≤0.011). The dearth of predominantly hyperactive-impulsive type subjects (n=12) precluded analysis of this subgroup. Each randomized GXR dose group in each trial demonstrated significantly greater reductions from baseline in ADHD-RS-IV Hyperactivity-Impulsivity and Inattentiveness subscale scores than did the respective placebo group at end point (p≤0.05 for all). The results support the use of GXR in the treatment of core ADHD symptoms as defined in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision, including hyperactivity, impulsivity, and inattention.

Psychiatric comorbidity and response to preventative therapy in the treatment of severe migraine trial

Mood and anxiety disorders are comorbid with migraine and commonly assumed to portend a poor response to preventive migraine therapies. However, there is little evidence to support this assumption. We examined impact of a mood and/or anxiety disorder diagnosis using American Psychiatric Association Diagnostic and Statistical Manual criteria on response to the three preventative migraine therapies evaluated in the Treatment of Severe Migraine trial (n = 177): β-blocker, behavioral migraine management, or behavioral migraine management +β-blocker. Daily diaries assessed migraine activity for the 16 months of the trial. The Migraine Specific Quality of Life Questionnaire and Headache Disability Inventory assessed headache-related disability at regular intervals. Mixed models for repeated measures examined changes in these three outcomes with preventative migraine therapy in participants with and without a mood or anxiety disorder diagnosis. Participants with a comorbid mood or anxiety disorder diagnosis recorded larger reductions in migraine days (p < .05) and larger reductions in the Migraine Specific Quality of Life Questionnaire (p < .001) and Headache Disability Inventory (p < .01) than did participants with neither diagnosis. Significantly larger reductions in migraine activity and migraine-related disability were observed in participants with a mood and/or anxiety disorder diagnosis than in participants who did not receive either diagnosis.

Attention-Deficit/Hyperactivity Disorder: A Controversial Diagnosis

Attention-deficit/hyperactivity disorder (ADHD) had its origins in the diagnosis of hyperkinesis or the hyperkinetic reaction of childhood (HRC) that was developed in the 1960s in the United States as a replacement for minimal brain dysfunction (MBD; Barkley, 1990, 1998; Schrag & Divoky, 1975). The distinction between the HRC and the MBD category was the removal, in the diagnosis, of the need to establish specific evidence of neurological damage. The requirement of evidence of neurological damage to the child was replaced by reliance upon observations of the child's behavior, generally reported to the medical practitioners by parents or teachers, as evidence of existence of the condition (Barkley, 1990, 1998). Over the next 40 years, the HRC undergoes a series of name changes including attention deficit disorder (ADD), ADD plus or minus hyperactivity, and finally to ADHD with the subtypes of inattention, hyperactivity, or a combined type. With each revision to the diagnosis in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM), the behavioral descriptors are broaden resulting in significant increases in the use of the diagnosis on children, adolescents, and adults (APA, 1968, 1980, 1987, 1994, 2000). With the release of the DSM-V in the near future, indications are that the trend demonstrated by APA to broaden the descriptors will be evidenced in the fifth edition of the manual. ADHD has been surrounded by controversy. There is little difference between the original diagnosis of the HRC and the definition of ADHD today. The controversy that surrounded the diagnosis of hyperkinesis still surrounds the use of the diagnosis of ADHD today. A United States House of Representatives hearing entitled, Federal Involvement in the Use of Behavior Modification Drugs on Grammar School Children of the Right to Privacy Inquiry: Hearing Before a Subcommittee of the Committee on Government Operations (Federal Involvement, 1970) highlighted the following concerns in relation to the diagnosis and associated drug treatment: * There was a philosophy of expediency underpinning the medical approach whereby, dependence on quick and inexpensive solutions offered by the new technology without adequate attention being paid to slower and perhaps more costly methods which would preserve the sanctity of human values and the precious resources of the human spirit. (Federal Involvement, 1970, p. 2) * The child who is subjected to medication therapy has a permanent record that may "cast a suspicion over that child's future" (Federal Involvement, 1970, p. 2). * An "overreliance on drug therapy could spread far beyond its apparent valid applications and thus denigrate the novel learning methods" (Federal Involvement, 1970, p. 2). * The adequacy of educational programs especially for gifted and creative children had not been addressed as a possible solution for behavioral problems (Federal Involvement, 1970). * There was a paradox of giving "speed" to children when at the same time the substance had been subject to widespread abuse in the community (Federal Involvement, 1970, p. 1). * There had been a focus in federal funding on drug experiments without due consideration of funding of alternative methods including improved educational practice (Federal Involvement, 1970). …

Reclassifying personality disorders

The classifications of personality disorder in the International Classification of Diseases (ICD) 1 WHOInternational classification of diseases, 10th revision: mental and behavioural disorders. Chapter V, F60-69. http://apps.who.int/classifications/apps/icd/icd10onlineDate: 1992 Google Scholar and the Diagnostic and Statistical Manual of Mental Disorders (DSM) 2 American Psychiatric AssociationDiagnostic and statistical manual of mental disorders, fourth edition. http://allpsych.com/disorders/dsm.htmlDate: 1994 Google Scholar are valuable but ripe for reform. The major deficiency is the failure to acknowledge the dimensional nature of personality disturbance. To divide the population into those who are normal and those who have personality disorder does not reflect the wide range of personality variation and associated levels of pathology. 3 Livesley WJ Schroeder ML Jackson DN Jang KL Categorical distinctions in the study of personality disorder: implications for classification. J Abnorm Psychol. 1994; 103: 6-17 Crossref PubMed Scopus (203) Google Scholar , 4 Kim Y-R Tyrer P Controversies surrounding classification of personality disorder. Psychiatry Investig. 2010; 7: 1-8 Crossref PubMed Scopus (9) Google Scholar The first flight of DSM-5The philosophical difficulties inherent in diagnosing mental illness are taken for granted by many psychiatrists. Yet it is important to remember that an entire branch of the modern medical profession relies on a diagnostic system in which imaging and laboratory methods can only exclude physical causes of presenting symptoms. The psychiatrist must rely on his or her judgment, and the wisdom of those predecessors and peers who constructed the psychiatric diagnostic manuals. Full-Text PDF ICD-11: a brave attempt at classifying a new worldThe 11th version of the International Classification of Diseases (ICD) launched on June 18 is the latest attempt at systematically describing and categorising all human mortality and morbidity. Designed for the global digital age, it is an onscreen, multipurpose, multilingual database interconnecting with other operating systems—including electronic hospital records. It is a quantum leap forward from the ICD-10, which, although revised several times over the past two decades, was originally published in 1992, when internet use was minimal, smartphones were unheard of, and patient records were paper based. Full-Text PDF