Classification Of Psychiatric Disorders Research Articles

CREB: A Promising Therapeutic Target for Treating Psychiatric Disorders.

Psychiatric disorders are complex, multifactorial illnesses. It is challenging for us to understand the underlying mechanism of psychiatric disorders. In recent years, the morbidity of psychiatric disorders has increased yearly, causing huge economic losses to the society. Although some progress, such as psychotherapy drugs and electroconvulsive therapy, has been made in the treatment of psychiatric disorders, including depression, anxiety, bipolar disorder, obsessive-compulsive and autism spectrum disorders, antidepressants and psychotropic drugs have the characteristics of negative effects and high rate of relapse. Therefore, researchers continue to seek suitable interventions. cAMP response element binding protein (CREB) belongs to a protein family and is widely distributed in the majority of brain cells that function as a transcription factor. It has been demonstrated that CREB plays an important role in neurogenesis, synaptic plasticity, and neuronal growth. This review provides a 10-year update of the 2013 systematic review on the multidimensional roles of CREB-mediated transcriptional signaling in psychiatric disorders. We also summarize the classification of psychiatric disorders and elucidate the involvement of CREB and related downstream signalling pathways in psychiatric disorders. Importantly, we analyse the CREB-related signal pathways involving antidepressants and antipsychotics to relieve the pathological process of psychiatric disorders. This review emphasizes that CREB signalling may have a vast potential to treat psychiatric disorders like depression. Furthermore, it would be helpful for the development of potential medicine to make up for the imperfection of current antidepressants and antipsychotics.

Variety ACEs and risk of developing anxiety, depression, or anxiety-depression co-morbidity: the 2006-2022 UK Biobank data.

Adverse childhood experiences (ACEs) and anxiety-depression co-morbidity are attracting widespread attention. Previous studies have shown the relationship between individual psychiatric disorders and ACEs. This study will analyze the correlation between anxiety-depression co-morbidity and different levels of ACEs. Seven categories of ACE and four classifications of psychiatric disorders were defined in a sample of 126,064 participants identified by the UK Biobank from 2006-2022, and correlations were investigated using logistic regression models. Then, to explore nonlinear relationships, restricted spline models were developed to examine differences in sex and age across cohorts (n = 126,064 for the full cohort and n = 121,934 for the European cohort). Finally, the impact of the category of ACEs on psychiatric disorders was examined. After controlling for confounders, ACEs scores showed dose-dependent relationships with depression, anxiety, anxiety-depression co-morbidity, and at least one (any of the first three outcomes) in all models. ACEs with different scores were significantly positively correlated with the four psychiatric disorders classifications, with the highest odds of anxiety-depression co-morbidity (odds ratio [OR] = 4.87, 95% confidence intervals [CI]: 4.37 ~ 5.43), p = 6.08 × 10-178. In the restricted cubic spline models, the risk was relatively flat for females at ACEs = 0-1 and males at ACEs = 0-2/3 (except in males, where ACEs were associated with a lower risk of anxiety, all other psychiatric disorders had an increased risk of morbidity after risk smoothing). In addition, the risk of having anxiety, depression, anxiety-depression co-morbidity, and at least one of these disorders varies with each category of ACEs. The prevalence of anxiety-depression comorbidity was highest across ACE scores after controlling for confounding factors and had a significant effect on each category of ACEs.

A Systematic Review of Misdiagnosis of Pediatric Bipolar Disorder: Assessments and Recommendations.

Bipolar disorders (BP) are a class of psychiatric disorders with a complex symptom presentation. This systematic review aims to summarize literature pertaining to the misdiagnosis of pediatric BP using the DSM-IV and DSM-5 criteria, while emphasizing the negative impact that untreated BP has on life outcomes. This paper also attempts to outline and summarize available recommendations which may aid in improving diagnostic accuracy of pediatric BP. Scholars Portal Journals, PsychINFO, and MEDLINE databases were used to search articles until March 21, 2023. Inclusion criteria limited this review to articles published between 1995 and 2022 using a pediatric (age < 18) sample. Exclusion criteria omitted articles containing samples with self-reported diagnoses. A total of 15 articles are included in this review; study results were synthesized using a narrative summary. Youth with BP are most frequently misdiagnosed with attention-deficit hyperactive disorder (ADHD), schizophrenia, and major depressive disorder (MDD). Misdiagnosis can lead to inappropriate intervention plans and a delay in proper treatment, negatively impacting a child's quality of life by contributing to social, occupational, and economic adversity. Finally, this review addresses the need for future quantitative research on the implications of false negative diagnoses of pediatric BP.

New research horizons of epidemiology applied to mental health.

Epidemiological research in psychiatry has always played an important role, having allowed a precise classification of psychiatric disorders and a quantification of their spread in the general population. In the current context of precision psychiatry, the fields of development of epidemiological research include: 1) the relationship between mental health and physical well-being, overcoming the stigma associated with psychiatric disorders; 2) gender differences; 3) the impact of the physical environment on mental health beyond the socio-cultural context. These issues can be explored through a close collaboration between various health professionals, and also by spreading the culture of mental health monitoring in contexts outside psychiatry.

An integrative model as a step toward increasing the awareness of eating disorders in the general population.

Eating disorders (EDs) represent a contradictory chapter of clinical psychiatry, i.e., although they are associated with significant prevalence and risks in the long term (including vital risk, especially for anorexia nervosa), the therapeutic resources are minimal and based on low-quality data. Another contradiction arose in the last few decades, i.e., a variety of new EDs have been described, either by clinicians or signaled by mass media, but their systematic exploration is progressing very slowly. Entities like "food addiction," "orthorexia nervosa," or "emotional eating disorder" still require intensive exploration in order to find the most accurate diagnostic instruments, diagnosis criteria, prevalence data, vulnerability factors, and therapeutic approaches. This article is focused on integrating into a comprehensive model a variety of EDs not specified or loosely defined by the current international classifications of psychiatric disorders. This framework is intended as an instrument for stimulating clinical and epidemiological research, with potential favorable consequences for therapeutic research. The dimensional model suggested here includes four main categories that accommodate the already recognized EDs (i.e., anorexia nervosa, bulimia nervosa, and binge eating disorder) as well as ten EDs that still need intensive research to find their clinical and pathophysiological characteristics. More good-quality studies are urgently required regarding this topic, based on the mental and physical negative impact these EDs may have in the short and long term, especially in vulnerable populations (e.g., pregnant women, athletes, adolescents, etc.).

Genetic network structure of 13 psychiatric disorders in the general population

Psychiatric disorders frequently co-occur and share common symptoms and genetic backgrounds. Previous research has used genome-wide association studies to identify the interrelationships among psychiatric disorders and identify clusters of disorders; however, these methods have limitations in terms of their ability to examine the relationships among disorders as a network structure and their generalizability to the general population. In this study, we explored the network structure of the polygenic risk score (PRS) for 13 psychiatric disorders in a general population (276,249 participants of European ancestry from the UK Biobank) and identified communities and the centrality of the network. In this network, the nodes represented a PRS for each psychiatric disorder and the edges represented the connections between nodes. The psychiatric disorders comprised four robust communities. The first community included attention-deficit hyperactivity disorder, autism spectrum disorder, major depressive disorder, and anxiety disorder. The second community consisted of bipolar I and II disorders, schizophrenia, and anorexia nervosa. The third group included Tourette's syndrome and obsessive-compulsive disorder. Cannabis use disorder, alcohol use disorder, and post-traumatic stress disorder make up the fourth community. The PRS of schizophrenia had the highest values for the three metrics (strength, betweenness, and closeness) in the network. Our findings provide a comprehensive genetic network of psychiatric disorders and biological evidence for the classification of psychiatric disorders.

МІЖДИСЦИПЛІНАРНІ АСПЕКТИ СИСТЕМ КЛАСИФІКАЦІЇ ПСИХІЧНИХ РОЗЛАДІВ

B a c k g r o u n d . The article demonstrates the development and influence of the main diagnostic systems in psychiatry, such as the DSM and the ICD, on the concept of psychiatric diseases. The problem of classification of psychiatric disorders is one of the main topics that is the field of study of the philosophy of psychiatry. The correct diagnosis within a particular diagnostic system directly affects the choice of appropriate drug treatment, psychotherapy and social support for people suffering from mental disorders. Misdiagnosis has not only negative medical but also social consequences, leading to stigmatization and avoidance of people suffering from mental disorders. M e t h o d s . The research uses an integrated approach to the analysis of psychiatric diagnostic systems, including historical, comparative and interdisciplinary methods. The application of the historical method contributed to a detailed study of the evolution of psychiatric diagnostic systems and changes in approaches to the classification of mental disorders. A comparative analysis of the main diagnostic systems was carried out, considering their structure, diagnostic criteria and interaction. The interdisciplinary method involves the integration of knowledge from psychiatry, philosophy, medical history, cultural studies, and psychology, providing a deep understanding of the medical, philosophical, social, and cultural aspects of mental disorders. R e s u l t s . The article analyzes the historical development of ideas and methodology for the classification of mental disorders from ancient Greece to the present. From Hippocrates and Plato to Sydenham, Kabanis, Pinel, and Eskierol, the authors trace the evolution of understanding of mental disorders, emphasizing the shift in emphasis from etiological theories to more descriptive and categorical models. The authors describe the current state of the DSM and ICD classification systems, which play a dominant role in psychiatric science and subsequent social support and welfare for people suffering from mental disorders. Changes that have occurred in these systems and their impact on psychiatric practice and research are discussed. Considerable emphasis is placed on the history of the diagnosis of post-traumatic stress disorder (PTSD), which becomes a symbolic indicator of the complexities and challenges associated with the modern classification of mental illness. The authors consider the phenomenological method as a tool for a deeper understanding of PTSD, especially in the context of the constant psychotraumatic factors of war, the consequences of which generate new challenges for Ukrainian psychiatric practice. The authors present a case study using the phenomenological approach to diagnose PTSD, which demonstrates the need for a detailed analysis of patients' internal experience for accurate diagnosis and effective treatment. C o n c l u s i o n s . The conclusions emphasize the importance of integrating philosophical methods into the diagnosis and analysis of mental illness in clinical practice. The authors call for the development of interdisciplinary research involving both philosophers and mental health professionals to develop more detailed and person-centered approaches to the diagnosis and treatment of mental disorders.

Transdiagnostic connectome signatures from resting-state fMRI predict individual-level intellectual capacity

Medication and other therapies for psychiatric disorders show unsatisfying efficacy, in part due to the significant clinical/ biological heterogeneity within each disorder and our over-reliance on categorical clinical diagnoses. Alternatively, dimensional transdiagnostic studies have provided a promising pathway toward realizing personalized medicine and improved treatment outcomes. One factor that may influence response to psychiatric treatments is cognitive function, which is reflected in one’s intellectual capacity. Intellectual capacity is also reflected in the organization and structure of intrinsic brain networks. Using a large transdiagnostic cohort (n = 1721), we sought to discover neuroimaging biomarkers by developing a resting-state functional connectome-based prediction model for a key intellectual capacity measure, Full-Scale Intelligence Quotient (FSIQ), across the diagnostic spectrum. Our cross-validated model yielded an excellent prediction accuracy (r = 0.5573, p < 0.001). The robustness and generalizability of our model was further validated on three independent cohorts (n = 2641). We identified key transdiagnostic connectome signatures underlying FSIQ capacity involving the dorsal-attention, frontoparietal and default-mode networks. Meanwhile, diagnosis groups showed disorder-specific biomarker patterns. Our findings advance the neurobiological understanding of cognitive functioning across traditional diagnostic categories and provide a new avenue for neuropathological classification of psychiatric disorders.

The origins of catatonia – Systematic review of historical texts between 1800 and 1900

Since January 1st 2022, catatonia is (again) recognized as an independent diagnostic entity in the 11th revision of the International Classification of Diseases (ICD-11). This is a relevant time to systematically review how the concept of catatonia has evolved within the 19th century and how this concept changed under the influence of a wide variety of events in the history of psychiatry. Here, we systematically reviewed historical and modern German and English texts focusing on catatonic phenomena, published from 1800 to 1900. We searched five different electronical databases (https://archive.org, www.hathitrust.org, www.books.google.de, https://link.springer.com and PubMed) and closely reviewed 60 historical texts on catatonic symptoms. Three main findings emerged: First, catatonic phenomena and their underlying mechanisms were studied decades before Karl Ludwig Kahlbaum's catatonia concept of 1874. Second, Kahlbaum not only introduced catatonia, but, more generally, also called for a new classification of psychiatric disorders based on a comprehensive analysis of the entire clinical picture, including the dynamic course and cross-sectional symptomatology. Third, the literature review shows that between 1800 and 1900 catatonic phenomena were viewed to be ‘located’ right at the interface of motor and psychological symptoms with the respective pathophysiological mechanisms being discussed. In conclusion, catatonia can truly be considered one of the most exciting and controversial entity in both past and present psychiatry and neurology, as it occupies a unique position in the border territory between organic, psychotic and psychogenic illnesses.

Functional Constructivism Approach to Multilevel Nature of Bio-Behavioral Diversity.

Attempts to revise the existing classifications of psychiatric disorders (DSM and ICD) continue and highlight a crucial need for the identification of biomarkers underlying symptoms of psychopathology. The present review highlights the benefits of using a Functional Constructivism approach in the analysis of the functionality of the main neurotransmitters. This approach explores the idea that behavior is neither reactive nor pro-active, but constructive and generative, being a transient selection of multiple degrees of freedom in perception and actions. This review briefly describes main consensus points in neuroscience related to the functionality of eight neurochemical ensembles, summarized as a part of the neurochemical model Functional Ensemble of Temperament (FET). None of the FET components is represented by a single neurotransmitter; all neurochemical teams have specific functionality in selection of behavioral degrees of freedom and stages of action construction. The review demonstrates the possibility of unifying taxonomies of temperament and classifications of psychiatric disorders and presenting these taxonomies formally and systematically. The paper also highlights the multi-level nature of regulation of consistent bio-behavioral individual differences, in line with the concepts of diagonal evolution (proposed earlier) and Specialized Extended Phenotype.

A journey through psychiatry - A personal perspective.

A journey through psychiatry - A personal perspective.

Psychiatric disorders as an imperfect community: interview with Peter Zachar, PhD

This interview with Peter Zachar, PhD, discusses his 2014 book ‘A Metaphysics of Psychopathology’, and explores his application of the philosophy of scientifically-inspired pragmatism to psychiatric classification, his critique of essentialistic thinking in psychiatry, and his notion of the imperfect community model with regards to psychiatric disorders. The imperfect community is a non-essentialist idea, namely, that the various members of the class of psychiatric disorders have many things in common, but there is no one thing (an essence) that they all have in common that distinguishes them as a group from non-disorders. The resulting domain is, however, not random or arbitrary – new constructs have been introduced for reasons that reflect our scientific goals and pragmatic interests. Zachar is sceptical about the possibility of a single correct and privileged psychiatric classification, but he recognises that the ways in which psychiatric symptoms empirically cluster together places constraints on psychiatric classification that, for instance, don’t apply to organising libraries. Classifications are contingent on multiple factors, including our scientific knowledge and goals. Epistemic and evaluative commitments, once identified, work together in a non-arbitrary way to constrain what counts as a good solution to the question of classification.

What a Clinician Should Know About the Neurobiology of Schizophrenia: A Historical Perspective to Current Understanding.

The brain is no doubt the "organ" of psychiatry; yet, over the years, few evidence-based classifications of psychiatric disorders have been based on brain mechanisms. The National Institute of Mental Health notably proposed one such system, known as Research Domain Criteria, although it has not yet influenced any changes in the DSM. Of all the major psychiatric disorders, the brain has been studied most extensively in schizophrenia, with its speculative pathology first documented by Emil Kraepelin as early as the beginning of the 20th century. Subsequently, the revolution in technology over the past 50 years has changed how investigators are able to view the brain before death without performing biopsies. Schizophrenia is thus found to have both structural and functional widespread brain anomalies that likely lead to its clinical deterioration. At the onset of illness, acquiring an MRI scan could be part of the routine evaluation to determine how progressive the disease has so far been. However, this practice is not yet recognized by the American Psychiatric Association in any of its guidelines on the treatment of schizophrenia.

Ethical aspects for genomic research in psychiatry

The genomic research is one of the most dynamically developing fields both in the worldwide and in Russia. Currently, the genetic approaches in psychiatry are used to solve the practical and scientific problems related to medical genetic counseling, identification of the genetic factors associated with characteristics of metabolism of medicines or development of their side effects, as well as to develop the new approaches to classification of psychiatric disorders. Given the complexity and the unresolved nature of the several methodological issues related to ethics and protection of the rights of patients with mental disorders, the legal regulation of genomic research in this category of patients is a specific interdisciplinary challenge which solution requires combining of the competencies of lawyers, medical ethics specialists, psychiatrists, psychologists, geneticists.

Vers une approche physiologique de la sémiologie en psychiatrie. Partie 2 : perspectives offertes par la biologie systémique

This second article, in a series of two, on the physiological approach of psychiatric semiology proposes to explore the place of physiology and clinical semiology according to a systemic biology approach. While the approach of psychiatric semiology has been closely linked to the construction of contemporary classifications of psychiatric disorders, two approaches tending to break away from classical nosographies have been proposed: the psychosystems project and the Cambridge model. For each of these approaches will be presented the general principle, the link with physiology and semiology, and the main limitations. It will be proposed to include the psychosystems project as well as the Cambridge model from a systemic biology perspective that could reintegrate semiology as an essential level of the psychiatric disorder approach, between biological and social value. The issues of such biological and social constraints will be approached according to an epistemological approach, notably through the questions raised by neurophenomenology, in order to propose a perspective of clinical neurophysiology to psychiatry: that is to say of a neurophysiology that takes seriously the clinical knowledge historically constituted of psychiatry, but also a clinic that does not deny the advances in neurophysiology on the understanding of brain function.

Classification of Psychiatric Disorders.

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.

Potential Toxic Effects of Olanzapine on Metabolic Parameters in &amp;lt;i&amp;gt;de Novo&amp;lt;/i&amp;gt; Paranoid Schizophrenic Patients. The Role of Adjunctive Aripeprazole: Clinical and Experimental Study

Background: Approximately 75% of all deaths in people with schizophrenia are caused by physical illness with cardiovascular disease [CVD] being the commonest cause of death. Factors predisposing people with schizophrenia to CVD include antipsychotic medication. Aim of Work: The aim of this study was to detect metabolic syndrome and its components in de novo paranoid schizophrenics on olanzapine therapy and the metabolic benefits of addition of aripeprazole, clinically and experimentally. Methodology: 1) Clinical study: 200 Outpatients suffered from de novo paranoid schizophrenia according to 10th International Classification of Psychiatric Disorders, Research Criteria [ICD10 RC] were included in the study. None of them had any component of metabolic syndrome. They were maintained on olanzapine [10 - 20 mg]. Patients were assessed clinically, psychometrically using Scale for the Assessment of Negative [SANS] and Positive [SAPS] Symptoms and metabolically at base line and after 6 months. Patients who had metabolic syndrome after 6 month of starting olanzapine therapy, were randomly divided into two groups according to added regime to maintained olanzapine: Group 1: olanzapine [10 mg/day] + placebo [empty hard gelatin capsule]. Group II: olanzapine [10 mg/day] + aripeprazole [10 mg/day]. 2) Experimental study: 40 male albino rats were randomly equally divided into 4 groups: Group 1 [control group]: received a standard diet, Group II [olanzapine treated]: received olanzapine at a dose of 0.5 mg/kg/day, Group III [aripiprazole treatd]: received aripiprazole at a dose of 2 mg/kg/day, Group IV [combined olanzapine and aripiprazole treated]: received olanzapine at a dose of 0.5 mg/kg/day combined with aripiprazole at a dose of 2 mg/kg/day orally. The duration of the study was 16 weeks. All treated rat groups were assessed for metabolic parameters, liver enzymes and histopathology. Results: Clinically, after the 6 months of olanzapine treatment [mean dose 12.75 mg], there was significant increase [p < 0.001] in weight, body mass index, triglyceride, total cholesterol, and fasting blood glucose level compared to base line level of these parameters (Table 1). 32 patients [16%] suffered from metabolic syndrome after 6 months of olanzapine therapy. After 3 months of aripeprazole, [10 mg/day], addition to maintained olanzapine therapy to patients suffered from metabolic syndrome, there was significant [p < 0.001] improvement in tested parameters (Table 2). Experimentally, the rats in group II [olanzapine treated rats] had significantly higher body weight [p = 0.002], liver weight [p < 0.001], metabolic parameters [p < 0.001] and liver enzymes [p < 0.001] than controls. Group 1v [combined olanzapine and aripeprazole treated rats] had significant decrease in metabolic parameters and liver enzymes in comparison to olanzapine treated rats (Table 3). Histopathologically, liver fat cells were significantly [p < 0.001] present in the olanzapine-only [8 rats] treatment group compared to group 1v [3 rats] and group 11 [zero]. Liver fat cells were higher in number and larger in size in group 1 compared to group 1v and group 1. Conclusion and Recommendation: Olanzapine treatment was found to be associated with risk factors of metabolic syndrome clinically and experimentally and its hepatic manifestation of non-alcoholic fatty liver disease in wister rats. Improvements were observed clinically and experimentally in metabolic measures, liver enzymes and liver histopathology by addition of aripeprazole. Patients on olanzapine therapy must be followed regularly regarding metabolic parameters, hepatic, cardiac and cerebrovascular morbidity, with urgent interference with early manifestations. It is recommended to check liver enzymes regularly for those patients kept on atypical antipsychotic drug [olanzapine].

The Diagnostic System: Why the Classification of Psychiatric Disorders is Necessary, Difficult, and Never Settled

The Diagnostic System: Why the Classification of Psychiatric Disorders is Necessary, Difficult, and Never Settled

Exploring the knowledge, explanatory models of illness, and patterns of healthcare-seeking behaviour of Fang culture-bound syndromes in Equatorial Guinea.

In 1994, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) included “culture-bound syndromes” in its classification of psychiatric disorders and associated them with disease processes that manifest in behavioural or thought disorders that develop within a given cultural context. This study examines the definitions, explanatory models, signs and symptoms, and healthcare-seeking behaviours common to Fang culture-bound syndromes (i.e., kong, eluma, witchcraft, mibili, mikug, and nsamadalu). The Fang ethnic group is the majority ethnic group in Equatorial Guinea. From September 2012 to January 2013, 45 key Fang informants were selected, including community leaders, tribal elders, healthcare workers, traditional healers, and non-Catholic pastors in 39 of 724 Fang tribal villages in 6 of 13 districts in the mainland region of Equatorial Guinea. An ethnographic approach with an emic-etic perspective was employed. Data were collected using semi-structured interviews, participant observation and a questionnaire that included DHS6 key indicators. Interviews were designed based on the Cultural Formulation form in the DSM-5 and explored the definition of Fang cultural syndromes, symptoms, cultural perceptions of cause, and current help-seeking. Participants defined “Fang culture-bound syndromes" as those diseases that cannot be cured, treated, or diagnosed by science. Such syndromes present with the same signs and symptoms as diseases identified by Western medicine. However, they arise because of the actions of enemies, because of the actions of spirits or ancestors, as punishments for disregarding the law of God, because of the violation of sexual or dietary taboos, or because of the violation of a Fang rite of passage, the dzas, which is celebrated at birth. Six Fang culture-bound syndromes were included in the study: 1) Eluma, a disease that is targeted at the victim out of envy and starts out with sharp, intense, focussed pain and aggressiveness; 2) Witchcraft, characterized by isolation from the outside, socially maladaptive behaviour, and the use of hallucinogenic substances; 3) Kong, which is common among the wealthy class and manifests as a disconnection from the environment and a lack of vital energy; 4) Mibili, a possession by evil spirits that manifests through visual and auditory hallucinations; 5) Mikug, which appears after a person has had contact with human bones in a ritual; and 6) Nsamadalu, which emerges after a traumatic process caused by violating traditions through having sexual relations with one’s sister or brother. The therapeutic resources of choice for addressing Fang culture-bound syndromes were traditional Fang medicine and the religious practices of the Bethany and Pentecostal churches, among others. Among African ethnic groups, symbolism, the weight of tradition, and the principle of chance in health and disease are underlying factors in the presentation of certain diseases, which in ethno-psychiatry are now referred to as culture-bound syndromes. In this study, traditional healers, elders, healthcare professionals, religious figures, and leaders of the Fang community in Equatorial Guinea referred to six such cultural syndromes: eluma, witchcraft, kong, mibili, mikug, and nsamadalu. In the absence of a multidisciplinary approach to mental illness in the country, the Fang ethnic group seeks healthcare for culture-bound syndromes from traditional healing and religious rites in the Evangelical faiths.

Reliability of DSM and empirically derived prototype diagnosis for mood, anxiety and personality disorders

BackgroundProminent psychiatric diagnostic systems such as the DSM-IV and ICD-10 have shown low reliability in clinical practice. An alternative approach to classification of psychiatric disorders is prototype matching. In the current study, we examined reliability of assessing mood, anxiety and personality disorders using a multi-method multi informant approach. More specifically, we examined diagnosis made by treating clinician and independent expert clinical interviewer, using three different diagnostic systems (DSM symptom count, DSM-IV prototype diagnosis and empirically derived prototype diagnosis). MethodsA convenience sample of clinicians (N = 80) and patients (N = 170) from eight community mental health clinics in Israel participated in the study. ResultsOur findings show fair to excellent interrater reliability for prototype dimensional diagnostic systems (ranged from 0.40 to 0.79) for most mood and anxiety disorders examined. Overall, dimensional diagnostic systems, yielded better interrater reliability for mood, anxiety and personality disorders, as compared with categorical diagnosis. There were no significant differences between dimensional systems. ConclusionsOur findings provide further support to the advantages of dimensional over categorical models in increasing reliability.