Classification System For Disorders Research Articles

Neurodevelopmental and Mental Health Conditions in Children With Medical Complexity.

Children with medical complexity (CMC) may be at a high risk of neurodevelopmental and mental health conditions given disease comorbidities and lived experiences. Little is known about the prevalence of these conditions at a population level. In this study, we estimated the prevalence of neurodevelopmental and mental health diagnoses in CMC relative to children without medical complexity and measured associations between these diagnoses in CMC and subsequent health care utilization and in-hospital mortality. We applied the Child and Adolescent Mental Health Disorders Classification System to identify neurodevelopmental and mental health diagnoses using all-payer claims data from three states (2012-2017). Poisson regression was used to compare outcomes in CMC with neurodevelopmental and mental health diagnoses to CMC without these diagnoses, adjusting for sociodemographic and clinical characteristics. Among 85 581 CMC, 39 065 (45.6%) had ≥1 neurodevelopmental diagnoses, and 31 703 (37.0%) had ≥1 mental health diagnoses, reflecting adjusted relative risks of 3.46 (3.42-3.50) for neurodevelopmental diagnoses and 2.22 (2.19-2.24) for mental health diagnoses compared with children without medical complexity. CMC with both neurodevelopmental and mental health diagnoses had 3.00 (95% confidence interval [CI]: 2.98-3.01) times the number of ambulatory visits, 69% more emergency department visits (rate ratio = 1.69, 95% CI: 1.66-1.72), 58% greater risk of hospitalization (rate ratio = 1.58, 95% CI: 1.50-1.67), and 2.32 times (95% CI: 2.28-2.36) the number of hospital days than CMC without these diagnoses. Neurodevelopmental and mental health diagnoses are prevalent among CMC and associated with increased health care utilization across the continuum of care. These findings illustrate the importance of recognizing and treating neurodevelopmental and mental health conditions in this population.

Upper cervical spine syndrome: A new perspective

Headaches are widespread in Western Society; they affect approximately 50% of the adult population in the United States. Headaches can present with a variety of clinical and regional symptoms. Although a headache disorder classification system exists, clinical experience has identified various overlapping causes for headaches. It remains clinically challenging to identify the exact etiology causing headaches. For example, the underlying mechanism of cervicogenic headaches remains elusive, but the upper cervical spine plays a key role. Abnormal upper cervical movement patterns, in combination with muscular dysfunctions, are a possible contributing factor to headaches. The upper vertebral spinal nerves C0-C3 have been correlated with cervicogenic headaches. It has been established that biomechanical dysfunction of the upper cervical spine can contribute to neck pain. The atlas plays a key role in the biomechanical dysfunction in the upper cervical spine. Previously, it has been identified that the relative position of the atlas to the axis correlates with headaches. Additionally, it has been demonstrated that an extended contraction of the homolateral obliquus capitis inferior muscles can result in positional default rotation of the atlas. As managing headaches remains multimodal and challenging, there is enough evidence to support the inclusion of the upper cervical spine to normalize joint position, joint mobility, muscle tonicity, and upright positioning. When recognizing the “upper cervical syndrome” and addressing the functioning of the atlas, clinical outcomes will improve for those treating patients with headaches.

Clinical efficacy of sodium aescinate administration following endovenous laser ablation for varicose veins.

Endovenous interventions and minimally invasive procedures are effective in the management of varicose veins. However, they can cause postoperative discomfort. To evaluate the clinical efficacy of sodium aescinate (SA) in improving edema, pain, vein-specific symptoms, and quality of life in patients following endovenous laser ablation (EVLA) for varicose veins. In this single-center randomized controlled trial (RCT), patients were allocated into two groups: in Group A, 60mg SA was administered twice daily for 20days, and in Group B (control), no venoactive drug was prescribed. The Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification system for chronic venous disorders was used to assess the varicose veins. The circumferences of the calf and ankle were recorded for evaluating edema. The 10-point Visual Analog Scale (VAS), Venous Clinical Severity Score (VCSS), and Aberdeen Varicose Veins Questionnaire (AVVQ) were used to measure the pain intensity, overall varicose vein severity, and patient's quality of life, respectively. The study included 87 patients (mean age, 59.9 ± 10.7years; 54 men) with CEAP class C2-C5 varicose veins who underwent EVLA and phlebectomy or foam sclerotherapy. The calf circumference recovered quicker in Group A than in Group B by days 10, 21, and 30 (difference from baseline was 1.04 ± 0.35 vs 2.39 ± 1.15 [p < .001], 0.48 ± 0.42 vs1.73 ± 1.00 [p < .001], and 0.18 ± 0.64 vs 0.82 ± 0.96 [p < .001], respectively). The ankle circumference recovered quicker in Group A than in Group B by days 10 and 21 (the difference from baseline was 1.37 ± 0.52 vs 2.36 ± 0.93 [p < .001] and 0.58 ± 0.60 vs 1.14 ± 0.88 [p = .002], respectively). Pain relief was achieved quicker in Group A than in Group B (0.257 ± 1.097 [p = .0863] vs 0.506 ± 1.250 [p = .0168] by day 21). There were no significant differences in the VCSS and AVVQ scores between both groups. There were no drug-related adverse effects. SA, in combination with compression therapy, can relieve edema and alleviate pain in patients following EVLA for varicose veins.

The Dimensional Conceptualization of Personality Disorders: Personality Organization, Personality Functioning, and Personality Disorders.

Over the past several decades, significant criticism of the categorical classification system for personality disorders has highlighted the need to transition to a dimensional classification system. This study reviewed key issues involved in the potential conversion of the diagnostic system of personality disorders from a categorical to a dimensional model. The result suggests that Kernberg's concept of personality organization can be used to indicate the overall severity of personality pathology.

New International Federation of Gynecology and Obstetrics ovulatory disorders classification system 2022. Diagnostic assessment of ovulatory dysfunction

Until recently, researchers and clinicians have used the World Health Organization classification of ovulatory disorders (1973), which was based on the levels of gonadotropins and estrogens in the blood serum (mainly follicle-stimulating hormone) and classified ovulatory disorders depending on the hypothalamic-pituitary-ovarian axis dysfunction levels.&#x0D; This review article presents a new classification system for ovulation disorders developed by the International Federation of Gynecology and Obstetrics (FIGO) in 2022. The first level of this classification system is based on an anatomical approach (hypothalamus, pituitary gland, ovaries), which is complemented by a separate category for polycystic ovary syndrome. At the second level, each anatomical category is classified according to the putative etiopathogenetic mechanisms underlying ovulation disorders. The third level suggests the presence of specific nosologies, which represent the direct cause of ovulation disorders. This new classification should be used after a preliminary examination that reveals the presence of an ovulation disorder. This review discusses various ovulation disorders and provides tools for their diagnosis in accordance with international guidelines and domestic recommendations.

Toward a Unified Classification System for Brain-Mind Disorders: Putting Calls for Integrated Clinical Neuroscience Into Action.

Dividing the brain-mind into the specialized fields of neurology and psychiatry has produced many granular advantages, but these silos have imposed barriers to comprehensively understanding and contextualizing the fundamentals governing mental life and its maladies. Scientific inquiry into these fundamentals cannot reach its full potential without interdigitating the boundaries of two specialties of the same organ for both scholarship and clinical practice. We propose that to truly integrate disorders of the brain and the mind for research and clinical care, we must carefully reexamine the classification of its disorders (nosology) as an instrument to develop a coherent pathological and psychological framework. We call on professional organizations from neurology, psychiatry, behavioral neurology, neuropsychiatry, neuropsychology, and other relevant subspecialties (eg, geriatric psychiatry) to convene a multidisciplinary task force to define the current classification principles of their subspecialties and work toward developing an integrated nosology. The effect of a shared classification system, which we acknowledge is a difficult proposition philosophically and politically, would have transformative potential across educational, clinical, scientific, programmatic, and sociocultural realms. If accomplished, this initiative would provide a definitive step toward reducing stigma (and promoting reimbursement parity) for the full spectrum of complex brain disorders (regardless of traditional neurologic vs psychiatric conceptualizations).

Assessment and Diagnostic Classification Using DC:0-5 in Early Childhood Mental Health Clinics: The Protocol for the Developmental Psychiatry Diagnostic Challenges Study (DePsy).

Mental health problems in early childhood are common, but there is a lack of psychiatric research on this age group. DC:0-5 is a multiaxial classification system for mental disorders in early childhood, providing a framework for standardizing clinical practice and research. However, research on the validity of DC:0-5 is scarce. The Developmental Psychiatry Diagnostic Challenges Study (DePsy) is a multi-site, prospective clinical study including six German early childhood mental health (ECMH) clinics. The main objective of the study is to contribute to the validation of Axis I and Axis II of DC:0-5. A second aim of the study is to describe the population of the participating clinics regarding diagnoses, family context, and treatment outcomes. Additionally, the impact of environmental risk factors, including parental Adverse Childhood Experiences (ACEs) and media use, on child psychopathology and caregiver-child relationships will be examined. Over two years, patients aged 0.0-5.9 years old will be enrolled in the study. Assessments include ICD-10 and DC:0-5 diagnoses, developmental tests, video-based observations of caregiver-child interactions, and questionnaires on child psychopathology, media use, parental stress, and treatment satisfaction. Study results will promote the standardization of assessment and treatment in ECMH clinics aiming to improve the development of patients and their families.

Toward Real-World Voice Disorder Classification.

Voice disorders significantly compromise individuals' ability to speak in their daily lives. Without early diagnosis and treatment, these disorders may deteriorate drastically. Thus, automatic classification systems at home are desirable for people who are inaccessible to clinical disease assessments. However, the performance of such systems may be weakened due to the constrained resources and domain mismatch between the clinical data and noisy real-world data. This study develops a compact and domain-robust voice disorder classification system to identify the utterances of health, neoplasm, and benign structural diseases. Our proposed system utilizes a feature extractor model composed of factorized convolutional neural networks and subsequently deploys domain adversarial training to reconcile the domain mismatch by extracting domain-invariant features. The results show that the unweighted average recall in the noisy real-world domain improved by 13% and remained at 80% in the clinic domain with only slight degradation. The domain mismatch was effectively eliminated. Moreover, the proposed system reduced the usage of both memory and computation by over 73.9%. By deploying factorized convolutional neural networks and domain adversarial training, domain-invariant features can be derived for voice disorder classification with limited resources. The promising results confirm that the proposed system can significantly reduce resource consumption and improve classification accuracy by considering the domain mismatch. To the best of our knowledge, this is the first study that jointly considers real-world model compression and noise-robustness issues in voice disorder classification. The proposed system is intended for application to embedded systems with limited resources.

Associations of continuum beliefs with personality disorder stigma: correlational and experimental evidence.

A pervasive and deeply entrenched stigma of personality disorders exists. For other mental disorders, a large body of research suggests that continuum beliefs (i.e., the endorsement of continuum perspectives on mental health and psychopathology) stimulate more favorable attitudes toward affected persons. Additionally, mental disorder classification systems increasingly incorporate continuous personality disorder models. Yet, it is unclear how continuum beliefs are related to personality disorder stigma. This study evaluated the link of continuum beliefs with personality disorder stigma based on correlational and experimental data. A large general population sample (N = 848) completed self-report measures of continuum beliefs regarding personality disorders, desired social distance, and prejudice toward persons with personality disorders. Additionally, participants were randomly presented with information supporting a continuous or a dichotomous view of personality disorders. Continuum beliefs were associated with lower desired social distance (r = -0.19) and prejudice (r = -0.22). Additionally, the brief continuum intervention was associated with increased continuum beliefs (d = 0.99) and decreased desired social distance (d = -0.14) and prejudice (d = -0.17). Finally, the intervention effects on desired social distance and prejudice were mediated by continuum beliefs. This study suggests that highlighting continuum views on personality disorders in public communication and interventions might reduce personality disorder stigma.

The relationship between pes planus and venous insufficiency.

The presence of pes planus may be responsible for the disorder of venous return during ambulation. Our aim in this study is to reveal that the risk of venous insufficiency may be increased in patients with pes planus. A total of 59 patients with 29 bilateral pes planus and 30 normal arches included in the study. Djian Annonier angle measurement, bilateral lower extremity venous Doppler ultrasonography (USG), foot function index (AFI), Comprehensive Classification System for Chronic Venous Disorders (CEAP) clinical scoring and Short Form-36 (SF-36) was evaluated. There was a statistically significant difference in AFI total, AFI pain, AFI disability and AFI activity limitation scores, bilateral lower extremity doppler USG and CEAP clinical scores in the patient group compared to the control group. These findings suggest that there may be a relationship between pes planus and venous insufficiency. However, large-scale studies with more patient involvement are needed.

Tanılar Üstü Yaklaşım ve Obsesif Kompulsif Bozukluk

The categorical approach of traditional psychiatric nosology has been a forceful approach for a very long time for explaining psychological disorders which are defined by symptom based diagnostic categories. However, in recent years, the importance of the "transdiagnostic" approach which is a new classification system is increasing. The transdiagnostic approach aims to examine dimensionally the common cognitive, behavioral, interpersonal and biological processes underlying many psychopathologies away from the categorical approach that classifies psychopathologies according to observable symptoms. This approach intends to treat the disorders through the common underlying processes and risk factors, thus heterogeneous and comorbid symptoms are better addressed and diagnostic categories that may change during treatment are avoided. In this review study, the current problems in diagnosing based on classification and gaps in the field were examined, and the approach itself was proposed as a solution. RDoC (Research Domain Criteria) which is a new classification system for psychiatric disorders within the scope of the approach, has created a new structure using modern research approaches in genetics, neuroscience and behavioral sciences. In the present study, the definition and emergence of the transdiagnostic approach, obsessive compulsive disorder and RDoC in the context of transdiagnostic approach and transdiagnostic treatment are explained. This review is intended to be a resource for both basic psychopathology research and the development of treatment methods within the framework of a transdiagnostic approach.

Nurse Education and Hospital Readmissions for Children With and Without a Mental Health Condition.

In adults, receiving care in a hospital with more baccalaureate-prepared nurses improves outcomes. This relationship is magnified in adults with serious mental illness or cognitive impairment. Whether the same is true in children with and without a mental health condition is unknown. The study purposes were to determine 1) whether the proportion of baccalaureate-prepared nurses affected the odds of readmission in children; and 2) whether this relationship differed for children with a mental health condition. We linked cross-sectional data from the 2016 Healthcare Cost and Utilization Project State Inpatient Databases, the RN4CAST-US nurse survey in Florida, and the American Hospital Association. Inclusion criteria were ages 3 to 21 years. Mental health conditions were defined as psychiatric or developmental/behavioral diagnoses. These were identified using the Child and Adolescent Mental Health Disorders Classification System. We used multivariable, hierarchical logistic regression models to assess the relationship between nurse training and readmissions. In 35 081 patients admitted to 122 hospitals with 4440 nurses, 21.0% of patients had a mental health condition and 4.2% had a 7-day readmission. For individuals without a mental health condition, each 10% increase in the proportion of baccalaureate-prepared nurses was associated with 8.0% lower odds of readmission (odds ratio = 0.92, 95% confidence interval = 0.87-0.97). For those with a mental health condition, each 10% increase in the proportion of baccalaureate-prepared nurses was associated with 16.0% lower odds of readmission (odds ratio = 0.84, 95% confidence interval = 0.78-0.91). A higher proportion of baccalaureate-educated nurses is associated with lower odds of readmission for pediatric patients. This association has a larger magnitude in patients with a mental health condition.

175 National Trends in Chemical Restraint for Pediatric Behavioral Health Patients in the Emergency Department

175 National Trends in Chemical Restraint for Pediatric Behavioral Health Patients in the Emergency Department

The FIGO ovulatory disorders classification system.

Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding, and infertility, and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical, and epidemiological research. Similarly, therapeutic approaches to ovulatory dysfunction potentially involve a spectrum of lifestyle, psychological, medical, and procedural interventions. Collaborative research, effective education, and consistent clinical care remain challenged by the absence of a consensus comprehensive system for classification of these disorders. The existing and complex system, attributed to WHO, was developed more than three decades ago and did not consider more than 30 years of research into these disorders in addition to technical advances in imaging and endocrinology. This manuscript describes the development of a new classification of ovulatory disorders performed under the aegis of the International Federation of Gynecology and Obstetrics (FIGO) and conducted using a rigorously applied Delphi process. The stakeholder organizations and individuals who participated in this process comprised specialty journals, experts at large, national, specialty obstetrical and gynecological societies, and informed lay representatives. After two face-to-face meetings and five Delphi rounds, the result is a three-level multi-tiered system. The system is applied after a preliminary assessment identifies the presence of an ovulatory disorder. The primary level of the system is based on an anatomic model (Hypothalamus, Pituitary, Ovary) that is completed with a separate category for PCOS. This core component of the system is easily remembered using the acronym HyPO-P. Each anatomic category is stratified in the second layer of the system to provide granularity for investigators, clinicians, and trainees using the "GAIN-FIT-PIE" mnemonic (Genetic, Autoimmune, Iatrogenic, Neoplasm; Functional, Infectious and Inflammatory, Trauma and Vascular; Physiological, Idiopathic, Endocrine). The tertiary level allows for specific diagnostic entities. It is anticipated that, if widely adopted, this system will facilitate education, clinical care, and the design and interpretation of research in a fashion that better informs progress in this field. Integral to the deployment of this system is a periodic process of reevaluation and appropriate revision, reflecting an improved understanding of this collection of disorders.

An Examination of the RDoC Negative Valence Systems Domain Constructs and the Self-Reports Unit of Analysis

In response to shortcomings with the current diagnostic classification system for mental health disorders, such as poor validity and reliability of categorical diagnoses, the National Institute of Mental Health proposed the Research Domain Criteria (RDoC) initiative to move towards a dimensional approach using translational research. The current study examined associations between measures of behaviors, cognitions, and mental health symptoms and how they overlap in the Negative Valence Systems (NVS) domain. Specifically, we examined how the Self-Reports unit of analysis reflects the RDoC NVS constructs of acute threat, potential threat, sustained threat, frustrative nonreward, and loss. The overall goal was to identify additional self-report measures that reflect these constructs. Participants, two student samples and two community samples (total N = 1,509), completed online self-reported measures. Questionnaire total and subscale scores were submitted to a principal-axis factor analysis with Promax rotation separately for each sample. For both student samples and one community sample six-factor solutions emerged reflecting major aspects of the RDoC NVS and positive valence systems, particularly acute threat (i.e., fear/panic), potential threat (i.e., inhibition/worry), sustained threat (i.e., chronic stress), loss (i.e., low well-being), frustrative nonreward (i.e., reactive aggression), and reduced behavioral activation. The second community sample differed in that fear/panic and frustration/anger was combined in a general distress factor. Recommendations for additional NVS self-report markers are discussed.

Psychodiagnostic Classification Systems: A Critical View

The need for a more and more comprehensive classification system of mental disorders that responds to the difficulties of the subject is more imperative than ever. The purpose of this study through a critical look is to highlight the way a diagnostic system "thinks" about the symptoms of each subject. Methodologically, in the context of the modern international literature, an attempt is made to capture perceptions from the field of scientific knowledge regarding psychodiagnostic systems that dominate the mental health field. More specifically, it reflects the way in which each psychodiagnostic system classifies symptoms in the context of a phenomenology of things, leaving aside the personal pain and the uniqueness of each subject. In conclusion, it seems that psychodiagnostic systems talk about symptoms that are divided into clusters and each of them gets a name. They don’t talk about causes, they don’t take into account the difference, nor the environment and the temperament of each person, as a result of which difficulties are created because they do not aim therapeutically at what gives birth to the symptom, but at what each symptom shows.

Impact of self-reported cognitive dysfunction on the alternative model of personality disorders among older adults

Objectives: The Alternative Model of Personality Disorders (AMPD) is a classification system for personality disorders (PDs) proposed in Section III of DSM-5. The AMPD contains two diagnostic constructs: personality functioning and pathological personality traits. Previous research has suggested that the model performed differently among older adults than younger adults (e.g., more generalized patterns). However, explanations for this difference in performance remain unclear. This study examined how self-reported cognitive dysfunction (a common complaint among older adults) impacts the AMPD’s two constructs among a later life sample. Method Older adults (N = 202) completed the Levels of Personality Functioning Scale-Self-Report, Personality Inventory for DSM-5, and Coolidge Axis II Inventory with its six self-report cognitive dysfunction scales. Results Results suggested high correlational overlap between subjective cognitive problems with personality functioning and pathological personality, as measured by the AMPD. Hierarchical regressions revealed that subjective measures of executive functions, perceptual motor, and language difficulties were most strongly related to the AMPD’s constructs. Results are discussed in the context of prior research on objective cognitive impairment among individuals with PDs. Conclusion The degree of overlap found within the current older adult sample suggested an age-related problem or potential age-bias, with older adults being at-risk of (a) having their subjective cognitive problems being incorrectly interpreted as personality pathology under the AMPD or (b) having personality pathology being overlooked under the AMPD, with symptoms instead attributed to subjective cognitive issues. This study suggested that subjective cognitive dysfunction may be one mechanism that contributes to differential performance of the AMPD among older adults.

Programmed for Automatic Bone Disorder Clustering Based on Cumulative Calcium Prediction for Feature Extraction.

The prediction of bone disorders varies between ortho-physicians. A precise bone disorder cataloging system is proposed based on a renewed method for estimating calcium value from a radiological image of the bone. A deliberate method was employed, the binning technique, for the input image which divides the input image into non-overlapping blocks to obtain accurate calcium volume estimation. In this proposed approach, the input image undergoes two stages of the process. In stage 1, input image preprocessing is accomplished with median filtering to eliminate the unwanted noise and it increases the quality of the image. Further, the processed image is fed to the Otsu-thresholding-segmentation method to highlight the affected regions from the processed bone image. The LBP (Local Binary Pattern) is a technique implemented to pull out the feature vector alone from the input image. Calcium value is estimated from abnormal regions from the segmented bone image and with the help of extracted texture features, the calcium concentration is obtained. MSVM (Multi-class Support Vector Machine) technique is applied to categorize as normal, osteoporosis, and osteopenia. In stage 2, the entire input is divided into 4 x 4 bins and preprocessing, segmentation, feature extraction, and calcium estimation process were applied similar to stage I to each bin separately and the calcium values of all bins are added together. Finally, stage 1 and stage 2 calcium values are summed up to obtain a more precise calcium estimation of the input image the feature vectors which were pull-out from others. The result can prove that the proposed binning technique is best for the bone disorder classification system which attained the greater accuracy of 97.4% and sensitivity of 98.3% when compared with and without binning technique. Validation of the results was performed with bone images, and these bone images were declared by the physician as bone disorder-affected images. The success rate of the bone disorder prediction is 80%.

Poor Separation of Clinical Symptom Profiles by DSM-5 Disorder Criteria.

Assessment of mental illness typically relies on a disorder classification system that is considered to be at odds with the vast disorder comorbidity and symptom heterogeneity that exists within and across patients. Patients with the same disorder diagnosis exhibit diverse symptom profiles and comorbidities creating numerous clinical and research challenges. Here we provide a quantitative analysis of the symptom heterogeneity and disorder comorbidity across a sample of 107,349 adult individuals (aged 18–85 years) from 8 English-speaking countries. Data were acquired using the Mental Health Quotient, an anonymous, online, self-report tool that comprehensively evaluates symptom profiles across 10 common mental health disorders. Dissimilarity of symptom profiles within and between disorders was then computed. We found a continuum of symptom prevalence rather than a clear separation of normal and disordered. While 58.7% of those with 5 or more clinically significant symptoms did not map to the diagnostic criteria of any of the 10 DSM-5 disorders studied, those with symptom profiles that mapped to at least one disorder had, on average, 20 clinically significant symptoms. Within this group, the heterogeneity of symptom profiles was almost as high within a disorder label as between 2 disorder labels and not separable from randomly selected groups of individuals with at least one of any of the 10 disorders. Overall, these results quantify the scale of misalignment between clinical symptom profiles and DSM-5 disorder labels and demonstrate that DSM-5 disorder criteria do not separate individuals from random when the complete mental health symptom profile of an individual is considered. Greater emphasis on empirical, disorder agnostic approaches to symptom profiling would help overcome existing challenges with heterogeneity and comorbidity, aiding clinical and research outcomes.

Client and Clinical Utility of the Assessment of Personality Disorders.

Clinical utility and client utility are important desirable properties when developing and evaluating a new classification system for mental disorders. This study reports on four focus groups followed up by a Delphi study among clinicians working with clients with personality disorders (PD) and clients with PD themselves to harness both user groups' perspectives on the utility of PD diagnosis. Our findings show that the client and clinician views of the concept of utility were closely aligned and include aspects of transparency of communication and the ability of an assessment to enhance hope, curiosity, motivation, and insight into a client's personality patterns. Unique to clinicians' appraisal was the ability of an assessment to capture both vulnerabilities and resilience of clients and to give information about the prognosis in treatment. Unique to clients' appraisal was the ability of an assessment to be destigmatizing and collaborative. These findings may serve to expand our definition and measurement of clinical utility, in that collaborative and nonstigmatizing procedures likely promote client acceptability. To capture both aspects, we offer two preliminary questionnaires (i.e., item sets open to further empirical testing) based on the data derived from the Delphi procedure.