Current Diagnostic Systems Research Articles

Idioms of Distress.

The presentations of psychosocial distress and cultural conflicts are often bodily symptoms, especially in traditional societies and village backgrounds. These might not meet the criteria of the current psychiatric diagnostic systems. Sociocultural milieu contributes to the unique presentations of the stress in the form of idioms of distress. The latter are alternative modes of expressing distress and indicate manifestations of distress in relation to personal and cultural meaning. Health professionals often consider these as hysterical, functional or having functional overlays, and abnormal illness behaviors. Management of idioms of distress would need cultural competence and sensitivity. This article highlights the common idioms of distress in India with specific focus on bodily symptoms.

An Overview and Comparison of Two Proposed Suicide-Specific Diagnoses: Acute Suicidal Affective Disturbance and Suicide Crisis Syndrome

Current psychological diagnostic classification systems do not fully capture the scope of suicidality, leading to recent advocacy for the inclusion of a suicide-specific diagnosable condition. We contend that a suicide-specific diagnosable condition should parsimoniously reflect acuity and characterize not only if, but also when, a person will engage in suicidal behavior. Two potential solutions to this diagnostic void have been proposed: (1) acute suicidal affective disturbance (ASAD) and (2) suicide crisis syndrome (SCS). This article provides an overview of the phenomenology and existing empirical evidence for ASAD and SCS, as well as a comparison between the two conditions. It also outlines a number of future research directions, including the need to examine both conditions prospectively in heterogeneous samples of people across the lifespan, as well as the necessity of comparing the reliability, validity, and clinical utility of these two syndromes directly within single studies. [ Psychiatr Ann . 2017;47(8):416–420.]

Psychological Formulation as an Alternative to Psychiatric Diagnosis

The article gives an overview of psychological formulation, a rapidly expanding practice in the United Kingdom that is supported by the British Psychological Society. It is argued that formulation can provide a credible alternative to psychiatric diagnosis in the context of public admissions about lack of reliability and validity of current diagnostic systems. However, vigilance and best-practice principles are essential to ensure that this approach is not assimilated back into the status quo.

Beyond Critique: The Partners for Change Outcome Management System as an Alternative Paradigm to Psychiatric Diagnosis

Critics claim that current psychiatric diagnostic systems lack reliability, validity, and clinical utility; are incompatible with known evidence of how change occurs in psychotherapy; are compromised by bias; and risk harmful effects for clients. This article argues that the Partners for Change Outcome Management System (PCOMS), a transparent, egalitarian process that collects and utilizes client feedback at each session, convincingly addresses these concerns. Furthermore, it suggests that PCOMS offers a viable alternative to the reimbursement and administrative functions of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases. The authors propose that PCOMS represents a radical realignment of the practitioner/client relationship via full, dialogical partnership at every level of psychotherapy practice and thus constitutes a step toward a new paradigm that reconnects psychotherapy and humanistic psychology with its core relational values.

Where Lies the Fault in Diagnosing Dhat Syndrome among Females? Understanding through a Case Study

Dhat syndrome is a culture-bound syndrome of South-East Asia, common in young men. However, similar entity has also been described in female patients who attribute their symptoms to nonpathological or physiological vaginal discharge. The current diagnostic system for psychiatric illnesses does not encompass Dhat syndrome in females, and so these group of patients receive alternative diagnoses such as somatoform disorder or depression. As a result of which the focus of unique Dhat syndrome-centered management gets weakened, affecting the clinical outcome. This case study focuses on the diagnostic dilemmas related to Dhat syndrome in females and pitfalls in the current diagnostic system.

Interpersonal dysfunction in personality disorders: A meta-analytic review.

Personality disorders are defined in the current psychiatric diagnostic system as pervasive, inflexible, and stable patterns of thinking, feeling, behaving, and interacting with others. Questions regarding the validity and reliability of the current personality disorder diagnoses prompted a reconceptualization of personality pathology in the most recent edition of the psychiatric diagnostic manual, in an appendix of emerging models for future study. To evaluate the construct and discriminant validity of the current personality disorder diagnoses, we conducted a quantitative synthesis of the existing empirical research on associations between personality disorders and interpersonal functioning, defined using the interpersonal circumplex model (comprising orthogonal dimensions of agency and communion), as well as functioning in specific relationship domains (parent-child, family, peer, romantic). A comprehensive literature search yielded 127 published and unpublished studies, comprising 2,579 effect sizes. Average effect sizes from 120 separate meta-analyses, corrected for sampling error and measurement unreliability, and aggregated using a random-effects model, indicated that each personality disorder showed a distinct profile of interpersonal style consistent with its characteristic pattern of symptomatic dysfunction; specific relationship domains affected and strength of associations varied for each personality disorder. Overall, results support the construct and discriminant validity of the personality disorders in the current diagnostic manual, as well as the proposed conceptualization that disturbances in self and interpersonal functioning constitute the core of personality pathology. Importantly, however, contradicting both the current and proposed conceptualizations, there was not evidence for pervasive dysfunction across interpersonal situations and relationships. (PsycINFO Database Record

The Psychophysiology of Anxiety and Mood Disorders

Abstract. Several decades of research are reviewed, assessing patterns of psychophysiological reactivity in anxiety patients responding to a fear/threat imagery challenge. Findings show substantive differences in these measures within principal diagnostic categories, questioning the reliability and categorical specificity of current diagnostic systems. Following a new research framework (US National Institute of Mental Health [NIMH], Research Domain Criteria [RDoC]; Cuthbert & Insel, 2013 ), dimensional patterns of physiological reactivity are explored in a large sample of anxiety and mood disorder patients. Patients’ responses (e.g., startle reflex, heart rate) during fear/threat imagery varied significantly with higher questionnaire measured “negative affect,” stress history, and overall life dysfunction – bio-marking disorder groups, independent of Diagnostic and Statistical Manuals (DSM). The review concludes with a description of new research, currently underway, exploring brain function indices (structure activation, circuit connectivity) as potential biological classifiers (collectively with the reflex physiology) of anxiety and mood pathology.

Thrombosis in diabetes: a shear flow effect?

Cardiovascular events are the major cause of morbidity and mortality in Type2 diabetes (T2D). This condition is associated with heightened platelet reactivity, contributing to increased atherothrombotic risk. Indeed, individuals with diabetes respond inadequately to standard antiplatelet therapy. Furthermore, they often experience recurrent events as well as side effects that include excess bleeding. This highlights the need for identification of novel regulators of diabetes-associated thrombosis to target for therapeutic intervention. It is well established that platelet aggregation, a process essential for thrombus formation, is tightly regulated by shear stress; however, the mechanisms underlying shear activation of platelets, particularly in the setting of diabetes, are still poorly understood. This review will address the limitations of current diagnostic systems to assess the importance of shear stress in the regulation of thrombus formation in T2D, and the inability to recapitulate the pro-thrombotic phenotype seen clinically in the setting of T2D. Moreover, we will discuss recent findings utilizing new technologies to define the importance of shear stress in thrombus formation and their potential application to the setting of diabetes. Finally, we will discuss the potential of targeting shear-dependent mechanisms of thrombus formation as a novel therapeutic approach in the setting of T2D.

Experimental verification of the vaporization's contribution to the shock waves generated by underwater electrical wire explosion under micro-second timescale pulsed discharge

This paper studies pressure waves generated by exploding a copper wire in a water medium, demonstrating the significant contribution of the vaporization process to the formation of shock waves. A test platform including a pulsed current source, wire load, chamber, and diagnostic system was developed to study the shock wave and optical emission characteristics during the explosion process. In the experiment, a total of 500 J was discharged through a copper wire load 0.2 mm in diameter and 4 cm in length. A water gap was installed adjacent to the load so that the current was diverted away from the load after breakdown occurred across the water gap. This allows the electrical energy injection into the load to be interrupted at different times and at different stages of the wire explosion process. Experimental results indicate that when the load was bypassed before the beginning of the vaporization phase, the measured peak pressure was less than 2.5 MPa. By contrast, the peak pressure increased significantly to over 6.5 MPa when the water gap broke down after the beginning of the vaporization phase. It was also found that when bypassing the load after the voltage peak, similar shock waves were produced to those from a non-bypassed load. However, the total optical emission of these bypassed loads was at least an order of magnitude smaller. These results clearly demonstrate that the vaporization process is vital to the formation of shock waves and the energy deposited after the voltage collapse may only have a limited effect.

The dimensional structure of psychopathology in 22q11.2 Deletion Syndrome

Background22q11.2 Deletion Syndrome (22q11.2DS) is one of the strongest known genetic risk factors for developing schizophrenia. Individuals with 22q11.2DS have high rates of neurodevelopmental disorders in childhood, while in adulthood ∼25% develop schizophrenia. Similar to the general population, high rates of comorbidity are common in 22q11.2DS. Employing a dimensional approach where psychopathology is examined at the symptom-level as complementary to diagnostic categories in a population at such high genetic risk for schizophrenia can help gain a better understanding of how psychopathology is structured as well as its genetic underpinnings. This is the first study to examine the dimensional structure of a wide spectrum of psychopathology in the context of a homogeneous genetic etiology like 22q11.2DS. MethodsWe evaluated 331 individuals with 22q11.2DS, mean age (SD) = 16.9(8.7); 51% males, who underwent prospective comprehensive phenotyping. We sought to replicate previous findings by examining a bi-factor model that derives a general factor of psychopathology in addition to more specific dimensions of psychopathology (i.e., internalizing, externalizing and thought disorder). ResultsPsychopathology in 22q11.2DS was divided into one ‘general psychopathology’ factor and four specific dimensions (i.e., ‘anxiety’, ‘mood’, ‘ADHD’ and ‘psychosis’). The ‘psychosis’ symptoms loaded strongly on the ‘general psychopathology’ factor. ConclusionsThe similarity of the symptom structure of psychopathology between 22q11.2DS and community and clinical populations without the deletion indicate that 22q11.2DS can provide a model to explore alternative approaches to our current nosology. Our findings add to a growing literature indicating the need to reorganize current diagnostic classification systems.

What does Positivity Add to Psychopathology? An Introduction to the Special Issue on ‘Positive Emotions and Cognitions in Clinical Psychology’

Research over the last two decades on the role of positive emotions and cognitions in psychological functioning is leading to conceptual changes regarding the nature of mental disorders and the mechanisms underlying their onset and maintenance. This introduction to the latest breakthrough research on positive emotions and cognition offers a brief description of the emerging presence of positivity in current diagnostic systems like the DSM5 and Research Domain Criteria (RDoC). It also analyzes some select findings from the literature on experimental psychopathology supporting the relevance of examining positive aspects of functioning in clinical psychology. In addition, the study of positive aspects of psychological functioning adds a more conceptually complex understanding of psychopathology. The multiple perspectives encompassed in this special issue shed light on our understanding of the different roles that positive emotions and cognitions play in mediating normal and abnormal human functioning and their importance to improving research methods and interventions in psychopathology.

Characterization of different subtypes of schizophrenia: Premorbid functioning, neurophysiological differences, functional outcomes

Introduction Although not included in current diagnostic systems, deficit versus non-deficit and resistant versus non-resistant schizophrenia subtypes look more promising than traditional schizophrenia subtypes in terms of stability across time, clinical utility and interest for research. Aims To critically analyze evidence supporting the validity of two schizophrenia subtypes: Deficit Schizophrenia (DS) and Treatment Resistant Schizophrenia (TRS). Methods Empirical data supporting the validity of DS and TRS subtypes will be critically reviewed. Results DS, in comparison with non-deficit schizophrenia, is characterized by poorer premorbid functioning, more insidious onset, lower prevalence of dysphoria, hostility, suicidal ideation, depressive symptoms and substance abuse, different neurobiological abnormalities, and poorer response to treatment. The diagnosis of DS shows high reliability and stability across time. However, research based on this approach has proven difficult, especially in first-episode schizophrenia, and findings have not been as homogeneous as expected. TRS patients, as compared to non-TRS ones, show persisting psychotic symptoms, greater severity of negative symptoms, more severe cognitive dysfunctions, poorer premorbid functioning, longer duration of untreated psychosis, more frequent co-morbidity with personality disorders, earlier illness onset and poorer social functioning. Conclusions Future research should consider a) refining diagnostic criteria for DS and identifying valid DS endophenotypes; b) dissecting TRS based on psychopathological characteristics (e.g. presence of primary and persistent negative symptoms or persistently severe positive symptoms), and underlying neurobiological mechanisms (e.g. dopamine synthesis capacity and glutamatergic transmission).

A symptom network structure of the psychosis spectrum

Current diagnostic systems mainly focus on symptoms needed to classify patients with a specific mental disorder and do not take into account the variation in co-occurring symptoms and the interaction between the symptoms themselves. The innovative network approach aims to further our understanding of mental disorders by focusing on meaningful connections between individual symptoms of a disorder and has thus far proven valuable insights to psychopathology. The aims of current study were to I) construct a symptom network and investigate interactions between a wide array of psychotic symptoms; II) identify the most important symptoms within this network and III) perform an explorative shortest pathway analysis between depressive and delusional symptoms.We analyzed interview data from n=408 male patients with non-affective psychosis using the Comprehensive Assessment of Symptoms and History (CASH). A network structure of 79 symptoms was computed to explore partial correlations between positive, negative, catatonia and affective symptoms.The resulting network showed strong connectivity between individual symptoms of the CASH, both within- and between-domains. Most central symptoms included ‘loss of interest’, ‘chaotic speech’, ‘inability to enjoy recreational interest in activities’, ‘inability to form or maintain relationships with friends’ and ‘poverty of content of speech’. The shortest pathway analysis between depressive and delusional symptoms displayed an important role for ‘persecutory delusions’.In conclusion, this study showed that individual psychotic symptoms are meaningfully related to each other not only within their own cluster, but also between different clusters and that important information may be acquired by investigating interactions at a symptom level.

New and Future Challenges Concerning the Use of Virtual Reality Tools for Assessing ADHD

Introduction In this short commentary, we highlight the changes in the conceptualization of ADHD from the perspective of the current main diagnostic systems (the DSM-5 and the imminent IDC-11) and their implications for the assessment/diagnosis of the disorder.

Acute suicidal affective disturbance: Factorial structure and initial validation across psychiatric outpatient and inpatient samples

BackgroundA new clinical entity, Acute Suicidal Affective Disturbance (ASAD), was recently proposed to characterize rapid-onset, acute suicidality including the cardinal symptom of behavioral intent. This study examines the proposed ASAD criteria factor-analytically and in relation to correlates of suicidal behavior and existing psychiatric disorders in samples of psychiatric outpatients and inpatients. MethodsTwo samples of psychiatric outpatients (N=343, aged 18–71 years, 60.6% female, 74.9% White) and inpatients (N=7,698, aged 15–99 years, 57.2% female, 87.8% White) completed measures of their ASAD symptoms and psychological functioning. ResultsAcross both samples, results of a confirmatory factor analysis supported the unidimensional nature of the ASAD construct. Additionally, results provided evidence for the convergent and discriminant validity of ASAD, demonstrating its relation to, yet distinction from, other psychiatric disorders and correlates of suicide in expected ways. Importantly, ASAD symptoms differentiated multiple attempters, single attempters, and non-attempters, as well as attempters, ideators, and non-suicidal patients, and was an indicator of past suicide attempts above and beyond symptoms of depression and other psychiatric disorders. LimitationsThis study utilized cross-sectional data and did not use a standardized measure of ASAD. ConclusionsASAD criteria formed a unidimensional construct that was associated with suicide-related variables and other psychiatric disorders in expected ways. If supported by future research, ASAD may fill a gap in the current diagnostic classification system (DSM-5) by characterizing and predicting acute suicide risk.

Can We Use MDDScore for the Identification of Comorbid Major Depressive Disorder (MDD) in Patients with Chronic Pain?

The prevalence of patients with chronic pain who display depressive symptoms is quite high, with depression potentially an integral component of chronic pain. Since the current subjective clinical diagnostic systems were not designed to assess depression in patients with chronic pain, they fail to adequately capture the nature of mood states of these patients. It is difficult to apply these assessment tools to segregate unipolar depression (MDD) from the demoralization inherent in chronic pain states. MDDScore™, a multivariate biomarker blood test for depression, was used to determine if it was possible to identify biomarker patterns consistent with major depressive disorder in multiple chronic pain states. Three study groups were analyzed, and included: (i) patients (n=93) with centralized Chronic Intractable Pain (CIP), (ii) patients (n=20) with chronic pain of diverse origin from Scripps Pain Clinic (SPC) and (iii) prospectively collected patients (n=28) with comorbid arthritis and depressive symptoms. A very distinct bimodal pattern was observed. Forty-nine of 93 CIP patients (52.7%), 18 of 28 (64.2%) of the arthritis patients, and 9 of 20 (45%) patients with chronic pain of diverse origin from Scripps Pain Clinic had MDDScores of ≥5. Thus, the biomarker panel could segregate patients into two major groups based upon MDDScores. These data suggest but not prove we can objectively identify chronic pain patients with a higher probability of comorbid major depression. Importantly, we can use the biomarkers on the MDDScore panel to gain insight into and gauge the residual (post-treatment) level of inflammation in these intensively treated patients. To this end, we determined and compared the serum concentrations of alpha-1 antitrypsin (A1AT), Myeloperoxidase (MPO) and soluble tumor necrosis factor receptor type 2 (sTNFR2) in each of the patient populations studied.

The XIIIth Banff Conference on Allograft Pathology: The Banff 2015 Heart Meeting Report: Improving Antibody-Mediated Rejection Diagnostics: Strengths, Unmet Needs, and Future Directions.

The 13th Banff Conference on Allograft Pathology was held in Vancouver, British Columbia, Canada from October 5 to 10, 2015. The cardiac session was devoted to current diagnostic issues in heart transplantation with a focus on antibody‐mediated rejection (AMR) and small vessel arteriopathy. Specific topics included the strengths and limitations of the current rejection grading system, the central role of microvascular injury in AMR and approaches to semiquantitative assessment of histopathologic and immunophenotypic indicators, the role of AMR in the development of cardiac allograft vasculopathy, the important role of serologic antibody detection in the management of transplant recipients, and the potential application of new molecular approaches to the elucidation of the pathophysiology of AMR and potential for improving the current diagnostic system. Herein we summarize the key points from the presentations, the comprehensive, open and wide‐ranging multidisciplinary discussion that was generated, and considerations for future endeavors.

The new transdiagnostic cognitive behavioral treatments: Commentary for clinicians and clinical researchers

Recognition of the limitations of the current categorical diagnostic system and increased understanding of commonalities across clinical problems associated with negative emotion, including anxiety and depression, has led to the development of transdiagnostic psychological interventions. This new approach holds promise in shifting our emphasis from diagnostic categories to treating core construct that cut across disorders. This paper identifies some of the similarities and differences across various cognitive-behavioral transdiagnostic protocols and key challenges in assessment and case conceptualization for clinicians wishing to use this approach. Some key needs in the research literature that would be particularly helpful to clinicians are also identified.

P.2.h.015 - Serum lipid profiles as predictive markers for completed suicide

A new clinical entity, Acute Suicidal Affective Disturbance (ASAD), was recently proposed to characterize rapid-onset, acute suicidality including the cardinal symptom of behavioral intent. This study examines the proposed ASAD criteria factor-analytically and in relation to correlates of suicidal behavior and existing psychiatric disorders in samples of psychiatric outpatients and inpatients.Two samples of psychiatric outpatients (N=343, aged 18–71 years, 60.6% female, 74.9% White) and inpatients (N=7,698, aged 15–99 years, 57.2% female, 87.8% White) completed measures of their ASAD symptoms and psychological functioning.Across both samples, results of a confirmatory factor analysis supported the unidimensional nature of the ASAD construct. Additionally, results provided evidence for the convergent and discriminant validity of ASAD, demonstrating its relation to, yet distinction from, other psychiatric disorders and correlates of suicide in expected ways. Importantly, ASAD symptoms differentiated multiple attempters, single attempters, and non-attempters, as well as attempters, ideators, and non-suicidal patients, and was an indicator of past suicide attempts above and beyond symptoms of depression and other psychiatric disorders.This study utilized cross-sectional data and did not use a standardized measure of ASAD.ASAD criteria formed a unidimensional construct that was associated with suicide-related variables and other psychiatric disorders in expected ways. If supported by future research, ASAD may fill a gap in the current diagnostic classification system (DSM-5) by characterizing and predicting acute suicide risk.

The dimensional nature of eating pathology: Evidence from a direct comparison of categorical, dimensional, and hybrid models.

Eating disorders are conceptualized as categorical rather than dimensional in the current major diagnostic system (Diagnostic and Statistical Manual of Mental Disorders; 5th ed.; American Psychiatric Association, 2013) and in many previous studies. However, previous research has not critically evaluated this assumption or tested hybrid models (e.g., modeling latent variables with both dimensional and categorical features). Accordingly, the current study directly compared categorical, dimensional, and hybrid models for eating pathology in a large, population-based sample. Participants included 3,032 female and male twins (ages 9-30 years) from the Michigan State University Twin Registry. The Minnesota Eating Behaviors Survey was used to assess disordered eating symptoms including body dissatisfaction, weight preoccupation, binge eating, and compensatory behaviors. Results showed that dimensional models best fit the data in the overall sample as well as across subgroups divided by sex and pubertal status (e.g., prepubertal vs. postpubertal). It is interesting to note that the results favored more categorical models when using a case-control subset of our sample with participants who either endorsed substantial eating pathology or no/little eating pathology. Overall, findings provide support for a dimensional conceptualization of eating pathology and underscore the importance of using community samples to capture the full range of severity of eating pathology when investigating questions about taxonomy. (PsycINFO Database Record