Diagnosis Of Mental Health Disorders Research Articles

Delusional themes in Body Dysmorphic Disorder (BDD): Comparisons with psychotic disorders and non-clinical Controls

The prevailing nosological classification of body dysmorphic disorder (BDD) encompasses an optional specifier “with absent insight/delusional beliefs” for patients who hold high conviction of the veracity of their disorder-specific beliefs. Yet limited research has examined the explicit nature of delusional beliefs in BDD. The current study therefore aimed to compare themes of delusional ideation in BDD relative to schizophrenia (SCZ) and healthy controls (HCs). Participants had a primary diagnosis of BDD (n = 44) or SCZ (n = 55), or were HCs (n = 55) with no personal or immediate family history of a diagnosable mental health disorder. Assessment of multidimensional delusional ideation was based on the Peters Delusional Inventory (PDI). Results showed that BDD and SCZ groups endorsed significantly more items, and had significantly elevated preoccupation and conviction than the HC group. Only the SCZ group exhibited significantly elevated distress relative to HC participants. In addition, BDD (akin to SCZ) participants were more likely to endorse somatic (appearance-related), control and thought alienation themes than the HC group. These findings suggest that delusional beliefs in BDD may not be strictly appearance-related, but rather span broader themes. This conveys therapeutic implications in terms of designing and administering targeted treatments aimed at delusional thinking in BDD.

HIGH RISK OF NEW PSYCHIATRIC DISORDERS AND SUICIDAL BEHAVIOR IN DEMENTIA

Occurrence of new mental health (MH) disorders in patients with dementia is neglected, with next to nothing known. We examined association between dementia diagnosis and risk of new psychiatric disorders and suicide, and MH services use. We merged four national databases from US Department of Veterans Affairs. Sample included 2,529,181 patients (≥50 years) in fiscal years (FY) 2012-2013 with no MH disorders. Dementia, psychiatric disorders (mood, anxiety, substance), suicidal behavior (ideation, plan, attempt, death by suicide) were identified by ICD-9/10 codes and national suicide databases. Hazard ratios (HR) were estimated using Cox proportional hazard models, with time-to-event defined as age at first diagnosis of MH disorder during FY 2014-2016. Analyses adjusted for medical/sociodemographic factors. Compared to those without dementia, dementia patients showed roughly 2-fold increased risk of new mood (HR: 2.19, 95% Wald CI: 2.15-2.24, p<.001) or anxiety (HR: 1.56, 95% CI: 1.50-1.63, p<.001) disorders. Recent dementia diagnosis was associated with highest risk of these disorders than prior or no diagnosis; for example, patients with recent diagnosis showed 72% greater risk of anxiety disorders (HR: 1.72, 95% CI: 1.63-1.81, p<.001). Although patients with prior dementia diagnosis had lower risk of suicidal behavior, risk increased with recent dementia diagnosis. However, dementia patients with new MH disorders showed little MH services use (< 20%). Patients with dementia have increased risk of new MH disorders, especially recent dementia diagnosis. Furthermore, MH services are underutilized, highlighting critical need for integration of such services in caring for dementia patients.

Early Intervention in Schools: Recommendations for Enhanced Psychological Services

Childhood and adolescence are times of adjusting to change and increasing demands in one’s life. As such, it is perhaps not surprising that in the United States alone, approximately 13% to 20% of children experience a mental disorder each year, or that 20% of adolescents experience a diagnosable mental health disorder.

Characterising heterogeneity in the use of different cannabis products: latent class analysis with 55 000 people who use cannabis and associations with severity of cannabis dependence.

As new cannabis products and administration methods proliferate, patterns of use are becoming increasingly heterogeneous. However, few studies have explored different profiles of cannabis use and their association with problematic use. Latent class analysis (LCA) was used to identify subgroups of past-year cannabis users endorsing distinct patterns of use from a large international sample (n = 55 240). Past-12-months use of six different cannabis types (sinsemilla, herbal, hashish, concentrates, kief, edibles) were used as latent class indicators. Participants also reported the frequency and amount of cannabis used, whether they had ever received a mental health disorder diagnosis and their cannabis dependence severity via the Severity of Dependence Scale (SDS). LCA identified seven distinct classes of cannabis use, characterised by high probabilities of using: sinsemilla & herbal (30.3% of the sample); sinsemilla, herbal & hashish (20.4%); herbal (18.4%); hashish & herbal (18.8%); all types (5.7%); edibles & herbal (4.6%) and concentrates & sinsemilla (1.7%). Relative to the herbal class, classes characterised by sinsemilla and/or hashish use had increased dependence severity. By contrast, the classes characterised by concentrates use did not show strong associations with cannabis dependence but reported greater rates of ever receiving a mental health disorder diagnosis. The identification of these distinct classes underscores heterogeneity among cannabis use behaviours and provides novel insight into their different associations with addiction and mental health.

3.44 CHARACTERISTICS OF PROVIDERS USING A CHILD PSYCHIATRIC ACCESS PROGRAM IN MARYLAND

Despite a significant increase in outpatient visits for diagnosis and treatment of mental health disorders among youth, there is a growing gap between the need for and availability of pediatric mental health services (MHS). Child Psychiatry Access Programs (CPAPs), similar to the Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP) program, have shown promise in increasing access to MHS. The purpose of this study is to describe the types of primary care clinicians (PCCs) that call BHIPP and to examine patterns of their use of BHIPP services.

Robert Haggerty, the New Morbidities, and the Dissonance between Education and Child Health Needs.

1. Julia A. McMillan, MD* 1. *Johns Hopkins School of Medicine, Baltimore, MD > In April 2018, the American Board of Pediatrics Foundation; the National Academies of Sciences, Engineering, and Medicine; and invited pediatric department chairs and pediatric residency program directors participated in a 2-day workshop dedicated to developing ways to prepare future pediatricians to meet the behavioral and mental health needs of children, needs that are increasing each year. Each participant pledged to develop a way. One way is to spread the word of such needs. What follows is a commentary by one of the workshop facilitators. > > —JZ Anniversaries are appropriate occasions to mark longevity and to celebrate achievements and progress, and the 40th anniversary of Pediatrics in Review (PIR) is no exception. As we celebrate the achievements of the past 40 years, however, it is also important to recognize opportunities that have been missed, warnings that have not been heeded. Robert J. Haggerty was the first editor-in-chief of PIR , and he served in that capacity for 25 years. Although Dr Haggerty is well-known and respected for his service as the founding editor of PIR, it is his recognition of the importance of what he called the biosocial aspects of pediatrics for which he may be best remembered. Just 4 years before the first issue of PIR was published, Dr Haggerty and coeditors Klaus Roghman and Ivan Pless wrote of the importance of biosocial considerations in child health. They cited, in particular, behavior disorders in preschool children, inadequate functioning in schools, and adjustment issues during adolescence. They called for a shift in the orientation of pediatric training programs and for allowing for more time during pediatric office visits to address these problems, which they called the new morbidities . (1) Dr Haggerty and his colleagues at the University of Rochester advocated a multidisciplinary approach to child health, addressing psychological problems and …

Comparing mental health disorders among sex trafficked children and three groups of youth at high-risk for trafficking: A dual retrospective cohort and scoping review

BackgroundIndividuals at high-risk for trafficking are often subject to preexisting complex trauma that only intensifies during the trafficking experience. This greatly increases their risk of mental illness, although the actual prevalence of mental health disorders in children who are sex trafficked remains unclear. ObjectiveTo examine the prevalence of mental health diagnoses among a sample of youth identified as being sex trafficked, and to discuss these rates in relation to other high-risk groups reported in the literature. Participants and setting143 female and male child trafficking victims in Wisconsin. MethodsWe retrospectively reviewed individual medical records, identifying mental health diagnoses and behaviors. The results were compared to summarized prevalence data for mental health disorders in sex trafficked, runaway children, juvenile offenders, and foster care children identified via a scoping review. ResultsWe observed significantly higher rates of ADHD (52.4%, p < 0.0001), bipolar disorder (26.6%, p < 0.0001), and PTSD (19.6%, p < 0.05 to p < 0.0001) in our sample of trafficked youth compared to all high-risk groups, as well as for depression (45.5%), anxiety (19.6%), conduct disorder (19.6%), ODD (25.9%), and psychosis (14.0%) relative to multiple groups individually. ConclusionsThe complex trauma suffered by child survivors of sex trafficking can impart numerous effects with overlapping symptomatology of many mental health disorders. Survivors’ adaptive responses to complex trauma may lead to improper diagnosis and treatment of mental health disorders at the expense of prompt access to trauma-focused therapies. Alternative diagnoses and treatments of this complex dysfunction are discussed.

The Impact of Childhood Emotional Abuse on Pain Interference Among People with Chronic Pain who Inject Drugs in Vancouver, Canada.

High levels of chronic pain interference with daily activities are known to negatively impact quality of life. Although mental health conditions have been associated with pain interference and child abuse, research has been mixed regarding it acting as a mediator, with even less known among people who inject drugs. Therefore, we sought to explore childhood emotional abuse and pain interference among this population. Data were derived from two prospective cohort studies of community-recruited people who inject drugs in Vancouver, Canada, between June 2014 and November 2016. We employed multivariable generalized estimating equations to examine the relationship between childhood emotional abuse and pain interference in the past six months. We also conducted a mediation analysis to examine whether mental health disorder diagnoses mediated this association. Among 822 eligible participants, 341 (41.5%) reported childhood emotional abuse. In a multivariable analysis, experiencing childhood emotional abuse remained independently associated with pain interference (adjusted odds ratio = 1.33, 95% confidence interval [CI] = 1.05-1.70) after adjusting for a range of confounders. Results from the mediation analysis yielded a statistically significant positive average causal mediation effect (β = 0.01, 95% CI = 0.001-0.02). Approximately 12% of the effect was due to mediation. Our results demonstrate among people who inject drugs with chronic pain, those who experienced childhood emotional abuse were more likely to report pain interference, which was partially mediated by mental health disorder diagnosis history. These findings highlight the importance of incorporating screening and appropriate treatment for mental illness into chronic pain treatment.

Menopausal Symptoms and Higher Risk Opioid Prescribing in a National Sample of Women Veterans with Chronic Pain.

The greatest increases in long-term opioid use and opioid-related overdose mortality in recent years have been among women in midlife. Common menopausal symptoms broadly affect health and health care utilization in midlife, but their contribution to chronic pain management during this period is unknown. To examine relationships between menopausal symptoms and long-term opioid prescription patterns among midlife women with chronic pain. Cross-sectional analysis of national Veterans Health Administration medical and pharmacy records (2014-2015). Women Veterans aged 45-64 with ≥ 1 outpatient visit and chronic pain diagnoses spanning ≥ 90days. Long-term opioids (prescribed oral opioids for ≥ 90days), high-dose long-term opioids (> 50mg average morphine equivalent daily dose), and long-term opioids co-prescribed with central nervous system depressants (benzodiazepine and non-benzodiazepine sedative-hypnotics, gabapentin/pregabalin, muscle relaxants). Multivariable logistic regression models were used to examine associations between outcomes and menopausal symptoms (menopausal symptom-related diagnoses (i.e., "symptomatic menopausal states") on ≥ 2 encounters and/or menopausal hormone therapy, adjusting for race, age, body mass index, and mental health and substance use disorder diagnoses. In this national sample of 104,984 midlife women Veterans with chronic pain (mean age 54.5, SD 5.4years), 17% had evidence of menopausal symptoms, 51% were prescribed long-term opioids, 13% were prescribed high-dose long-term opioids, and 35% were co-prescribed long-term opioids and central nervous system depressants. In multivariable analyses, women with menopausal symptoms had increased odds of long-term opioids (OR 1.21, 95% CI 1.18-1.26), high-dose long-term opioids (OR 1.08, 95% CI 1.02-1.13), and long-term opioids co-prescribed with central nervous system depressants (sedative-hypnotics OR 1.25, 95% CI 1.22-1.30; gabapentin/pregabalin OR 1.23, 95% CI 1.20-1.27; muscle relaxants OR 1.24, 95% CI 1.20-1.28). Among midlife women Veterans with chronic pain, evidence of menopausal symptoms was associated with potentially risky long-term opioid prescription patterns, independent of known risk factors.

Effects of Mental Health Disorders on Nursing Home Residents' Nine-Month Pain Trajectories.

To determine the key classes of nursing home residents' nine-month pain trajectories, the influence of residents' mental health disorders on membership in these classes, and nine-month health-related outcomes associated with pain trajectory class membership. Four times over a nine-month period, the MDS 3.0 resident assessment instrument was used to record the demographic characteristics, mental health disorder diagnoses, pain characteristics, and health and functioning outcomes of 2,539 Department of Veterans Affairs Community Living Center (VA CLC) residents. Growth mixture modeling was used to estimate the key classes of residents' nine-month pain trajectories, the influence of residents' mental health disorders on their pain trajectory class membership, and the associations of class membership with residents' health and functioning outcomes at nine-month follow-up. Four-class solutions best described nursing home residents' nine-month trajectories of pain frequency, severity, and interference. Residents with dementia and severe mental illness diagnoses were less likely, and those with depressive disorder, PTSD, and substance use disorder diagnoses more likely, to belong to adverse nine-month pain trajectory classes. Membership in adverse pain frequency and pain severity trajectory classes, and in trajectory classes characterized by initially high but steeply declining pain interference, portended more depressive symptoms but better cognitive and physical functioning at nine-month follow-up. Nursing home residents' mental health disorder diagnoses help predict their subsequent pain frequency, severity, and interference trajectories. This may be clinically useful information for improving pain assessment and treatment approaches for nursing home residents.

Estimating the Health Status of Privately Insured Gender Minority Children and Adults.

Purpose: The purpose of this study was to characterize the health status of privately insured gender minority individuals. Methods: We created a diagnosis-based algorithm to identify gender minority children and adults in the 2009-2015 IBM® MarketScan® Commercial Database. We compared the age-adjusted health status among individuals with and without gender minority-related diagnosis codes. Results: The percentage of the privately insured population with gender minority-related diagnosis codes increased from 0.004% in 2009 to 0.026% in 2015. Age-adjusted analyses demonstrated that individuals with gender minority-related diagnosis codes were more likely to have diagnoses for mental health disorders (odds ratio [OR] = 8.5; 95% confidence interval [CI] = 8.1-9.0), substance use disorders (OR = 3.4; 95% CI = 2.9-3.9), and diabetes (OR = 1.4; 95% CI = 1.2-1.6), driven by high prevalence of these conditions among individuals younger than 18 years. Conclusions: Our findings highlight a markedly greater prevalence of mental health and substance use disorder diagnoses among privately insured gender minority individuals. These results establish a reference point for evaluating the impact of federal- and state-level policies that ban health insurance discrimination based on gender identity on the health and health care use of gender minority individuals.

Characterizing peaks in the EEG power spectrum

The EEG is an important noninvasive brain signal measured from scalp electrodes with the potential for application in the diagnosis of neurological and mental health disorders. In this context analysis of the spectral properties of the EEG are an important aspect of understanding the signal. One characteristic of the signal that has been observed is the presence of intermittent periodicity or regular oscillatory activity under certain conditions. Typically, though not always, this periodicity occurs at ∼10 Hz (called alpha oscillations) and is observed most reliably under eyes closed conditions as a peak in the power spectrum. In the literature the alpha oscillation is generally characterized by the power in the relevant band of the power spectrum. However, since it occurs embedded within a background of nonperiodic activity with a 1/fγ spectral envelope, this approach does not separate the oscillation from the background nonperiodic activity and therefore provides an imprecise view that is largely determined by the spectral decay rather than the embedded periodicity. Here we present an approach to assess periodicity in the EEG signal that is robust to distortions by changes in the 1/f background nonperiodic activity and is particularly suited for detection of small peaks where the band is overwhelmed by the background decay. The method utilizes the second order derivative of the FFT of the signal autocorrelation to define the resulting metric ‘Oscillation Energy’ (or Eα for alpha oscillations). We demonstrate its performance compared to several variants of traditional power spectrum measures with simulated signals and show its application to example EEG signals. We believe a more precise metric to characterize peaks arising from periodicity like this will enable researchers in the field to develop a clearer understanding of this feature of the signal and its relation to behaviors.

Decreasing Stigmatization: Reducing the Discrepancy Between "Us" and "Them". An Intervention for Mental Health Care Professionals.

Objective: Stigmatization has negative consequences for people with mental health disorder diagnosis. Studies indicate that professionals have stigmatizing attitudes and behavior towards clients. Continuum beliefs are associated with less stigmatizing attitudes. The effect of a workshop to diminish stigmatizing attitudes and to enhance continuum beliefs is examined. Method: A total of 202 mental health professionals from (Functional) Assertive Community Treatment [(F)ACT] teams were randomly assigned to a workshop or a waiting list control group. Stigmatizing attitudes and continuum beliefs were assessed in both conditions at baseline and follow-up. Results: Compared to baseline, the workshop group showed an increase on continuum beliefs. However, there was no effect of the intervention on stigmatizing attitudes. Contrary to the expectations, stigmatizing attitudes increased in the waiting list condition. Conclusion: Communicating the continuity aspect can be valuable in decreasing the “us and them” discrepancy between professionals and people with mental health disorders. Further research on continuum beliefs is needed.

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as...

Examining the mental health outcomes of peer-led school-based interventions on young people aged between 4 and 18\u2009years old: a systematic review protocol

BackgroundRecent estimates suggest that one in ten young people worldwide experiences a diagnosable mental health disorder, with many more suffering subsyndromal levels of psychological distress. As young people spend much of their time in schools, the role of educational settings in the delivery of mental health provision is increasingly recognised. Advances in neurodevelopmental research have highlighted the important and complex role of peer influence on adolescent behaviours, suggesting peer-led support schemes have high potential utility. Schools worldwide have implemented peer-led interventions with mixed results, but the global evidence base on their effectiveness remains limited. This systematic review aims to examine the evidence base of the outcomes of school-based peer-led interventions on the mental health of young people aged 4–18.MethodsEligible studies will be randomised controlled trials and observational studies that report on the mental health outcomes of a peer-led school-based intervention. Eligible participants will be aged 4–18 and will be current students of the intervention school. Individual- and group-based interventions will be included. The following 11 databases will be screened based upon their reach in healthcare and education: PsycINFO, MEDLINE, EMBASE, CINAHL, CENTRAL, BEI, Scopus, Web of Science, ERIC, SSCI and Social Care Online. There will be no restriction placed on publication period, original language or country of publication. Papers will be systematically screened for eligibility by two review authors. Data will be presented as a descriptive report. A meta-analysis will be carried out if a subset of studies allows, given the anticipated high levels of heterogeneity.DiscussionThis systematic review will be the first to synthesise the global evidence on the mental health outcomes of peer-led interventions for children and adolescents in a school setting. It will analyse the available data in order to understand the role of these interventions in schools, inform future developers of peer support programmes and identify gaps in current research. This review will be of value to policy makers, health and education services, researchers and those involved in delivering peer support initiatives.Systematic review registrationPROSPERO CRD42018116243

087 Characterizing the Priapism Superuser: A Longitudinal, Population-based Study

Priapism is a medical emergency requiring prompt intervention and utilizes significant healthcare resources. The estimated cost of emergency visits and hospital admission for priapism is $1,778 and $41,909, respectively. To our knowledge, no studies have characterized the patient factors associated with recurrent episodes of priapism on a population level. The purpose of this study is to identify patient factors associated with recurrent hospital visits for priapism. The Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases for California from 2007-2011 were linked and utilized. Patients were identified as having a diagnosis of priapism by ICD-9 diagnosis code (607.3). They were tracked longitudinally for subsequent encounters for priapism. Patients with >3 hospital encounters for priapism were compared to those with ≤3 hospital encounters in regards to patient and treatment characteristics. 2,843 patients presented for 4,344 hospital (emergency room or inpatient) encounters with a diagnosis of priapism in California between 2007-2011. Of these patients, 2,256 (79.35%) had a single encounter for priapism, while 5.42% had more than three priapism hospital visits (Figure 1). On multivariate analysis, predictive factors for recurrent priapism visits included African American race, diagnosis of sickle cell disease, diagnosis of mental health disorder, and diagnosis of substance abuse disorder. Patients with recurrent priapism are more likely to be discharged from the emergency department (OR 0.19, p<0.005) and are less likely to undergo a therapeutic priapism procedure, such as irrigation or shunt (OR 0.712, p<0.005).

Virtual Reality Therapy: Emerging Topics and Future Challenges.

Virtual reality (VR) is no longer a fantasy or a novelty to be used for pure entertainment. It is a technology that has, over the past three decades, taken hold and enriched multiple areas of science, most notably healthcare. Starting from these premises, this special issue will specifically investigate how VR and other important advanced technologies are being adopted and adapted for use in the healthcare field, with a specific focus toward the diagnosis and treatment of mental health disorders.

Mental health disorder, pain, and pain treatment among long-term care residents: Evidence from the Minimum Data Set 3.0

Objective: This study evaluated: (a) associations between long-term care residents’ mental health disorder diagnoses and their pain self-reports and pain treatments, and (b) the extent to which communication, cognitive, and physical functioning problems help explain disparities in the pain and pain treatments of long-term care residents with and without mental health disorders.Method: Minimum Data Set 3.0 records of 8,300 residents of Department of Veterans Affairs Community Living Centers were used to determine statistically unadjusted and adjusted cross-sectional associations between residents' mental health diagnoses and their pain and pain treatments.Results: Residents diagnosed with dementia and serious mental illness (SMI) were less likely, and those diagnosed with depressive disorder, post-traumatic stress disorder (PTSD), and substance use disorder (SUD) were more likely, to report recent, severe, and debilitating pain. Among residents affirming recent pain, those with dementia or SMI diagnoses were twice as likely to obtain no treatment for their pain and significantly less likely to receive as-needed pain medication and non-pharmacological pain treatments than were other residents. Those with either depressive disorder or PTSD were more likely, and those with SUD less likely, to obtain scheduled pain medication. In general, these associations remained even after statistically adjusting for residents' demographic characteristics, other mental health disorder diagnoses, and functioning.Conclusion: Long-term care residents with mental health disorders experience disparities in pain and pain treatment that are not well-explained by their functioning deficits. They may benefit from more frequent, thorough pain assessments and from more varied and closely tailored pain treatment approaches.

Pass the parcel: Service provider views on bridging gaps for youth with dual diagnosis of intellectual disability and mental health disorders in regional areas.

Youth with both intellectual disability (ID) and mental health (MH) disorders (dual diagnosis) have complex physical and MH needs that can make providing integrated care for this complex group challenging. We conducted a mixed methods needs assessment to identify gaps and challenges in care delivery, identify bridges for these and identify what works well in existing services. Our research team recruited service providers (n = 126) caring for youth aged 14-24 years with a dual diagnosis in the Illawarra Shoalhaven region of New South Wales, Australia, to participate in focus group interviews. Data were transcribed and analysed thematically. We identified six themes related to caring for youth with dual diagnosis in regional areas: access to services and information about services, communication between service providers and with clients and carers, the divide between MH and ID, early intervention and health promotion, capacity building of service providers and capacity building of clients and carers. Across these themes, service providers highlighted the transition from child to adult services as a particularly challenging time for clients, families and carers. Our data suggest several approaches to break down silos and to facilitate collaboration between current services for youth with a dual diagnosis, including increasing specialised ID/MH services and building the capacity of current disability and MH service providers. Our results provide important information to provide quality and integrated care for youth with complex health needs.

Supportive Peer Relationships and Mental Health in Adolescence: An Integrative Review

In the United States, nearly one in five adolescents has a diagnosable mental health disorder. Beginning in the teenage years, adolescents become less reliant on their parents for support and begin to turn to their peer group for support; therefore, it is important to understand the role of peers during this developmental time, especially in relation to mental health. The purpose of this project is to review the literature regarding positive peer support and mental health in adolescence. CINAHL, PubMed, and PsycINFO were used to conduct the review. The inclusive years of the search were 2007–2017. A total of 15 studies were included for review. The results were consistent over time and settings, demonstrating the positive role of peer support in adolescences with mental health care needs. Following a synthesis of the literature, gaps in research and implications for practice and further research, are discussed.