Diagnostic Classification Of Mental Disorders Research Articles

THEORETICAL AND PHENOMENOLOGICAL APPROACHES TO STUDYING THE CONCEPT OF PERSONALITY TRANSFORMATION OF MILITARY SERVICEMEN AS A CONSEQUENCE OF COMBAT TRAUMA

The purpose of the work – to investigate the personality profile of military personnelwith personality disorders resulting from combat trauma, based on a systematic approachto the study of individual- psychological, pathopsychological, and psychosocial features,in the projection of two different modern diagnostic classifications of mental disorders(ICX-11 and DSM-5) taking into account the pathogenetic and pathoplastic influenceof the premorbid personality structure on the formation of the syndrome complex, itstransformation and the possibility of reverse development.Conclusions. 1. The analysis of modern literature shows that the issue of personalitytransformation in the process of overcoming life crises is quite relevant. It is consideredby scientists in various aspects and manifestations, however, with the increase indevelopment, there is a lack of comprehensive, substantiated theoretical research. Inconnection with the ongoing military operations, as well as the increase in the frequencyof mental disorders as a result of combat trauma, the study of personality transformationin military personnel is of particular relevance. 2. Combat mental trauma is a deformation of the psychological mechanisms of self-regulation and a breakthrough by the combatstress factor of the protection of the psyche of the individual, as a result of which thereis an excess of its adaptive capabilities. 3. In the context of the transition of domesticpsychiatry to the new classification of ICD-11, understanding the transformation ofpersonality under the influence of combat trauma into the development of personalitydisorders appears as one of the most urgent issues of modern theoretical and practicalpsychiatry. Accordingly, there is a task of developing and using additional tools forthe objectification of severity assessment. 4. Taking into account the above, it can beargued that the development of diagnostic algorithms and differential diagnosis of thetransformation of the personality structure into personality disorders in servicemenas a result of combat trauma, as well as the development of recommendations for therehabilitation and resocialization of servicemen with personal mental disorders thatarose as a result of combat trauma, is relevant, necessary and timely.

Functional Connectivity-Based Prediction of Autism on Site Harmonized ABIDE Dataset.

The larger sample sizes available from multi-site publicly available neuroimaging data repositories makes machine-learning based diagnostic classification of mental disorders more feasible by alleviating the curse of dimensionality. However, since multi-site data are aggregated post-hoc, i.e. they were acquired from different scanners with different acquisition parameters, non-neural inter-site variability may mask inter-group differences that are at least in part neural in origin. Hence, the advantages gained by the larger sample size in the context of machine-learning based diagnostic classification may not be realized. We address this issue using harmonization of multi-site neuroimaging data using the ComBat technique, which is based on an empirical Bayes formulation to remove inter-site differences in data distributions, to improve diagnostic classification accuracy. Specifically, we demonstrate this using ABIDE (Autism Brain Imaging Data Exchange) multi-site data for classifying individuals with Autism from healthy controls using resting state fMRI-based functional connectivity data. Our results show that higher classification accuracies across multiple classification models can be obtained (especially for models based on artificial neural networks) from multi-site data post harmonization with the ComBat technique as compared to without harmonization, outperforming earlier results from existing studies using ABIDE. Furthermore, our network ablation analysis facilitated important insights into autism spectrum disorder pathology and the connectivity in networks shown to be important for classification covaried with verbal communication impairments in Autism. Multi-site data harmonization using ComBat improves neuroimaging-based diagnostic classification of mental disorders. ComBat has the potential to make AI-based clinical decision-support systems more feasible in psychiatry.

Taxonomy and utility in the diagnostic classification of mental disorders.

One strategy for improving the clinical utility of mental health diagnostic systems is to better align them with how clinicians conceptualize psychopathology in practice. This approach was used in International Classification of Diseases 11th Revision (ICD-11) development, but its underlying assumption-a link between taxonomic "fit" and clinical utility-remains untested. Using data from global mental health clinician samples (combined N = 5404), we investigated the association between taxonomic fit and clinical utility in mental disorder categories. The overall association between fit and utility was positive (r = 0.19) but statistically not different from zero (95% confidence interval [CI]: -0.06, 0.43) in this small sample (N = 39 ICD/DSM categories). However, a positive association became clear after correcting for outliers (r = 0.34 [0.05, 0.58] or higher). Further insights were apparent for specific diagnoses given their locations in the scatterplot. Results suggest a positive link between taxonomic fit and clinical utility in mental disorder diagnoses, highlighting future research directions.

Reliability and Clinical Utility of ICD-11 Diagnostic Guidelines for Severe Mental Disorders in Nigeria

An essential foundation for global mental health is the development of reliable, clinically useful and globally applicable diagnostic classification of mental disorders. This study is aimed at assessing the inter-rater reliability and clinical utility of the proposed diagnostic guidelines for severe mental disorders in the eleventh edition of the International Classification of Diseases and Related Health Problems (ICD-11) in Nigeria. The study was conducted in Nigeria at 2 mental health facilities as part of a 13 country project coordinated by the World Health Organization. Following training, 32 clinician raters assessed the reliability and clinical utility of the proposed diagnostic guidelines for schizophrenia and other primary psychotic disorders, mood disorders, anxiety and fear-related disorders, and disorders specifically associated with stress. Using SPSS version 21, analysis of data was conducted at the Data Coordinating Center (DCC), Columbia University. For reliability, estimates of intraclass κ coefficients for diagnoses ranged between 0.71 (Schizoaffective disorder) and 0.93 (Schizophrenia). In ratings of the clinical utility, the guidelines were perceived as easy to use, corresponding accurately to patients' presentations (i.e. having satisfactory goodness-of-fit), clearly understandable, and as providing useful guidance on distinguishing a disorder from normality and from other mental disorders. Overall, the reliability of the diagnostic guidelines was good in Nigeria, ranging from substantial to almost perfect. Utility ratings were generally satisfactory. The results support the suitability of the ICD-11 diagnostic guidelines for implementation at a worldwide level.

Accounting for Social Processes in the Development of Diagnostic Classification Systems: Commentary on the “Standards and Guidelines for the Development of Diagnostic Nomenclatures and Alternatives in Mental Health Research and Practice”

Diagnostic classifications of mental disorders are complex systems that integrate both scientific and social priorities. The Task Force on Developing Humanistic Approaches to Psychological Diagnosis of the Society for Humanistic Psychology has released a set of guidelines intended to guide the development of mental health classifications. This commentary argues that the attention paid in the guidelines to social processes is a desirable and inherent component of the development of any classification. Social influences regarding the definition of the concepts and the processes by which people develop them are integrally intertwined, contrary to the common view that nonscientific factors should be excluded from classification systems as much as possible. These guidelines offer a much needed resource for developing future mental health classifications.

The ICD-11 developmental field study of reliability of diagnoses of high-burden mental disorders: results among adult patients in mental health settings of 13 countries.

Reliable, clinically useful, and globally applicable diagnostic classification of mental disorders is an essential foundation for global mental health. The World Health Organization (WHO) is nearing completion of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11). The present study assessed inter-diagnostician reliability of mental disorders accounting for the greatest proportion of global disease burden and the highest levels of service utilization - schizophrenia and other primary psychotic disorders, mood disorders, anxiety and fear-related disorders, and disorders specifically associated with stress - among adult patients presenting for treatment at 28 participating centers in 13 countries. A concurrent joint-rater design was used, focusing specifically on whether two clinicians, relying on the same clinical information, agreed on the diagnosis when separately applying the ICD-11 diagnostic guidelines. A total of 1,806 patients were assessed by 339 clinicians in the local language. Intraclass kappa coefficients for diagnoses weighted by site and study prevalence ranged from 0.45 (dysthymic disorder) to 0.88 (social anxiety disorder) and would be considered moderate to almost perfect for all diagnoses. Overall, the reliability of the ICD-11 diagnostic guidelines was superior to that previously reported for equivalent ICD-10 guidelines. These data provide support for the suitability of the ICD-11 diagnostic guidelines for implementation at a global level. The findings will inform further revision of the ICD-11 diagnostic guidelines prior to their publication and the development of programs to support professional training and implementation of the ICD-11 by WHO member states.

Do mental health professionals use diagnostic classifications the way we think they do? A global survey.

We report on a global survey of diagnosing mental health professionals, primarily psychiatrists, conducted as a part of the development of the ICD-11 mental and behavioural disorders classification. The survey assessed these professionals' use of various components of the ICD-10 and the DSM, their attitudes concerning the utility of these systems, and usage of "residual" (i.e., "other" or "unspecified") categories. In previous surveys, most mental health professionals reported they often use a formal classification system in everyday clinical work, but very little is known about precisely how they are using those systems. For example, it has been suggested that most clinicians employ only the diagnostic labels or codes from the ICD-10 in order to meet administrative requirements. The present survey was conducted with clinicians who were members of the Global Clinical Practice Network (GCPN), established by the World Health Organization as a tool for global participation in ICD-11 field studies. A total of 1,764 GCPN members from 92 countries completed the survey, with 1,335 answering the questions with reference to the ICD-10 and 429 to the DSM (DSM-IV, DSM-IV-TR or DSM-5). The most frequent reported use of the classification systems was for administrative or billing purposes, with 68.1% reporting often or routinely using them for that purpose. A bit more than half (57.4%) of respondents reported often or routinely going through diagnostic guidelines or criteria systematically to determine whether they apply to individual patients. Although ICD-10 users were more likely than DSM-5 users to utilize the classification for administrative purposes, other differences were either slight or not significant. Both classifications were rated to be most useful for assigning a diagnosis, communicating with other health care professionals and teaching, and least useful for treatment selection and determining prognosis. ICD-10 was rated more useful than DSM-5 for administrative purposes. A majority of clinicians reported using "residual" categories at least sometimes, with around 12% of ICD-10 users and 19% of DSM users employing them often or routinely, most commonly for clinical presentations that do not conform to a specific diagnostic category or when there is insufficient information to make a more specific diagnosis. These results provide the most comprehensive available information about the use of diagnostic classifications of mental disorders in ordinary clinical practice.

PSIKOLOGI POSTMODERNISME: Kritik dan Tawaran terhadap Psikologi Positivistik

Positivistic hegemony in psychology is entrenched from the beginning of its birth in 1879. The ontology of modern psychology emphasizes on observable empirical realities. However, the human side of the aspect of the imaginable region is included in irrationality. This work system is seen in the process of diagnostic classification of mental disorders in PPDGJ which is full of cultural bias or legal practice of causality in the flow of behavioristic, whose practice negates the uniqueness of each individual human being studied (individual differences). The generalist assumptions of knowledge based on objective and universal methods of natural sciences are at odds with the spirit of psychology harmonize humans. Therefore, the psychology of postmodernism comes as a critique and offer in understanding human behavior as a whole by using various paradigms both using communicative hermeneutics and Derrida deconstruction.

Genetic findings are challenging the symptom-based diagnostic classification system of mental disorders.

The present diagnostic classification of mental illnesses is primarily based on symptomatology. A recent cross-disorder genome-wide association study revealed that there were genetic similarities between multiple clinically defined diagnoses (including schizophrenia, bipolar disorder, depression, attention deficit hyperactivity disorder, and autism spectrum disorder) on regions of chromosomes 3p21 and 10q24 and single-nucleotide polymorphisms (SNPs) within two L-type voltage-gated calcium channel subunits of CACNA1C and CACNB2. These findings suggest that the pathogenesis of these five independent disorders are related. Such cross-disorder genetic studies challenge the current symptom-based diagnostic classification of mental disorders. Researchers need to identify creative ways to bridge the gap between these two approaches to understanding and labelling mental disorders.

Psychologists' perspectives on the diagnostic classification of mental disorders: Results from the WHO‐IUPsyS Global Survey

This study examined psychologists’ views and practices regarding diagnostic classification systems for mental and behavioral disorders so as to inform the development of the ICD-11 by the World Health Organization (WHO). WHO and the International Union of Psychological Science (IUPsyS) conducted a multilingual survey of 2155 psychologists from 23 countries, recruited through their national psychological associations. Sixty percent of global psychologists routinely used a formal classification system, with ICD-10 used most frequently by 51% and DSM-IV by 44%. Psychologists viewed informing treatment decisions and facilitating communication as the most important purposes of classification, and preferred flexible diagnostic guidelines to strict criteria. Clinicians favorably evaluated most diagnostic categories, but identified a number of problematic diagnoses. Substantial percentages reported problems with crosscultural applicability and cultural bias, especially among psychologists outside the USA and Europe. Findings underscore the priority of clinical utility and professional and cultural differences in international psychology. Implications for ICD-11 development and dissemination are discussed.

Research planning for the future of psychiatric diagnosis

More than 10 years prior to the anticipated 2013 publication of DSM-5, processes were set in motion to assess the research and clinical issues that would best inform future diagnostic classification of mental disorders. These efforts intended to identify the clinical and research needs within various populations, examine the current state of the science to determine the empirical evidence for improving criteria within and across disorders, and stimulate research in areas that could potentially provide evidence for change. In the second phase of the revision process, the American Psychiatric Institute for Research and Education (APIRE) recently completed the 5-year international series of 13 diagnostic conferences convened by APA/APIRE in collaboration with the World Health Organization and the National Institutes of Health (NIH), under a cooperative grant funded by the NIH. From these conferences, the DSM-5 Task Force and Work Groups have developed plans for potential revisions for DSM-5, including the incorporation of dimensional approaches within and across diagnostic groups to clarify heterogeneity, improve diagnostic validity, and enhance clinical case conceptualization. Use of dimensions for measurement-based care has been shown to be feasible in psychiatric and primary care settings and may inform monitoring of disorder threshold, severity, and treatment outcomes. The integration of dimensions with diagnostic categories represents an exciting and potentially transformative approach for DSM-5 to simultaneously address DSM-IV's clinical short-comings and create novel pathways for research in neurobiology, genetics, and psychiatric epidemiology.

Vice and the Diagnostic Classification of Mental Disorders: A Philosophical Case Conference

Abstract: This main article for a Philosophy, Psychiatry, & Psychology philosophical case conference is intended to raise philosophical, psychiatric, and public policy issues concerning the relationship between concepts of criminality, mental disorder, and the classification of mental disorders. After introducing the basic problem of the confounding of “vice” and mental disorder concepts in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition—Text Revision, the author summarizes three different cases from the literature that illustrate the problem of the vice–mental disorder relationship. Four general aspects of the conceptual issues are presented to frame the discussion, and general questions in a range of domains are posed for commentators.

Post-traumatic stress disorder: The development of effective psychological treatments

Post-traumatic stress disorder (PTSD) has only relatively recently been introduced into the diagnostic classification of mental disorders. Building on advances in the treatment of other anxiety disorders, a range of effective psychological treatments for PTSD has been developed. The most effective of these treatments focus on the patient's memory for the traumatic event and its meaning. This paper briefly reviews the currently available evidence for these treatments. It then illustrates the process of developing effective psychological treatments by discussing how a combination of phenomenological, experimental and treatment development studies, and theoretical considerations was used to develop a trauma-focused cognitive–behavioral treatment, cognitive therapy (CT) for PTSD. This treatment program builds on Ehlers & Clark's (2000) model of PTSD, which specifies two core cognitive abnormalities in PTSD. First, people with chronic PTSD show idiosyncratic personal meanings (appraisals) of the trauma and/or its sequelae that lead to a sense of serious current threat. Second, the nature of the trauma memory explains the occurrence of re-experiencing symptoms. It is further proposed that the idiosyncratic appraisals motivate a series of dysfunctional behaviors (such as safety-seeking behaviors) and cognitive strategies (such as thought suppression and rumination) that are intended to reduce the sense of current threat, but maintain the problem by preventing change in the appraisals and trauma memory, and/or lead to increases in symptoms. CT addresses the cognitive abnormalities and maintaining behaviors in an individualized, but focused, way. Four randomized controlled trials and two dissemination studies showed that CT for PTSD is acceptable and effective.

Functioning and disability associated with mental disorders: the evolution since ICIDH

The International Mental Health Task Force participated actively from the outset of the revision of the ICIDH and development of the ICF. The Task Force was responsible for development of all aspects of functioning and disability associated with mental disorders. Building upon knowledge gained since the publication of the ICIDH, it had unique responsibility for development of the ICF chapter on mental functioning. It was also responsible to assure the ICF section on activities and participation integrated and reflected the functioning and disability associated with mental disorders without the redundancy of ICIDH. As context to the revision, the article describes the relationship of diagnostic classifications of mental disorders with disability, and analyses the mental disorder aspects of impairments and disabilities in the ICIDH. Membership in the Task Force represented diversity in geographical, cultural, professional, and personal perspectives on disabilities. This diverse acumen was focused on a range of activities that both specified the unique aspects of functioning and disability associated with mental disorders and assured inclusion of the mental health perspective on the domains of functioning and disability common to physical conditions. Finally, the article notes four current applications of the ICF that are inclusive of the mental health perspective.

Gender Bias in the Diagnostic Classification of Mental Disorders

Gender Bias in the Diagnostic Classification of Mental Disorders