DSM-5 Diagnosis Research Articles

Meta-analytic tests of measurement invariance of internalizing and externalizing psychopathology across common methodological characteristics.

Factor analytic models of common mental disorders have been hypothesized to be affected by various methodological features, which could undermine the assumption that Internalizing and Externalizing reflect part of the natural structure of psychopathology. In this study, we addressed this issue by testing whether and how methodological features affect the empirical structure of psychopathology using meta-analytic measurement invariance models of Internalizing and Externalizing across multiple sample characteristics. Published studies estimating factor analytic models from Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses were screened. A total of 47 samples (N = 118,966) were included in the meta-analysis. Data were pooled into meta-analytic correlation matrices using random effects models that accounted for sampling variability. Multigroup confirmatory factor analytic models of Internalizing and Externalizing were fit to the pooled matrix of DSM diagnoses to test invariance of the structure, factor loadings, and factor covariance. Results supported partial or full invariance across (a) samples selected versus not selected for psychopathology, (b) diagnoses defined by binary DSM thresholds versus dimensional symptoms counts, and (c) diagnoses based on lifetime versus current symptoms. Tentative analyses indicated noninvariance across samples that made diagnoses using hierarchical exclusion rules versus those that did not. Our study suggests that the Internalizing and Externalizing structure is largely robust to common methodological characteristics thought to impact factor analytic models. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Parenting Among Women in Methadone Treatment: Contributions of Mental Health Problems and Violence Exposure.

The aim of the current study is to explore factors associated with quality of parenting among women in treatment for opioid use disorders. 150 Black American women with 3-5year old children were recruited through methadone treatment programs. Parenting representations were assessed through the Working Model of the Child Interview and parenting behavior through video recordings of mother-child interaction. Interviews were used to assess mothers' history of violence exposure and to make DSM diagnoses. Mothers' mood disorder was related to distorted representations and to expressions of concerned affect (anxiety, fear, guilt). Mothers' personality disorder was related to expressions of negative affect (anger and frustration) and inversely related to sensitive parenting behavior. Mothers' experience of family violence during childhood and partner violence during adulthood were related to concerned affect in their representations. Women in treatment for substance use disorder have complex and interconnected needs, including parenting supports and trauma-informed mental health services.

Validation of the DSM-5 Level 1 Cross-Cutting Symptom Measure in a Community Sample

The shift toward transdiagnostic and dimensional approaches to diagnosing mental disorders has created a need for assessment tools that efficiently measure a range of mental health symptoms and their severity. The present study aimed to evaluate the psychometric properties and diagnostic utility of the DSM-5 Level 1 Cross-Cutting Symptom Measure (CCSM), developed by the American Psychiatric Association as a brief transdiagnostic measure of mental health symptoms, in community-dwelling adults. Participants (N = 482) completed symptom measures corresponding to CCSM domains and self-reported diagnostic criteria were used to establish DSM-5 diagnoses. The results showed CCSM domains had significant validity correlations with longer measures of the same or similar mental health constructs and overall symptom severity was associated with functional impairments and current treatment status. Several domains demonstrated moderate diagnostic efficiency for corresponding DSM-5 diagnoses. The recommended thresholds for depression, anxiety, and substance use domains showed strong sensitivity (≥ 0.83) but low specificity (range = 0.60-.73), whereas the personality functioning threshold showed low sensitivity (0.51) and excellent specificity (0.92). These results suggest CCSM domains are internally consistent and valid measures of psychopathology. Further, these findings indicate the CCSM shows promise as a screening tool for specific DSM-5 disorders in community samples.

Study protocol for "MDMA-assisted therapy as a treatment for major depressive disorder: A proof of principle study".

Major depressive disorder (MDD) is a world-leading cause of disability. The available treatments are not effective in all patients, and there is a significant need for more effective treatment options. Here we present the protocol for an investigator-initiated and publicly funded trial of MDMA-assisted therapy (MDMA-AT) for MDD. This single-site, open-label study investigates the proof of principle and safety of MDMA-AT in participants with MDD and provides an initial impression of treatment effectiveness. A total of 12 participants [>18 years] with DSM-5 diagnosis of MDD will receive a flexible dose of MDMA in a therapeutic setting on two dosing days over a 4 week period preceded by three preparatory sessions. Each MDMA dosing session will be followed by three integration sessions. The primary outcome is change in MDD symptom severity, as measured by the mean change in MADRS scores from Baseline to 8 weeks after the second MDMA session. The secondary outcome is change in functional impairment, as evaluated by the mean change in Sheehan Disability Scale scores from Baseline to 8 weeks after the second MDMA session. Safety measures include vital signs, the incidence of Adverse Events and suicidality as measured by the Colombia-Suicide Severity Rating Scale. This proof of principle trial will inform the development of fully powered clinical trials, optimize the protocol for the administration of MDMA-AT in participants with MDD and explore uncertainties including barriers to recruitment, retention and acceptability of MDMA-AT as a treatment for MDD. EudraCT number 2021-000805-26.

Avoidant restrictive food intake disorder and suicidal ideation

Most DSM-5 eating disorder diagnoses are associated with elevated suicide risk; however, little is known about the relationship between Avoidant/Restrictive Food Intake Disorder (ARFID) and suicidal ideation. The aim of the current study was to examine suicidal ideation within an adult ARFID sample. Patients with eating disorders (N = 936), some of whom met criteria for a current DSM-5 diagnosis of ARFID (n = 79), completed the Beck Depression Inventory II Item 9, regarding suicidal ideation. The study was conducted within an eating disorder treatment facility that offers inpatient, residential, partial hospitalization program, and intensive outpatient levels of care. Findings suggest no significant pairwise differences in suicidal ideation prevalence between participants with ARFID and those with any other ED diagnosis. Thorough screening for suicidal thoughts and risk among those with ARFID is warranted at all levels of care. We suggest that future research expand upon this work in a larger adult ARFID sample.

Number and characteristics of patients seeking treatment for eating disorders at a CBT-E clinical service before and during the COVID-19 pandemic

This retrospective study aimed to assess the number, demographic and clinical characteristics of patients seeking treatment for eating disorders at a clinical service specialized in delivering enhanced cognitive behavior (CBT-E) before (01/01/2018 - 08/03/2020) and during (09/03/2020 - 31/12/2021) the coronavirus (COVID-19) pandemic. A larger number of adults than adolescents sought treatment both before (121 [66%] vs. 62 [44%]) and during the COVID-19 pandemic (108 [53%] vs. 95 [47%]) (chi-squared=6.66, p=0.010). However, the percentage of adolescents seeking treatment was higher in the pandemic than in pre-pandemic years (60.5% vs. 39.5%). On the contrary, the rate of adults with an age of ≥25 years was lower during the COVID-19 pandemic (chi-square=8.71, p=0.033). No significant difference was found in demographics, clinical characteristics, and DSM-5 diagnoses between patients seeking treatment before and during the COVID-19 pandemic. In conclusion, the results show a significant increase in adolescent patients seeking outpatient CBT-E during the COVID-19 pandemic.

Neuropsychiatric symptoms in the psychiatric counseling of patients admitted with COVID-19 infection

BackgroundCovid-19 patients suffer from psychiatric disorders too. The present study was designed to investigate the rate of psychiatric consultation requests in a general hospital. Reasons for consultation requests, types of psychiatric diagnoses, and factors in consultation requests were also investigated. MethodsThis cross-sectional study included all patients admitted with Covid-19 and referred to psychiatric consultation service in a major Covid-19 center in Tehran, Iran (2020). After acceing patients’ electronic files, records of patients’ demographic information, positive psychiatric symptoms, past psychiatric history and DSM5 diagnoses were made. Statistical analyses were done in SPSS 26 using descriptive statistics and chi-square and Fisher's exact test (p<0.05). ResultsOut of 1791 Covid-19 hospitalized patients, 132 patients (7.3%) had been referred to psychiatric consultation service. The most common reason for requests were restlessness and aggression (23.5%). Meanwhile, 92.4% of the patients were diagnosed to suffer from at least one psychiatric disorder including insomnia (64%), delirium (30.3%), anxiety due to hypoxia (15.3%) and generalized anxiety disorder (10.6%). ConclusionAlthough studies report a high prevalence of psychiatric disorders in Covid-19 patients, requests for psychiatric consultations and consideration of psychiatric disorders are still remarkably low. The most common disorders appeared to be insomnia, delirium and anxiety.

Childhood sexual abuse and food addiction severity in a clinical sample of individuals with overweight or obesity.

A higher risk of food addiction (FA) in individuals reporting childhood sexual abuse (CSA) has been well demonstrated with community samples, but studies including clinical samples failed to replicate this relation. This study examined, among individuals presenting eating and weight disorders, the risk of FA for those reporting CSA while considering the severity of CSA and other types of traumas. Participants (N = 187) completed a DSM-5 diagnosis assessment and questionnaires on LimeSurvey evaluating FA, interpersonal traumas, depressive level, body esteem, dieting/weight preoccupations, and body mass index (BMI). Logistic regressions were used to calculate the odds ratio (OR) of FA using interpersonal traumas as risk factors, and t tests were used to compare individuals with FA and CSA and those with FA without CSA. Of all interpersonal traumas, CSA was associated with the highest risk of FA, with ORs of 1.73 (p = 0.094) and 2.07 (p = 0.034). The relationship with the abuser, the type of sexual abuse and the number of abuses were significant or marginally significant risk factors, with ORs ranging from 1.26 to 1.50. Finally, no significant difference was found between FA with CSA and FA without CSA. Using a clinical sample, this study showed a higher risk of FA in individuals reporting CSA and provided evidence that the relationship with the abuser, the type of sexual abuse, and the number of abuses are relevant factors. Additionally, in individuals with FA, the presence or absence of CSA did not influence depressive level, body esteem, dieting/weight preoccupations, or BMI. Level V, cross-sectional, descriptive study.

Phenome-wide Association Analysis of Substance Use Disorders in a Deeply Phenotyped Sample

BackgroundSubstance use disorders (SUDs) are associated with a variety of co-occurring psychiatric disorders and other SUDs, which partly reflects genetic pleiotropy. Polygenic risk scores (PRSs) and phenome-wide association studies are useful in evaluating pleiotropic effects. However, the comparatively low prevalence of SUDs in population samples and the lack of detailed information available in electronic health records limit these data sets’ informativeness for such analyses. MethodsWe used the deeply phenotyped Yale-Penn sample (n = 10,610 with genetic data; 46.3% African ancestry, 53.7% European ancestry) to examine pleiotropy for 4 major substance-related traits: alcohol use disorder, opioid use disorder, smoking initiation, and lifetime cannabis use. The sample includes both affected and control subjects interviewed using the Semi-Structured Assessment for Drug Dependence and Alcoholism, a comprehensive psychiatric interview. ResultsIn African ancestry individuals, PRS for alcohol use disorder, and in European individuals, PRS for alcohol use disorder, opioid use disorder, and smoking initiation were associated with their respective primary DSM diagnoses. These PRSs were also associated with additional phenotypes involving the same substance. Phenome-wide association study analyses of PRS in European individuals identified associations across multiple phenotypic domains, including phenotypes not commonly assessed in phenome-wide association study analyses, such as family environment and early childhood experiences. ConclusionsSmaller, deeply phenotyped samples can complement large biobank genetic studies with limited phenotyping by providing greater phenotypic granularity. These efforts allow associations to be identified between specific features of disorders and genetic liability for SUDs, which help to inform our understanding of the pleiotropic pathways underlying them.

A-260 Regional Cerebral Blood Flow Differences in ADHD Subtypes Among Children

Abstract Objective: To identify regional cerebral blood flow (rCBF) differences among children with varying Attention-deficit/hyperactivity disorder (ADHD) subtypes. The participants were part of an archival de-identified database that received SPECT scans at baseline. The sample (N= 3222) consisted of ADHD classifications of asymptomatic (N=773), combined type (N=1157), hyperactive (N=25), inattentive (N=479), mostly impulsive (N=122), mostly inattentive (N=633), and undetermined (N=33). The sample consisted of 70.3% males and 29.4% females with Caucasians (N=1652), African Americans (N=58), Hispanics (N=79), Asians (N=42), and unknown (N=1391). A one-way between-subjects ANCOVA was performed controlling for age and gender, where ADHD type was the independent variable and brain region was the dependent variable. The main effect of ADHD type was statistically significant for the baseline left occipital, F (7, 3425) = 2.462, p =.016, ηp2=.005. Post hoc tests showed there was a significant difference between the hyperactive and mostly impulsive group (p=.043), where the hyperactive group demonstrated higher rCBF perfusion. Research is limited regarding rCBF perfusion among ADHD subtypes, with no research on the hyperactive subtype, this is the first study providing evidence that youth diagnosed with hyperactive subtype may have increased activation across brain regions as compared to other subtypes. Specifically, our results suggest there may be increased activity in the brain region that is primarily responsible for visual processing among children in the ADHD hyperactive group. SPECT imaging may be useful in determining differences between ADHD subtypes and their resulting behavioral and cognitive functioning. Limitations of this study included the use of DSM-IV-TR rather than DSM-5 diagnosis criteria.

Video-based screening for children with suspected autism spectrum disorder – experience during the COVID-19 pandemic in India

BackgroundAssessments for children with autism spectrum disorder (ASD) must adapt to the current COVID-19 pandemic through innovation in screening and assessment strategies using technology. To our knowledge there are no such studies reported from India. We aimed to study the predictive ability of video-based screening tool with definitive diagnosis in children with ASD. MethodThirty-nine children were screened independently by two examiners with a video-based screening tool to start intervention followed by an in-person evaluation by clinical DSM-5 diagnosis three months later. ResultSimilar to studies from developed countries, videos assessments showed a 94.87% correlation with the final diagnosis. Interobserver video agreement had a kappa correlation of 0.803, which was classified as substantial agreement. ConclusionVideo-based evaluations may be used as an interim assessment to initiate early intervention in children with ASD in resource-limited setups in the current pandemic situation. Large, well-designed prospective studies are required to confirm our results.

How do family beliefs overshadow the management of postpartum delirious mania? A rare case report of adolescent postpartum delirious mania

Delirious mania (D.M.), which is described as an advancement of delirium in a patient with acute mania, is related to the high morbidity and mortality rate. Despite the high occurrence of delirium (15-20%) in bipolar disorder, D.M. is frequently misdiagnosed. D.M. is not classified as a DSM diagnosis, and no treatment guidelines exist. This case report presents a rare case report of an adolescent Postpartum Delirious Mania. Also, we will discuss how family beliefs overshadow Postpartum Delirious Mania treatment. Patients with postpartum psychosis or mania achieved favorable treatment outcomes using a structured treatment algorithm during the acute phase of the illness. After remission, maintenance with lithium appears to be highly protective against relapse. Inpatient psychiatric treatment is required to protect the mother's and baby's safety. Emphasize are needed on sleep hygiene and a consistent feeding schedule. In practical practice, this frequently entails the discontinuation of nursing. Lactation inhibitors should be avoided at all costs. Based on observations from our case, family beliefs overshadow the management of postpartum delirious mania. we propose the importance of psychoeducation, especially for the family and the caregivers are essential for the patient's health.

Guided internet-based cognitive behavioral therapy for insomnia in patients with borderline personality disorder: Study protocol for a randomized controlled trial

Borderline personality disorder (BPD) is a highly disabling psychiatric disorder with emotion dysregulation at its core, resulting in affective instability, impulsivity and sometimes self-harming or suicidal behavior. Sleep is increasingly recognized to play a crucial role in emotion regulation. BPD patients often suffer from (severe) insomnia, potentially aggravating symptoms and preventing recovery from BPD. Yet, the effects of insomnia treatments have not been investigated in context of BPD. Guided internet-based cognitive behavioral therapy for insomnia (iCBT-I; i-Sleep) has been proven effective in improving both insomnia and affective symptoms. In this randomized controlled trial among 96 patients with a DSM-5 diagnosis of BPD (or other personality disorder with ≥4 BPD traits) and insomnia symptoms, we will test the effectiveness of iCBT-I before regular BPD treatment starts, during the waitlist period, on BPD symptoms. Patients in the control group monitor their sleep through a sleep diary during the waitlist period and also receive standard BPD treatment after that. Using linear mixed models we will test the hypothesis that the iCBT-I group improves more than the control group on BPD symptoms (primary outcome), insomnia severity, additional subjective and objective sleep variables, emotion regulation, comorbid anxiety and depression complaints, and quality of life. These effects are thought to arise from a direct effect of improved sleep on emotion regulation and a synergistic effect on the consolidation and internalization of the BPD treatment effect. To our knowledge, this is the first trial assessing effectiveness of CBT-I in patients with BPD (traits). The accessibility of the studied intervention greatly facilitates clinical implication in case of positive results.

Efficacy of Applied Relaxation as indicated preventive intervention in individuals at increased risk for mental disorders: A randomized controlled trial

The objective was to examine the efficacy of Applied Relaxation (AR) as indicated preventive intervention to reduce psychopathological symptoms and prevent incident mental disorders. In a parallel-group randomized controlled trial, N = 277 adults with elevated tension/distress, anxiety, or depressive symptomatology (Depression-Anxiety-Stress Scale, DASS-21) but no 12-month DSM-5 diagnosis of any mental disorder assessed via standardized interview (DIA-X-5) were randomized to an intervention group (IG; n = 139) receiving group-based AR training, or an assessment-only control group (CG, n = 138). Self-report questionnaires at baseline, post (immediately after the 10 week intervention or a similar time frame in CG) and 12-month follow-up included the DASS-21 as primary outcome measure of intervention efficacy. Incident subthreshold and threshold mental disorders were assessed via DIA-X-5 at 12-month follow-up as primary outcome of prevention efficacy. Intervention and prevention effects were examined on an intent-to-treat basis with missing data replaced using chained multiple imputation. Mixed-model analyses revealed accelerated symptom improvement in IG versus CG with a medium baseline-to-post between-group effect size (d = 0.59, 95%CI: 0.36–0.82). Logistic regression analysis revealed a significantly lower incidence rate for (sub-)threshold mental disorders until 12-month follow-up in IG (34.7%) versus CG (49.3%; Odds Ratio: 0.54, 95%CI: 0.31–0.92, Risk Ratio: 0.70, 95%CI: 0.51–0.96, Risk Difference = −0.15, 95%CI: −0.28 to −0.02). Group-based AR as a promising indicative preventive intervention should be tested in long-term studies and relative to a credible alternative intervention to assure that the intervention effects are not entirely due to demand characteristics, expectancies, or non-specific effects.

Eating disorder behaviors as predictors of suicidal ideation among people with an eating disorder.

Suicidality is known to be elevated among people with an eating disorder. The aim of the current study was to examine whether any of three specific behavioral facets of eating disorders (i.e., purging, binge eating, restricting) would be the strongest predictors of suicidal ideation, controlling for one another, in longitudinal analyses from admission to discharge. We hypothesized that purging, above and beyond restricting or binge eating, would be the most important predictor of suicidal ideation. In the present study, patients with an eating disorder (N =936), the majority of whom met criteria for a current DSM-5 diagnosis of Anorexia Nervosa (n =560), completed the Eating Pathology Symptoms Inventory (EPSI) and the Beck Depression Inventory II-Item 9 suicidal ideation index, at admission and again at discharge. The settings were eating disorder treatment facilities offering inpatient, residential, partial hospitalization program (PHP), and intensive outpatient (IOP) levels of care. We pitted EPSI purging, EPSI restriction, and EPSI binge eating against one another in a regression framework predicting discharge suicidal ideation controlling for suicidal ideation at admission. EPSI Purging significantly predicted both presence/absence of suicidal ideation (β=.22, t =2.48, p=.01; OR=1.25, 95% CI [1.05, 1.49]) and intensity of suicidal ideation (β=.04, t =2.31, p=.02) at discharge, whereas neither EPSI Restricting nor EPSI Binge Eating did (p > .30). Study results suggest that purging may have particular relevance in estimating suicide risk in patients with an eating disorder.

Clinical utility of the Diagnostic Criteria for Psychosomatic Research for a comprehensive assessment of the elderly.

According to the revised version of the Diagnostic Criteria for Psychosomatic Research (DCPR-R), this study explored the prevalence and clinical correlates of DCPR-R psychosomatic syndromes in the elderly and tested whether DCPR-R provide an incremental contribution to the prediction of psychosocial functioning over and above DSM-5. One hundred seven elderly subjects were recruited. Participants received a clinical assessment, which included the DCPR-Revised Semi-Structured Interview (DCPR-R SSI), the Structured Clinical Interview for DSM-5-Clinician Version (SCID-5-CV), the Psychological Well-Being (PWB) Scales, the Geriatric Anxiety Scale (GAS)and the Geriatric Depression Scale (GDS). Analyses of covariance (ANCOVA) and hierarchical regression analyses were run. Twenty-two (20.6%) subjects had at least one DSM-5 diagnosis, and 62 (57.9%) reported at least one DCPR-R diagnosis. Subjects with at least one DCPR-R diagnosis showed lower PWB Personal Growth and PWB Purpose in Life than those without DCPR-R diagnoses. When the incremental validity of the DCPR-R was tested using PWB Personal Growth, PWB Purpose in Life, PWB Self-acceptance, GAS Cognitive symptoms and GAS affective symptoms subscales as criterion variable, the DCPR-R increased up to 0.135-0.263 the explained variance. The DCPR-R might be implemented together with the DSM-5 to have a comprehensive assessment of elderly subjects.

What can we learn about the psychiatric diagnostic categories by analysing patients' lived experiences with Machine-Learning?

BackgroundTo deliver appropriate mental healthcare interventions and support, it is imperative to be able to distinguish one person from the other. The current classification of mental illness (e.g., DSM) is unable to do that well, indicating the problem of diagnostic heterogeneity between disorders (i.e., the disorder categories have many common symptoms). As a result, the same person might be diagnosed with two different disorders by two independent clinicians. We argue that this problem might have resulted because these disorders were created by a group of humans (APA taskforce members) who relied on more intuition and consensus than data. Literature suggests that human-led decisions are prone to biases, group-thinking, and other factors (such as financial conflict of interest) that can enormously influence creating diagnostic and treatment guidelines. Therefore, in this study, we inquire that if we prevent such human intervention (and thereby their associated biases) and use Artificial Intelligence (A.I.) to form those disorder structures from the data (patient-reported symptoms) directly, then can we come up with homogenous clusters or categories (representing disorders/syndromes: a group of co-occurring symptoms) that are adequately distinguishable from each other for them to be clinically useful. Additionally, we inquired how these A.I.-created categories differ (or are similar) from human-created categories. Finally, to the best of our knowledge, this is the first study, that demonstrated how to use narrative qualitative data from patients with psychopathology and group their experiences using an A.I. Therefore, the current study also attempts to serve as a proof-of-concept.MethodWe used secondary data scraped from online communities and consisting of 10,933 patients’ narratives about their lived experiences. These patients were diagnosed with one or more DSM diagnoses for mental illness. Using Natural Language Processing techniques, we converted the text data into a numeric form. We then used an Unsupervised Machine Learning algorithm called K-Means Clustering to group/cluster the symptoms. ResultsUsing the data mining approach, the A.I. found four categories/clusters formed from the data. We presented ten symptoms or experiences under each cluster to demonstrate the practicality of application and understanding. We also identified the transdiagnostic factors and symptoms that were unique to each of these four clusters. We explored the extent of similarities between these clusters and studied the difference in data density in them. Finally, we reported the silhouette score of + 0.046, indicating that the clusters are poorly distinguishable from each other (i.e., they have high overlapping symptoms).DiscussionWe infer that whether humans attempt to categorise mental illnesses or an A.I., the result is that the categories of mental disorders will not be unique enough to be able to distinguish one service seeker from another. Therefore, the categorical approach of diagnosing mental disorders can be argued to fall short of its purpose. We need to search for a classification system beyond the categorical approaches even if there are secondary merits (such as ease of communication and black-and-white (binary) decision making). However, using our A.I. based data mining approach had several meritorious findings. For example, we found that some symptoms are more exclusive or unique to one cluster. In contrast, others are shared by most other clusters (i.e., identification of transdiagnostic experiences). Such differences are interesting objects of inquiry for future studies. For example, in clear contrast to the traditional diagnostic systems, while some experiences, such as auditory hallucinations, are present in all four clusters, others, such as trouble with eating, are exclusive to one cluster (representing a syndrome: a group of co-occurring symptoms). We argue that trans-diagnostic conditions (e.g., auditory hallucinations) might be prime targets for symptom-level interventions. For syndrome-level grouping and intervention, however, we argue that exclusive symptoms are the main targets.ConclusionCategorical approach to mental disorders is not a way forward because the categories are not unique enough and have several shared symptoms. We argue that the same symptoms can be present in more than one syndrome, although dimensionally different. However, we need additional studies to test this hypothesis. Future directions and implications were discussed.

Prevalence of Anxiety Disorder Comorbidities in Female Outpatients with Substance Use Disorder in a Referral Public Psychiatric Hospital in Tehran, Iran

Background: Nowadays, the attention to the combination of Substance Use Disorders (SUD) and anxiety disorders in women is increasing; therefore, the aim of this study was to investigate the prevalence of anxiety disorders in women substance users and epidemiological features of this population.&#x0D; Methods: In a cross-sectional study, 48 female outpatients with SUD referred to the Iran psychiatric hospital substance use clinic with a range of 18 to 65 years, were involved in the study. All participants referred to the substance use clinic of Iran psychiatric center to follow up on the comorbidities and psychiatric disorders, were involved in the study. The Structured Clinical Interview for DSM-5 (SCID) was used to anxiety disorders and SUD diagnoses. The SCID is a semi-structured interview guide for making the major DSM-5 diagnoses. It is administered by a clinician who is familiar with the DSM-5 classification and diagnostic criteria. Finally, gathered data were analyzed by SPSS-22.&#x0D; Results: Totally, 48 patients enrolled to this study. The mean age of patients was 34.2±9.4. Crystal (60.4%) and alcohol (50%) were the most commonly used substances. Of the 48 substance users, 47.9% had at least one type of anxiety disorders. The most common anxiety disorders in substance users were generalized anxiety disorder (37.5%), social anxiety disorder (18.8%), and agoraphobia and panic disorder (12.5%). A statistically significant correlation was found between agoraphobia and opium (p=0.04), generalized anxiety disorders and benzodiazepines (p=0.02).&#x0D; Conclusion: In the present study, it was shown that anxiety disorders co-occur with SUD at a high rate. Generalized anxiety disorders and social anxiety disorder were the two most prevalent conditions among substance users. Analysis showed a statistically significant correlation between agoraphobia and opium, general anxiety disorders and benzodiazepines.

Effect of Psychiatric Advance Directives Facilitated by Peer Workers on Compulsory Admission Among People With Mental Illness

Reducing the use of coercion in mental health care is crucial from a human rights and public health perspective. Psychiatric advance directives (PADs) are promising tools that may reduce compulsory admissions. Assessments of PADs have included facilitation by health care agents but not facilitation by peer workers. To determine the efficacy of PADs facilitated by peer workers (PW-PAD) in people with mental disorders. A multicenter randomized clinical trial was conducted in 7 French mental health facilities. Adults with a DSM-5 diagnosis of schizophrenia, bipolar I disorder, or schizoaffective disorder who had a compulsory admission in the past 12 months and the capacity to consent were enrolled between January 2019 and June 2020 and followed up for 12 months. The PW-PAD group was invited to fill out a PAD form and meet a peer worker who was trained to assist in completing and sharing the form with relatives and psychiatrists. The primary outcome was the rate of compulsory admission at 12 months after randomization. The overall psychiatric admission rate, therapeutic alliance, quality of life, mental health symptoms, empowerment, and recovery outcomes were also investigated. Among 394 allocated participants (median age, 39 years; 39.3% female; 45% with schizophrenia, 36% bipolar I disorder, and 19% schizoaffective disorder), 196 were assigned to the PW-PAD group and 198 to the control group. In the PW-PAD group, 27.0% had compulsory admissions compared with 39.9% in the control group (risk difference, -0.13; 95% CI, -0.22 to -0.04; P = .007). No significant differences were found in the rate of overall admissions, therapeutic alliance score, and quality of life. Participants in the PW-PAD group exhibited fewer symptoms (effect size, -0.20; 95% CI, -0.40 to 0.00), greater empowerment (effect size, 0.30; 95% CI, 0.10 to 0.50), and a higher recovery score (effect size, 0.44; 95% CI, 0.24 to 0.65), compared with those in the control group. Peer worker-facilitated PADs are effective in decreasing compulsory hospital admissions and increasing some mental health outcomes (self-perceived symptoms, empowerment, and recovery). Involving peer workers in the completion of PADs supports the current shift of mental health care from substitute decision-making to supported decision-making. ClinicalTrials.gov Identifier: NCT03630822.

Bodily expression of psychological distress in adolescents: a qualitative study

IntroductionThe bodily expression of psychological disorders is one of the leading motives for consultations in adolescent medicine. The diagnostic entity corresponding to DSM-5 "Somatic symptom and related disorders" is sparsely used in the English-language literature, especially for adolescents. Qualitative studies on this topic mostly concern the experiences of healthcare professionals. This study seeks to explore the experience of adolescents expressing psychological distress through their body.MethodsThis exploratory research took place in a Paris hospital department of adolescent medicine. Our sampling method was purposive. For inclusion, patients had to be aged 11–24 years, with a "somatic symptom disorder" meeting the DSM-5 criteria. Semi-directive interviews were proposed with visual narration inspired by photoelicitation. Thematic analysis allowed us to explore the data with an inductive approach.ResultsThirty adolescents were interviewed; they were 14–22 years old and mostly had somatic symptom or functional neurological disorders. Three principal themes emerged from our analysis of the interview contents: the personal, including bodily, experience of the disorder, the experience of relationships, and the question of what is visible through the body.ConclusionThis research allowed us to discuss the reversal of generations, the function of the DSM-5 diagnosis, illuminated by sociology, and finally, cultural pathways. It shows the importance of recognizing the reality of the adolescents' bodily feelings, reassuring them by ruling out serious causes, and supporting their search for meaning. It is important to think about a specific framework of family therapy that can make effective use of this experience of the reversal of generations.