DSM-IV Disorders Research Articles

Influencing factors of posttraumatic stress disorder in Shidu parents who have lost their only child: a cross-sectional survey

BackgroundIn China, parents who have lost their only child are referred to as Shidu parents (SDPs). This study aimed to investigate the prevalence and risk factors of post-traumatic stress disorder (PTSD) and investigate the influence of depressive and anxiety symptoms on the development of PTSD.MethodFour hundred and thirty-six SDPs completed assessments of PTSD (Structured Clinical Interview for DSM-IV Disorders, SCID-IV; The Clinician-Administered PTSD Scale-IV, CAPS-IV), depression (Hamilton depression scale), and anxiety (Hamilton Anxiety Scale) via in-person interviews. Logistic regression and hierarchical multiple linear regression analyses were used to explore the association of demographic characteristics, depression, and anxiety symptoms with PTSD.ResultsThe prevalence of PTSD in SDPs was 14.45%. The comorbidity of depression and anxiety symptoms was 87.30% in the SDPs with PTSD. The logistic regression model, which included factors of gender, age, education, depression, and anxiety, which contributed to the development of PTSD, was significant [χ² (11) = 122.47, p < 0.001]. The hierarchical multiple linear regression analysis indicated that female gender and the severity of comorbidities (depression and anxiety) were positively associated with the severity of PTSD.ConclusionThis study found that the severity of depression and anxiety was closely related to the severity of PTSD, supporting that SDPs are highly prone to the co-occurrence of PTSD, depression, and anxiety after bereavement. Our findings may provide more insights into the development of individualized interventions for parents who have experienced the loss of their only child.

Identification of latent classes in mood and anxiety disorders and their transitions over time: a follow-up study in the adult general population.

Mood and anxiety disorders are heterogeneous conditions with variable course. Knowledge on latent classes and transitions between these classes over time based on longitudinal disorder status information provides insight into clustering of meaningful groups with different disease prognosis. Data of all four waves of the Netherlands Mental Health Survey and Incidence Study-2 were used, a representative population-based study of adults (mean duration between two successive waves = 3 years; N at T0 = 6646; T1 = 5303; T2 = 4618; T3 = 4007; this results in a total number of data points: 20 574). Presence of eight mood and anxiety DSM-IV disorders was assessed with the Composite International Diagnostic Interview. Latent class analysis and latent Markov modelling were used. The best fitting model identified four classes: a healthy class (prevalence: 94.1%), depressed-worried class (3.6%; moderate-to-high proportions of mood disorders and generalized anxiety disorder (GAD)), fear class (1.8%; moderate-to-high proportions of panic and phobia disorders) and high comorbidity class (0.6%). In longitudinal analyses over a three-year period, the minority of those in the depressed-worried and high comorbidity class persisted in their class over time (36.5% and 38.4%, respectively), whereas the majority in the fear class did (67.3%). Suggestive of recovery is switching to the healthy class, this was 39.7% in the depressed-worried class, 12.5% in the fear class and 7.0% in the high comorbidity class. People with panic or phobia disorders have a considerably more persistent and chronic disease course than those with depressive disorders including GAD. Consequently, they could especially benefit from longer-term monitoring and disease management.

The mediating role of social stress sensitivity on the relationship between hostile attribution bias and paranoia: An experience sampling study

IntroductionHeightened affective responses to daily life stressors, referred to as elevated affective reactivity to stress (or ‘stress sensitivity’), have been proposed as a putative mechanism of schizophrenia. Previous studies on stress sensitivity mainly used a case-control design; given that schizophrenia is heterogeneous its relationship with specific symptoms (e.g. paranoia) is yet to be addressed. In view of the continuum approach of understanding psychotic symptoms, the relationship between stress sensitivity (especially ‘social stress sensitivity’) and paranoia in the general population is important. Supported by emerging evidence of the relationship between hostile attribution bias (i.e. a tendency to interpret others’ actions as hostile and intentional) and paranoia, we hypothesized that social stress sensitivity mediates the relationship between hostile attribution bias and momentary experiences of paranoia.Objectives Using experience sampling method, this study aimed to examine the association between social stress sensitivity, hostile attribution bias and momentary paranoia in non-clinical young adults. We also tested the role of social stress sensitivity as mediator of the relationship between hostile attribution bias and momentary paranoia.MethodsConsented participants free from any past and current psychiatric diagnoses (confirmed with the Structured Clinical Interview for DSM-IV Disorders) completed the measure of hostile attribution bias (i.e. abbreviated Ambiguous Intentions Hostility Questionnaire). Participants then filled in an ESM questionnaire measuring momentary levels of paranoia, social stress (i.e. pleasantness of and preference for being alone or with others) and negative affect on a mobile phone app repeatedly, ten times per day over six days. Social stress reactivity was calculated as the within-moment correlation between social stress and negative affect. The associations between social stress sensitivity, hostile attribution bias and momentary paranoia, and the mediating role of social stress sensitivity, were tested with multilevel modelling.Results The final sample consisted of 131 participants (57.3% female, mean age= 20.36 (SD= 2.93)). The mean compliance rate was 71.9% (SD= 0.16). Social stress sensitivity was positively associated with momentary paranoia (B= 0.03, p= .002). Hostile attribution bias was associated with momentary paranoia (B= 0.41, p&lt; .001), as well as social stress reactivity (B= 0.10, p= .003). The mediating effect from hostile attribution bias to momentary paranoia via social stress sensitivity was significant (ab= 0.05, 95% CI [0.03-0.07]).ConclusionsSocial stress sensitivity was related to momentary paranoia, as well as hostile attribution bias. Our finding suggests social stress reactivity as a potential mechanism underlying the relationship between hostile attribution bias and paranoia.Disclosure of InterestNone Declared

Persistent depression in pregnant refugee and migrant women living along the Thai-Myanmar Border: a secondary qualitative analysis.

Antepartum depression affects around 15% of pregnant women worldwide, and may negatively impact their infants' physical, cognitive and social development, and confer a greater risk of emotional dysregulation in their children. Risk factors for antepartum depression disproportionately affect women from resource-sparse settings. In particular, pregnant refugee and migrant women face many barriers to diagnosis and care of mental health conditions, yet this group is under-represented in the literature. This study explores what refugee and migrant women living along the Thai-Myanmar border perceive as being contributory and protective factors to their antepartum depression, through secondary qualitative analysis of responses to clinical interviews for depression. Previous research investigating perinatal depression in pregnant refugee and migrant women on the Thai-Myanmar border involved assessing 568 women for depression, using the Structured Clinical Interview for the diagnosis of DSM-IV Disorders (SCID). This study analyses a subsample of 32 women, diagnosed with persistent depression during the antepartum period. Thematic analysis of responses to the SCID and social and demographic surveys was undertaken to investigate factors which contribute towards, or protect against, persistent antepartum depression. Major themes which women described as contributing towards persistent antepartum depression were financial problems, interpersonal violence, substance misuse among partners, social problems and poor health. Factors women considered as protecting mental wellbeing included social support, accessible healthcare and distractions, highlighting the need for focus on these elements within refugee and migrant settings. Commonly expressed phrases in local Karen and Burmese languages were summarised. Knowledge of factors affecting mental wellbeing in the study population and how these are phrased, may equip stakeholders to better support women in the study area. This study highlighted the limitations of contextually generic diagnostic tools, and recommends the development of tools better suited to marginalised and non-English speaking groups.

Psychometric testing and the predictive validity of the Postpartum Depression Predictors Inventory-Revised (PDPI-R): A longitudinal study with Turkish women

ObjectiveThe aim of this study was to investigate the validity and reliability of the prenatal and postnatal versions of the Postpartum Depression Predictors Inventory-Revised (PDPI-R) and to examine the predictive validity of PDPI-R in Turkish women, considering two gold standards to determine postpartum depression (PPD). MethodsThis prospective longitudinal study was conducted between August 2021 and September 2023. A total of 301 pregnant women participated in the study. Participants completed the PDPI-R during the third trimester of pregnancy (T1) and at 4 weeks postpartum (T2). At T2, participants also completed the Edinburgh Postnatal Depression Scale (EPDS), and women were interviewed using the Structured Clinical Interview for DSM-IV Disorders. ResultsThe prenatal version of the PDPI-R predicted PPD with 64% (R:0.64) accuracy on the basis of the EPDS and 78% accuracy (R:0.78) according to DSM IV criteria. The postnatal version of the PDPI-R predicted PPD with 71% (R:0.71) accuracy on the basis of the EPDS and 81% accuracy (R:0.781) based on DSM IV criteria. The cut-off points exhibited the highest sensitivity and specificity values at 8.5 for the prenatal version and 10.5 for the postnatal version. ConclusionsThe PDPI-R is a valid and reliable screening tool for identifying Turkish women at high risk of developing PPD and for estimating the psychosocial risk associated with PPD.

Factors associated with satisfaction and perceived helpfulness of mental healthcare: a World Mental Health Surveys report

BackgroundMental health service providers are increasingly interested in patient perspectives. We examined rates and predictors of patient-reported satisfaction and perceived helpfulness in a cross-national general population survey of adults with 12-month DSM-IV disorders who saw a provider for help with their mental health.MethodsData were obtained from epidemiological surveys in the World Mental Health Survey Initiative. Respondents were asked about satisfaction with treatments received from up to 11 different types of providers (very satisfied, satisfied, neither satisfied nor dissatisfied, somewhat dissatisfied, very dissatisfied) and helpfulness of the provider (a lot, some, a little, not at all). We modelled predictors of satisfaction and helpfulness using a dataset of patient-provider observations (n = 5,248).ResultsMost treatment was provided by general medical providers (37.4%), psychiatrists (18.4%) and psychologists (12.7%). Most patients were satisfied or very satisfied (65.9-87.5%, across provider) and helped a lot or some (64.4-90.3%). Spiritual advisors and healers were most often rated satisfactory and helpful. Social workers in human services settings were rated lowest on both dimensions. Patients also reported comparatively low satisfaction with general medical doctors and psychiatrists/psychologists and found general medical doctors less helpful than other providers. Men and students reported lower levels of satisfaction than women and nonstudents. Respondents with high education reported higher satisfaction and helpfulness than those with lower education. Type of mental disorder was unrelated to satisfaction but in some cases (depression, bipolar spectrum disorder, social phobia) was associated with low perceived helpfulness. Insurance was unrelated to either satisfaction or perceived helpfulness but in some cases was associated with elevated perceived helpfulness for a given level of satisfaction.ConclusionsSatisfaction with and perceived helpfulness of treatment varied as a function of type of provider, service setting, mental status, and socio-demographic variables. Invariably, caution is needed in combining data from multiple countries where there are cultural and service delivery variations. Even so, our findings underscore the utility of patient perspectives in treatment evaluation and may also be relevant in efforts to match patients to treatments.

THE MODERATING ROLE OF RACE AND ETHNICITY BETWEEN NEGATIVE FAMILY INTERACTIONS AND MENTAL HEALTH AMONG OLDER ADULTS

Abstract Studies generally show that negative social interactions are detrimental to mental health for older adults. Furthermore, empirical evidence suggests that negative interactions may function differently in relation to mental health across racial/ethnic groups given their unique life circumstances and social conditions. This study examines whether the association between negative family interactions and mental health outcomes varies by race and ethnicity. Samples of older African Americans, Caribbean Blacks, and non-Latino Whites aged 55 and older were drawn from the National Survey of American Life (N = 1,439). Mental health variables included depressive symptoms, any lifetime disorder according to The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and number of lifetime DSM-IV disorders. Regression models were used to test the study aim. Analyses indicated that negative interactions with family were positively associated with all 3 mental health outcomes. Several racial/ethnic differences emerged. The association between negative family interactions and depressive symptoms was stronger among Whites than African Americans. While negative family interactions were positively associated with number of disorders among Caribbean Blacks, negative interactions were unrelated to number of disorders among African Americans. This study demonstrates the racial and ethnic differences in diverse aging populations and the importance of recognizing the heterogeneity of the Black American population in minority research. Clinical practice should focus on reducing negative family interactions, and future research should examine whether psychosocial resources (e.g., stress appraisals, neighborhood social cohesion) can attenuate the association between negative family interactions and mental health for older African Americans.

Effect of 25 hydroxyvitamin D on attention deficit and hyperactivity in school-age children with ADHD.

To observe the serum levels of 25 hydroxyvitamin D [25 (OH) D] in healthy school-age children and children with attention deficit hyperactivity disorder (ADHD) and to analyze the effects of serum 25 (OH) D on the symptoms of attention deficit and hyperactivity in school-age children with ADHD. According to the Diagnostic and Statistical Manual of Mental Disorders DSM-IV diagnostic criteria for ADHD in children, 80 healthy children aged 6 years or less than 10 years old and children diagnosed with ADHD in the Department of Rehabilitation Medicine, Department of Pediatrics and Department of Physical Examination of our hospital were randomly selected as research subjects. The serum 25 (OH) D level, attention deficit hyperactivity (Swanson, Nolan, and Pelham, version IV [SNAP-IV] parental version) score and Conners child behavior (PSQ) index were observed and compared between the 2 groups. In addition, the children with ADHD whose serum 25 (OH) D was lower than normal were treated with supplemental VitD3, and the changes in serum 25 (OH) D, SNAP-IV parental score and PSQ index of ADHD children were observed and compared. Serum 25(OH)D was insufficient or deficient in 26 healthy children, but the SNAP-IV score and PSQ index were normal. Serum 25(OH)D was lower than normal in 69 patients in the ADHD group, which was negatively correlated with SNAP-IV score (r = -0.3479, P = .0034) and negatively correlated with PSQ index (r = -0.3566, P = .0026). After vitamin D3 (VitD3) supplementation in 69 children with serum 25(OH)D levels lower than the normal ADHD group, it was found that the SNAP-IV score (r = -0.4654, P = .0037) and PSQ index (r = -0.5680, P = .0002) of 34 children with ADHD were negatively correlated with the increase in serum 25(OH)D. The SNAP-IV score and PSQ index of the other 35 children with ADHD showed no correlation with the increase in serum 25 (OH) D (P > .05). Serum 25(OH)D levels lower than normal are more common in school-age children, and levels lower than normal are not the key pathogenic factor of ADHD in school-age children, but serum 25(OH)D levels lower than normal may be the upregulation factor of attention deficit and hyperactivity disorder expression in some school-age children with ADHD. The lower level of serum 25(OH)D may be closely related to the severity of ADHD symptoms in some children.

The economic burden of mental disorders: results from the Netherlands mental health survey and incidence study-2.

Currently, there is a paucity of up-to-date estimates of the economic burden caused by mental disorders. Such information could provide vital insight into one of the most serious and costly-yet to some extent preventable-health challenges facing the world today. Data from a national psychiatric-epidemiological cohort study (NEMESIS-2, N = 6506) were used to provide reliable, relevant, and up-to-date cost estimates (in 2019 Euro) regarding healthcare costs, productivity losses, and patient and family costs associated with DSM-IV mental disorders both at individual level, but also in the general population and in the workforce of the Netherlands (per 1 million population). In the general population, the costs of mood disorders, specifically depression, are substantial and rank above those from the anxiety disorders, whilst costs of anxiety disorders are more substantial than those stemming from substance use disorders, even when the per-person costs of drug abuse appear highest of all. In the workforce, specific and social phobias are leading causes of excess costs. The workforce has lower healthcare costs but higher productivity costs than general population. The findings suggest that (preventive) healthcare interventions targeting the workforce are likely to become cost-effective and underscore the importance for employers to create healthy work environments. Overall, the results highlight the need to strengthen the role of mental health promotion and prevention of mental disorders in the social domain before people require treatment to reduce the staggering and costly burden caused by mental disorders to individuals and society.

Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries

Information on the frequency and timing of mental disorder onsets across the lifespan is of fundamental importance for public health planning. Broad, cross-national estimates of this information from coordinated general population surveys were last updated in 2007. We aimed to provide updated and improved estimates of age-of-onset distributions, lifetime prevalence, and morbid risk. In this cross-national analysis, we analysed data from respondents aged 18 years or older to the World Mental Health surveys, a coordinated series of cross-sectional, face-to-face community epidemiological surveys administered between 2001 and 2022. In the surveys, the WHO Composite International Diagnostic Interview, a fully structured psychiatric diagnostic interview, was used to assess age of onset, lifetime prevalence, and morbid risk of 13 DSM-IV mental disorders until age 75 years across surveys by sex. We did not assess ethnicity. The surveys were geographically clustered and weighted to adjust for selection probability, and standard errors of incidence rates and cumulative incidence curves were calculated using the jackknife repeated replications simulation method, taking weighting and geographical clustering of data into account. We included 156 331 respondents from 32 surveys in 29 countries, including 12 low-income and middle-income countries and 17 high-income countries, and including 85 308 (54·5%) female respondents and 71 023 (45·4%) male respondents. The lifetime prevalence of any mental disorder was 28·6% (95% CI 27·9-29·2) for male respondents and 29·8% (29·2-30·3) for female respondents. Morbid risk of any mental disorder by age 75 years was 46·4% (44·9-47·8) for male respondents and 53·1% (51·9-54·3) for female respondents. Conditional probabilities of first onset peaked at approximately age 15 years, with a median age of onset of 19 years (IQR 14-32) for male respondents and 20 years (12-36) for female respondents. The two most prevalent disorders were alcohol use disorder and major depressive disorder for male respondents and major depressive disorder and specific phobia for female respondents. By age 75 years, approximately half the population can expect to develop one or more of the 13 mental disorders considered in this Article. These disorders typically first emerge in childhood, adolescence, or young adulthood. Services should have the capacity to detect and treat common mental disorders promptly and to optimise care that suits people at these crucial parts of the life course. None.

Temporal priority of lifetime alcohol use disorders and comorbid psychiatric disorders in adults: Results from a population-based nationwide survey in Korea

BackgroundDespite the high prevalence of alcohol use disorders (AUDs) in Korea, few studies have been conducted on the temporal priority with comorbid mental disorders. We investigated the temporal priority of lifetime AUDs and comorbid mood and anxiety disorders among the general population of Korea. MethodsData of 18,807 respondents aged 18 years or older, collected from three national epidemiological surveys comprising face-to-face interviews using the Korean version of the Composite International Diagnostic Interview for DSM-IV mental disorders. For each mood or anxiety disorder, the extent to which one mental disorder precedes another was investigated by calculating the proportion of primary AUDs by that of primary mood or anxiety disorder. ResultsRegarding alcohol dependence, dysthymic disorder is 5.6 times more likely to occur before alcohol dependence. Moreover, generalized anxiety disorder, social phobia, and specific phobia are 3.6 times, 4.5 times, and 6.3 times more likely to occur before, respectively. Regarding alcohol abuse, specific phobia is 6.3 times more likely to occur before, whereas major depressive disorder is two times more likely to occur after. Moreover, the lag times between primary alcohol abuse and subsequent mood or anxiety disorders were longer than those between primary alcohol dependence and the latter. LimitationsThe age of onset might be subject to recall bias. The presence of non-respondents could have influenced the results. ConclusionWe need to recognize that one of the mental disorders could lead to another and consider it in the management of people with AUDs or mood and anxiety disorders.

Prevalence and trends of common mental disorders from 2007-2009 to 2019-2022: results from the Netherlands Mental Health Survey and Incidence Studies (NEMESIS), including comparison of prevalence rates before vs. during the COVID-19 pandemic.

Up-to-date information on the prevalence and trends of common mental disorders is relevant to health care policy and planning, owing to the high burden associated with these disorders. In the first wave of the third Netherlands Mental Health Survey and Incidence Study (NEMESIS-3), a nationally representative sample was interviewed face-to-face from November 2019 to March 2022 (6,194 subjects; 1,576 interviewed before and 4,618 during the COVID-19 pandemic; age range: 18-75 years). A slightly modified version of the Composite International Diagnostic Interview 3.0 was used to assess DSM-IV and DSM-5 diagnoses. Trends in 12-month prevalence rates of DSM-IV mental disorders were examined by comparing these rates between NEMESIS-3 and NEMESIS-2 (6,646 subjects; age range: 18-64 years; interviewed from November 2007 to July 2009). Lifetime DSM-5 prevalence estimates in NEMESIS-3 were 28.6% for anxiety disorders, 27.6% for mood disorders, 16.7% for substance use disorders, and 3.6% for attention-deficit/hyperactivity disorder. Over the last 12 months, prevalence rates were 15.2%, 9.8%, 7.1%, and 3.2%, respectively. No differences in 12-month prevalence rates before vs. during the COVID-19 pandemic were found (26.7% pre-pandemic vs. 25.7% during the pandemic), even after controlling for differences in socio-demographic characteristics of the respondents interviewed in these two periods. This was the case for all four disorder categories. From 2007-2009 to 2019-2022, the 12-month prevalence rate of any DSM-IV disorder significantly increased from 17.4% to 26.1%. A stronger increase in prevalence was found for students, younger adults (18-34 years) and city dwellers. These data suggest that the prevalence of mental disorders has increased in the past decade, but this is not explained by the COVID-19 pandemic. The already high mental disorder risk of young adults has particularly further increased in recent years.

Association of maternal exposure to Superstorm Sandy and maternal cannabis use with development of psychopathology among offspring: the Stress in Pregnancy Study.

Early-life adverse experiences can elevate the magnitude of the risk of developmental psychopathology, but the potential synergistic effects of multiple factors have not been well studied. To determine whether prenatal exposures to maternal stress (Superstorm Sandy) and maternal cannabis use synergistically alter the risk of developmental psychopathology. The study included 163 children (53.4% girls), longitudinally tracked (ages 2-5 years) in relation to the effects of two early-life adverse exposures (Superstorm Sandy and maternal cannabis use). Offspring were grouped by exposure status (neither, only maternal cannabis use, only Superstorm Sandy or both). DSM-IV disorders for offspring were derived from structured clinical interviews; caregiver-reported ratings of family stress and social support were also assessed. A total of 40.5% had been exposed to Superstorm Sandy and 24.5% to maternal cannabis use. Offspring exposed to both (n = 13, 8.0%), relative to those exposed to neither, had a 31-fold increased risk of disruptive behavioural disorders (DBDs) and a seven-fold increased risk of anxiety disorders. The synergy index demonstrated that offspring with two exposures had synergistic elevation in risk of DBDs (synergy index, 2.06, P = 0.03) and anxiety disorders (synergy index, 2.60, P = 0.004), compared with the sum of single risks. Offspring with two exposures had the highest parenting stress and lowest social support. Our findings are consistent with the double-hit model suggesting that offspring with multiple early-life adverse exposures (Superstorm Sandy and maternal cannabis use) have synergistically increased risks of mental health problems. Given the increasing frequency of major natural disasters and cannabis use, especially among women under stress, these findings have significant public health implications.

Prevalence and Co-Occurrence of Developmental and Emotional-Behavioral Problems in Young Children.

A limited number of studies have estimated the prevalence of emotional-behavioral disorders among young children. None have assessed their co-occurrence with developmental delays using standardized assessment tools. Our objective was to estimate the prevalence of emotional-behavioral disorders and their co-occurrence with developmental delays among young children (2-5.5 years). Parents of young children (N=987) enrolled from pediatric waiting rooms completed developmental-behavioral screening questionnaires. Based on results, 585 families were invited to and 439 completed evaluations that included structured diagnostic interviews with parents to assess child psychopathology (Preschool Age Psychiatric Assessment (PAPA)), developmental testing with children (including the Bayley Scales of Infant and Toddler Development, third Edition for children ≤ 42 months; Differential Ability Scales, second Edition for older children), and videotaped observation to establish whether autism risk was sufficient to warrant further evaluation. According to PAPA algorithms, 23.0% of children met criteria for a DSM-IV disorder, while 9% qualified for a developmental delay. Presence of delay doubled the odds of having a DSM-IV disorder (OR=2.1; CI: 1.02-4.3), and presence of disorder doubled the odds of having a moderate-to-severe developmental delay (OR=2.0; CI: 1.10-3.50). Prevalence of DSM-IV disorders (48.8% (95% CI: 33.5-64.5%)) and developmental delays (57.5% (95% CI: 41.7-71.9%)) were both higher among children at risk for autism. While developmental delay did not vary by race/ethnicity, prevalence of DSM-IV disorders was lower among African-American/Black (10.6%; CI: 2.9-18.3) and Hispanic/Latino children (11.1%; CI: 4.3-17.9). Developmental delays and emotional-behavioral disorders among young children seen in pediatric settings are characterized by high prevalence and substantial co-occurrence.

Personal Recollections about the Development of Bipolar II Disorder

Background: This paper reviews the development of Bipolar II disorder, defining the development of diagnosis and the current state of the art in treatment. Methods: Through his training and working in psychiatry, the author recounted the early days when Bipolar II disorder was conceptualized and developed as a separate clinical entity at the Department of Psychiatry at Washington University, US National Institute of Mental Health, and New York State Psychiatric Institute/Columbia University. The author also participated in the process leading to the inclusion of Bipolar II in the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) in 1994. In this review, the author presents his recollections how bipolar II disorder came about and entered the diagnostic criteria that we now use in psychiatry. Results: The diagnostic criteria of Bipolar II disorder in DSM-IV and DSM-5 were reviewed. Then, the author stressed the importance of differentiating Bipolar II disorder clinically, how to make the diagnosis of Bipolar II disorder, differentiating mania from hypomania, differentiating hypomania from unipolar depression (i.e., major depressive disorder), and provided useful clinical tips related to ascertaining this diagnosis. Then, he reviewed and raised some issues in treating Bipolar II disorder. The neuroscience-based nomenclatures were given for all drugs used in treating Bipolar II disorder in this review. Conclusion: Bipolar II disorder has come a long way to be accepted as a valid clinical entity. The author believes that more clinical knowledge can further improve the diagnosis and treatment for patients with Bipolar II disorder.

A cross-sectional study to assess the magnitude of depression among young adults at selected higher educational institutions in Tamil Nadu, India: A study protocol.

One in ten young adults aged 20 to 24 years was diagnosed as suffering from DSM-IV disorder with associated impairment. Depression is a major challenge to public health around the world. The main aim of this project is to estimate the burden of depression among young adults and this is the first kind of study in nature that tends to establish a depression prevention resource center for young adults. A descriptive cross-sectional study will be conducted among 6922 young adults. A simple random sampling strategy will be used to obtain the study sample. The semi-structured tool will be used to obtain the result. Descriptive statistics and frequency percentages will be determined for categorical variables. Mean, median, and range will be calculated along with standard deviations (SD) and interquartile range (IQR). Percentage prevalence will be calculated for each categorical variable with a 95% confidence interval (CI). The P-value of <0.05 will be considered as statistically significant. A semi-structured questionnaire was developed and the questionnaires were translated into Tamil (for local relevancy), and back translated into English. Data regarding socio-demographic and mental health-related information, such as coping ability, problem-solving, personal history, academic performance, and treatment history will be collected. The study was authorized by the Institutional Review Board (IRB), School of Public Health, SRMIST, and Institutional Ethics Committee (IEC) in Chengalpattu, Tamil Nadu, with the IEC Protocol Number: P0/2020/10/02. The ethics committee evaluated and rated the methods and tools used to assess depression among young adults.

Mood or energy/activity symptoms in bipolar mania: which are the most informative?

In the DSM-III and the DSM-IV, bipolar disorder (BD) is classified as a mood disorder and diagnosis requires presence of a mood change, i.e., euphoria or irritability. In contrast, DSM-5 states that there must be some increase in energy or motor activity in addition to the mood change. Our aim was to identify which types of symptoms (i.e., mood or energy/activity-related symptoms) are the most informative in a manic episode. Symptoms of manic episodes in 106 outpatients with BD were assessed in a naturalistic study using the Young Mania Rating Scale (YMRS) between November 2002 and November 2015. The scale items were divided into three groups according to clinical criteria: mood, energy/activity, and other. For comparisons between groups, the Samejima graded response model from Item Response Theory (IRT) and the Test Information Function (TIF) were computed. Chi-square tests were used to verify the association between the groups of symptoms by comparing the area under the curve of the TIF results. The information accounted for by energy/activity represents 77% of the proportion of the total TIF; about 23% is related to mood and other groups of symptoms. These proportions are statistically different (χ²[1] = 30.42, p < 0.001). On average, changes in energy/activity tend to be more informative than mood changes during the manic phases of BD.

A COMPARATIVE CLINICAL STUDY OF TAKRADHARA AND SHIRO-ABHYANG WITH YASHTIMADHUADYA TAIL IN THE MANAGEMENT OF CHITTODVEGA (GENERALIZED ANXIETY DISORDER)

In this study the term Chittodvega is compared to Generalized Anxiety Disorder DSM-IV, Can exist as a separate disease or can be etiological factor for other psychic and psychosomatic disorders. The first line of treatment according to Ayurveda is Nidana-Parivarjana, i.e., avoidance of aetiological factors. Also, Charakacharya has described three types of treatments, namely – Daivavyapashraya, Yuktivyapashraya and Sattvavajaya.Shiro-abhyang and takradhara (shirodhara) are classified under Murdha tail and are taken for study in chittodvega (GAD). Acharyas have prescribed MedhyaRasayana treatment (mental health promoting) for the management of mental illnesses. Yashtimadhu (Glycyrrhiza glabra) has been included among the four main MedhyaRasayana drug by Acharya Charaka and used as routine remedy for the management of the mental illness. Acharya Shrushutsays, In Blocking of channels (stroto-avrodh) and vayudushti diseases takra is very useful. Anxiety is a state of heensatva and use of takradhara in anxiety will help to improve the satva of patient. Therefore, Shiro-abhyang with Yashtimadhu oil and takradhara are used for Study.

Differences in the Prevalence and Profile of DSM-IV and DSM-5 Alcohol Use Disorders-Results from the Singapore Mental Health Study 2016.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for alcohol use disorders (AUD) was a significant shift from the historical DSM-IV Text Revised version. Following this shift in diagnostic criteria, a difference in the prevalence of AUD was expected. The current study aimed to evaluate the consequences of the modification of the diagnostic criteria from DSM-IV to DSM-5 AUD using lifetime diagnosis in Singapore's multi-ethnic population using data from a nationwide epidemiological study. Respondents were assessed for lifetime mental disorders using the Composite International Diagnostic Interview (CIDI) administered through face-to-face interviews. Lifetime DSM-IV AUD diagnoses were compared with DSM-5 AUD diagnoses generated by modifying the criteria and the addition of the craving criterion. Sociodemographic correlates of lifetime DSM-IV/DSM-5 AUD were examined using multiple logistic regression analysis. Associations between DSM-IV/DSM-5 AUD, chronic conditions, and the HRQOL summary scores were examined using logistic and linear regression after controlling for significant sociodemographic factors. The lifetime prevalence of DSM-IV AUD was 4.6% (0.5% for dependence and 4.1% for abuse) in the adult population, while the lifetime prevalence of DSM-5 AUD was 2.2%. Younger age, male gender, and lower education were associated with higher odds of both DSM-IV and DSM-5 AUD. However, those who were economically inactive (versus employed) (AOR, 0.4; 95% CI 0.2-0.9) and had a higher monthly household income (SGD 4000-5999 versus below SGD 2000) had lower odds of DSM-IV AUD (AOR, 0.4; 95% CI 0.2-0.7), but this was not observed among those with DSM-5 AUD. Both DSM-IV and DSM-5 AUD were associated with significant comorbidities in terms of other mental disorders; however, those diagnosed with lifetime GAD had significantly higher odds of having DSM-5 AUD (AOR, 5; 95% CI 1.9-13.2) but not DSM-IV AUD. While using the DSM-5 criteria would result in a lower prevalence of AUD in Singapore, it remains a highly comorbid condition associated with a poor health-related quality of life that is largely untreated, which makes it a significant public health concern.

Sleep Complaints Among Adults With Major Depressive Episode Are Associated With Increased Risk of Incident Psychiatric Disorders

Objective: Sleep alterations have been suggested as a cause and consequence of psychiatric disorders. In this context, we evaluated the incidence of psychiatric disorders following sleep complaints in adults with major depressive episode (MDE).Methods: In a large, nationally representative 3-year prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions conducted in 2001-2002 (Wave 1) and 2004-2005 (Wave 2), we used structural equation modeling to examine shared and specific effects of trouble falling asleep, early morning awakening, and hypersomnia on incidence of common comorbid DSM-IV disorders among patients with MDE. The analyses adjusted for sociodemographic and clinical characteristics, including sedative or tranquilizer use.Results: Among participants with MDE at Wave 1, 3-year incidence rates were dysthymia = 2.9%, general anxiety disorder = 8.2%, panic disorder = 3.4%, social anxiety disorder = 4.0%, specific phobia = 3.0%, alcohol use disorder = 8.1%, nicotine dependence = 6.2%, cannabis use disorder = 2.7%, and other drug use disorder = 4.9%. Participants with 3-year incident psychiatric disorders commonly had trouble falling asleep (67.6% for cannabis use disorder to 76.4% for panic disorder), early morning awakening (43.3% for cannabis use disorder to 55.6% for dysthymia), and hypersomnia (51.3% for nicotine use disorder to 72.1% for social anxiety disorder). The effects of the incident general psychopathology factor, representing mechanisms related to incidence of all psychiatric disorders, were exerted almost exclusively through a factor representing shared effect across all sleep complaints. Sleep complaints were associated with increased risk of incident psychiatric disorders, independent of sociodemographic and clinical characteristics.Conclusions: These findings suggest that sleep complaints should be clinically assessed in all psychiatric disorders, as these prodromal symptoms might constitute transdiagnostic biomarkers and therapeutic targets for prevention.