Expression Of Mental Disorders Research Articles

Why All of Medicine Should Care About <emph type="ital">DSM-5</emph>

THE FIFTH EDITION OF DIAGNOSTIC AND STATISTICAL Manual of Mental Disorders (DSM-5) is scheduled for publication in 2013. Although psychiatrists and other mental health care professionals have a high level of interest in this forthcoming edition, other health care professionals should also be interested in the development of DSM-5. For instance, in primary care settings, approximately 30% to 50% of patients have prominent mental health symptoms or identifiable mental disorders, which have significant adverse consequences if left untreated. Even in surgical specialties, many presurgical and postsurgical developments are associated with significant mental health issues. This Commentary is intended to discuss several major goals of the DSM-5 process, which include facilitating further integration of psychiatry into the mainstream of medical practice, facilitating the clinical feasibility of addressing the diagnostic challenges posed by mental disorders in general medical settings, and emphasizing the importance of attending to patients with mental disorders regardless of the clinician’s medical specialty. Given the public health importance of mental disorders and their significant contribution to the global burden of disease, the DSM-5 revision process will continue to receive a great deal of attention. In 1999, when the development of DSM-5 began, an overriding concern was how best to address a range of issues that had emerged over the previous 20 to 25 years. Such concerns included the potential for adding dimensional assessments to disorders, exploring the option of separating diagnoses from their associated disabilities, examining the expressions of all disorders across the entire life span, and the need to address differences in mental disorder expression as conditioned by gender and cultural characteristics. Advances in neuroscience presented further opportunities to evaluate the readiness of findings in pathophysiology, genetics, pharmacogenomics, structural and functional imaging, cross-cultural psychiatry, and neuropsychology to influence the development of DSM-5. These areas of concern were summarized in a group of white papers published as A Research Agenda for the DSM-V. A second volume of white papers, Age and Gender Considerations in Psychiatric Diagnosis: A Research Agenda for DSM-V, was subsequently commissioned by the American Psychiatric Association to address developmental psychopathology issues in greater detail across the life span (including very young children and geriatric age groups), as well as gender-related differences in the occurrence and expression of mental disorders. From these volumes emerged a clear set of priorities for DSM-5, including addressing the consequences of continuing to use (1) the hierarchical “pure” diagnostic categories reified through the Feighner criteria, research diagnostic criteria, and the DSM-III; (2) the high rates of co-occurring diagnoses identified by these criteria in individuals with at least 1 mental disorder; (3) the frequent use of the not otherwise specified designations for patients who did not fit any of the criteria; and (4) the heterogeneous mix of conditions within current diagnostic boundaries. Subsequently, some important questions that should be emphasized during the forthcoming stages of revision include the following. How can the clinical assessments of mental disorders be improved? In many ways, the categorical system of DSM-IV does not reflect the clinical realities of the patients seen by clinicians on a daily basis. Patients often present with symptoms not included in the diagnostic criteria of their primary diagnosis. For example, patients with schizophrenia often have problems with sleep, and patients with major depression often have significant symptoms of anxiety. Further, methods to assess symptom and disorder severity are poorly specified in DSM-IV, a particular problem for quantifying response to treatment and a hindrance to the application of evidence-based medicine. The developers of DSM-5 are examining potential opportunities to incorporate new assessments into routine clinical practice through the use of simple measures of common cross-cutting symptoms, as well as disorder-specific severity ratings that are responsive to change in clinical status over time.

Environmental Regulation Of The Neural Epigenome

There are numerous examples of enduring effects of early experience on gene transcription and neural function. We review the emerging evidence for epigenetics as a candidate mechanism for such effects. There is now evidence that intracellular signals activated by environmental events can directly modify the epigenetic state of the genome, including CpG methylation, histone modifications and microRNAs. We suggest that this process reflects an activity-dependent epigenetic plasticity at the level of the genome, comparable with that observed at the synapse. This epigenetic plasticity mediates neuronal differentiation and phenotypic plasticity, including that associated with learning and memory. Altered epigenetic states are also associated with the risk for and expression of mental disorders. In a broader context, these studies define a biological basis for the interplay between environmental signals and the genome in the regulation of individual differences in behavior, cognition and physiology, as well as the risk for psychopathology.

The Conceptual Development of DSM-V

The Conceptual Development of DSM-V

Diagnostic, Symptom, and Functional Assessments of Hispanic Outpatients in Community Mental Health Practice

With increased US Hispanic diversity come diagnostic challenges associated with culture, language, and expression of mental disorders. In a community-based clinic, we compared diagnostic agreement between Hispanic and non-Hispanic clinicians, and a structured diagnostic instrument, in live and videotaped interviews with Hispanic adults. Percentage agreement and kappas show low diagnostic reliability between clinicians, and between clinicians and instrument. Significant differences appeared in rates of various diagnoses. Non-Hispanic clinicians rated patients' functional capacity and symptom-severity as significantly worse than Hispanic clinicians. Findings match past research with Hispanic patients and raise questions about diagnostic reliability in multi-cultural community mental health practice.

Role of Epigenetics in Mental Disorders

The purpose of this paper was to selectively review the literature on the role of epigenetics in mental illnesses. Aberrant epigenetic regulation has been clearly implicated in the aetiology of some human illnesses. In recent years a growing body of evidence has highlighted the possibility that epigenetics may also play a key role in the origins and expression of mental disorders. Epigenetic phenomena may help explain some of the complexity of mental illnesses and provide a basis for discovering novel pharmacological targets to treat these disorders.

Life events and life satisfaction in Nigerian patients with undifferentiated somatoform disorder and a non clinical population

Background: Expression of mental disorder through physical symptoms is a common clincial presentation in Nigeria. Objective: To compare life events and life satisfaction in Nigerians with undifferentiated somataform disorder and normal subjects. Method: Ninety one patients with undifferentiated somatoform disorder and 67 normal community dwelling subjects were assessed with the Social Readjustment Rating Scale (SRRS), Stress Quiz (SQ), and Life Satisfaction Scale (LS). Results: There was no statistically significant difference between the SRRS scores of the patients and normal subjects; however, patients scored significantly higher than the normal subjects on the Stress Quiz. Conclusion: In a Receiver Operating Characteristic analysis, the most distinguishing factor between patients and subjects was life satisfaction, with the latter having much higher life satisfaction . Keywords : Undifferentiated somatoform disorder, life events, life satisfaction, Nigeria. Nigerian Medical Journal Vol. 48 (1) 2007: pp. 9-13

1997 IPA/Bayer Research Awards in Psychogeriatrics. The wish to die in very old persons near the end of life: a psychiatric problem? Results from the Berlin Aging Study.

The wish to die in elderly persons is currently under debate. Experts are questioning whether it is natural for these individuals to show a wish to die, whether the right to eventually kill oneself should be respected, or whether suicidal intentions in old age are expressions of mental disorders that need intensive, professional care. A representative community sample of 516 persons aged 70 to 105 was extensively investigated by psychiatrists using the structured interview Geriatric Mental State Examination-Version A (GMS-A) and several self-rating and observer-rating scales. Diagnoses were made according to DSM-III-R criteria and by clinical judgment. The goal of the study was to find examples of "pathology-free wishes to kill oneself." A total of 115 out of 516 very old (70 to 105 years) persons, which represents 21.1% of the community population, said at the time of investigation that they wanted to die or felt life was not worth living (Hamilton Depression Rating Scale [HAMD] score 1, 2, or 3). Forty-three very old persons (6% of the community population) had the wish to be dead according to the HAMD or the GMS-A, and 11 persons (2% of the community population) had suicidal intentions. Depending on the intensity of suicidality, 80% to 100% were clinically diagnosed as having psychiatric disorders and half to three quarters showed symptoms fulfilling the criteria of at least one specified psychiatric diagnosis. Acute suicidal intentions were in all cases associated with at least one specified diagnosis according to DSM-III-R. Thirteen persons out of 54 who actually wanted to die (GMS-A category 4, 5, 6 or HAMD category 2, 3) did not fulfill criteria for specified diagnoses. Seven individuals showed scores in self-rating and observer-rating scales that speak for mental disorders apart from pure suicidality. Six remaining persons are described in greater detail in short case vignettes. They showed either mild but chronic psychiatric disorders, fluctuating courses, or an atypical phenomenology of psychiatric disorders. The results of this study strongly suggest that the wish to be dead in the very old is most probable, and suicidal intentions are definitely associated with psychiatric disorders.

The Effects of Dwelling Density on Mental Disorders in Filipino Men

Much concern has been voiced for the effects of overpopulation on the patterns and quality of contemporary life. However, little has been written or noted about the effects of overpopulation upon the development and expression of mental disorders. Through factor analysis of a symptom checklist administered to urban male Filipinos, three distinct symptom patterns are identified as being strongly associated with the number of people in the dwelling. One pattern is characterized by psychosomatic difficulties and alienation anxiety, another by arousal and withdrawal behaviors, and the third by anxiety and eruptive violence. Interpretations of the development of these patterns are offered and the importance of this type of research cited.

Cross-cultural analysis of selected emotional questions from the Cornell Medical Index.

When considering the problems of the cross cultural applicability of mental health questionnaires, the influence of cultural factors on the results is of central importance. Zola (1966) has suggested that there are at least two ways in which symptoms usually defined as indicating illness in one popula tion may be ignored in others. First, the estimate of the prevalence of a condition may be misleading, for if the corresponding symptoms are common within the population, they might not be considered symptomatic of any illnesses. Secondly, the form taken by the illness may depend on the dominant value-orientations of the culture. Hunt (1959) has concluded that 'studies provide evidence of extensive cultural variability in the expression of mental disorder'. The cultural relativity and dependence on the values of the society may greatly affect the measurement and definition of mental illness in different societies (Wittkower and Fried, 1958; Opler, 1959; Hakanson, 1968). These selective contextual processes, and not aetiological ones, account for many epidemiological differences in the prevalance of mental disorders between societies and subgroups within a society. This has led Zubin and Kietzman (1966) to distinguish culture-depen dent and culture-free aspects of mental disorders. The cultural influences can be seen clearly in studies in which ethnic origin has been found to be highly related to the perception and interpretation of symptoms, to the corresponding reaction, and to the content of disorder (Zborowski, 1952 and 1969; Opler and Singer, 1956; Zola, 1966). The cultural dependence of mental disorders restricts the applic ability of universal measurement methods in many cultures. The problem of validity in comparing field studies of mental disorder has proved to be difficult (Dohrenwend and Dohrenwend, 1965).

Psychiatric outpatients in America and the Netherlands: A transcultural comparison

Following a discussion of the methological problems encountered in transcultural research, a systematic comparison of psychiatric patients seen in selected outpatient faoilities in the Netherlands and the United States was undertaken. The purpose of the study was to learn about differences in utilization of the clinics, as well as differences in symptomatology and functioning of the two populations. The American clinics were found to see proportionately fewer male, and fewer older patients, than the Dutch clinics. While American clinics appear to see more than ten times as many patients diagnosed as schizophrenic than do the Dutch clinics, comparisons of symptoms suggest that these differences are due mainly to varying diagnostic habits. It is likely that the higher proportion of cases diagnosed as suffering from hysterical symptoms among Dutch cases also reflect differences in diagnostic habits. Cultural differences in symptom choice were apparent. Depressed Dutch patients more often than American patients showed apathy, guilt feelings and psychomotor retardation, among American patients depression appeared to lead more often to more “violent” symptoms such as agitation or suicidal ideation. Complaints about feelings of inadequacy were marked more among Americans than Dutch patients, and more among younger American men than women. Americans more often than Dutch patients feel lonely and complain about social isolation. Among both clinic populations impairment of functioning at work, marital and social adjustment, were related to extent of psychopathology as measured in terms of selected symptoms of schizophrenia and depression. In both countries patients from the lower socio-economic strata and those unmarried, were unemployed more often than those with higher social status and those married. The data suggest, but because of the relatively small number of cases do not prove, that in the Netherland clinic population level of education is a less important factor in unemployment than in the United States, in contrast symptoms of schizophrenia are associated to a more marked degree with unemployment in the Netherland than in the USA cohort. The data presented in this paper must be considered as suggestive rather than conclusive. Differences in reported symptoms and functioning to an unknown degree may reflect observer bias, or cultural differences in what patients will complain about. For many reasons one cannot generalize from the data reported here about differences in types of mental disorder between countries, among other because there always is the possibility that the observed difference to a more or less large extent reflects differences in referral and admission policies. Because of the importance of the study of the impact of social factors on the prevalence and mode of expression of mental disorders it is hoped that systematic comparison between countries will be forthcoming in the not too distant future.