Manual Of Mental Disorders Research Articles

The Use of Battered Woman Syndrome in U.S. Criminal Courts.

Although not recognized by any edition of the Diagnostic and Statistical Manual of Mental Disorders, battered woman syndrome (BWS) has been offered as a defense in U.S. criminal courts for several decades. This article reviews examples of criminal cases in which BWS has been used in the United States as well as the implications of BWS for the practice of forensic psychiatry. Historically raised in cases of self-defense, BWS has also been used in criminal defenses involving duress, as well as by prosecutors to explain witness recantations. Case law suggests that expert witness testimony on BWS is often admissible in jurisdictions across the United States, yet its use in criminal defenses has received mixed responses from various courts. We examine limitations on the use of BWS in criminal courts and the potential use of posttraumatic stress disorder as an alternative and more reliable diagnosis in similar legal contexts.

Mind your language!

Tantrum – What's the fuss? Let's talk about words. Spastic. Retard. Retarded. All terms used in the globally renowned Diagnostic and Statistical Manual of Mental Disorders (DSM) until recently, to describe a neurodivergent person. It is thanks to the former President of America, Barrack Obama (2010), that such terms were replaced – only in 2013. Did the inclusion of these terms in this clinicians' and psychiatrists' handbook make it acceptable?

Progress but no cigar: Comment on Bach and Tracy (2022).

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model of personality disorder (AMPD) introduced innovations that are likely to be enduring features of a scientific classification of personality disorder: (a) an explicit definition of personality disorder, (b) a description of levels of severity, (c) a dimensional model of individual differences, and (d) the important principle that classifications should use and be consistent with the findings of normal personality science. Bach and Tracy's review of evidence of the clinical utility of the alternative model compared with traditional typal diagnoses clearly demonstrates that dimensional classification does not adversely affect clinical utility. Based on this evidence, they propose that the AMPD minus the hybrid component be adopted as the Diagnostic and Statistical Manual of Mental Disorders classification of personality disorder. It is argued that the recommendation is premature because evidence of clinical utility is insufficient in the absence of evidence of construct validity. The rest of the commentary explores the conceptual and methodological problems arising from the way the AMPD's innovative features are translated into a diagnostic classification. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The DSM should replace maladaptive traits with the five-factor model: Comment on Clark and Watson (2022).

In their target article, Watson and Clark made a number of useful suggestions for improving Criterion B of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, alternative model of personality disorders, all of which assume that personality variation will be represented in the next iteration of the Diagnostic and Statistical Manual of Mental Disorders as a maladaptive trait variation diagnostic of personality disorders (PDs). I describe how maladaptive traits are not equivalent to normal-range five-factor model traits in terms of domain structure, range, and stability, and I conclude that rather than making subtle changes to the existing maladaptive trait model for PDs, it would be better to replace it with a genuine five-factor model that could be used to conceptualize all patients, whether or not they are diagnosed with a PD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Opportunities and challenges of new classification systems for personality disorders: Commentary on "clinical utility of the AMPD: A 10th year anniversary review".

At the time of publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model of personality disorders, skepticism regarding the clinical utility of a dimensional conceptualization of personality disorders was high including questions about its feasibility for clinicians, its reliability, predictive value, and implications for science and treatment. Following huge research activities summarized by the article of Bach and Tracy (2022), there is meanwhile convincing evidence that a dimensional classification of personality disorders that meets with high utility for clinical decision-making is accepted by clinicians and meets with patients´ needs because it can be easily connected with treatment planning oriented at functional impairments rather than diagnostic categories. Being close to mechanistic models of psychopathology, the alternative model of personality disorders provides a suitable framework to converge self- and interpersonal dysfunctioning indicated in Criterion A with (sub-)domains of the Research Domain Criteria and Hierarchical Taxonomy of Psychopathology systems and, thus, to inspire research to better understand the psychological and neurobiological mechanisms of change. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sociocultural context and the DSM-5 alternative model of personality disorder: Comment on Widiger and Hines (2022).

Widiger and Hines (2022) provide a brief overview of the development of the alternative model of personality disorder (AMPD) housed within Section 3 of the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013). They highlight 8 issues and controversies related to the AMPD in need of resolution for improvement of both the AMPD model itself as well as the field of personality disorders more broadly. In this brief commentary, I add a 9th issue in need of attention both with respect to the AMPD but also within the field of personality disorders more broadly: (9) How is sociocultural context to be accommodated in AMPD-and more generally personality disorder-theory, research, and treatment? The historical intraindividual, deficit-based models for conceptualizing personality disorders linger in current personality disorder discourse. However, failure to appropriately consider sociocultural context that systematically predisposes wide swaths of the population to unequal access to resources and exposure to psychological stressors, which can impact the appearance of personality pathology, serves to stigmatize minoritized individuals. The personality disorder field, and the AMPD discourse, must appropriately contend with sociocultural context in its models otherwise it risks developing models with limited generalizability and that hold potential to adversely affect sexual and gender minoritized populations, among others. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Depression and Its Associated Factors among Diabetes Mellitus Patients Attending the primary health care centers in United Arab Emirates: A Cross-Sectional Study

Diabetes mellitus (DM) and depression are major global public health problems. Depression negatively affects the course of DM through hormonal, neuronal, or immune system changes that directly affect the body's ability to produce or use insulin. The coexistence of depression with DM also results in poor glycemic control by causing poor self-care behaviors such as lack of physical activity. The coexistence of depression with DM also results in poor glycemic control. The study aimed to assessing depression and Its associated Factors among diabetes mellitus patients attending the primary health care centers in United Arab Emirates. This study was conducted on 463 diabetic patients attended the primary health care centers during 8th may to 26th may, 2021. Nine primary health care centers were selected according to the accessibility. The Patient Health Questionnaire-9 (PHQ-9) was selected of the actual 9 criteria upon which the diagnosis of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) depressive disorders is based. Our study showed that there was non-significant difference in depression Levels between non-smokers and smokers, there was non-significant difference in depression Levels and education levels, there was significant difference in depression Levels and marital status, non-significant difference in depression Levels and nationality, non-significant difference in depression Levels and type of diabetes. Conclusion based on this study the prevalence of depression among female diabetes mellitus was high. From this study we concluded that depression levels: non-depressed, mild depression, moderate depression, moderately and severe depression are high in married participants comparing with single, divorced and widow participants

Adolescents With Non-Suicidal Self-Harm—Who Among Them Has Attempted Suicide?

We aimed to determine differences between adolescents with non-suicidal self-harm with and without a history of suicide attempt (SA). Sixty-eight adolescents with a mean age of 15.6 years (SD = 1.5) attending child and adolescent psychiatric outpatient clinics for repeated self-harm in Oslo, Norway, were included. A battery of instruments was used to assess sociodemographic information and psychopathology such as Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses, emotional and behavioral problems, borderline symptoms, depression, hopelessness, suicidal ideation, and history of SA. Twenty-six participants (38.2%) reported a lifetime history of SA. Compared to the participants without a history of SA, those with an SA history had used a higher number of methods of self-harm and methods with higher lethality and had higher degrees of emotional and behavioral problems. They also scored higher in depressive symptoms, borderline pathology, emotional dysregulation, hopelessness, and suicidal ideation. History of SA was independently associated with perceived moderate to high risk of death on the most severe episode of self-harm (adjusted odds ratio [aOR], 15.93; 95% confidence interval [CI], 1.96–129.66), a longer duration (months) since self-harm debut (aOR, 1.07; 95% CI, 1.01–1.13), and suicidal ideation severity (aOR, 1.05; 95% CI, 1.01–1.11). Parental report of behavioral problems associated with SA suggested a strong association with externalizing problems. A combination of having a high level of psychopathology, externalizing problems, an extended history of self-harm behavior and use of more lethal self-harm methods seems to entail a significantly increased risk for making SAs among adolescents with non-suicidal self-harm. HIGHLIGHTS Non-suicidal self-harm (NSSH) with suicide attempt may be distinctive from NSSH without suicide attempt. Adolescents with NSSH with suicide attempt had relatively greater psychopathology. Protracted/lethal self-harm methods and externalizing problems indicate comorbidity.

Анкета увлеченности компьютерными играми для юношей и взрослых: психометрические характеристики

There has been a discussion about the inclusion of video game disorder in the list of diseases of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) and the upcoming ICD-11 (International Classification of Diseases, 11th revision), however, modern psychology lacks screening tools to distinguish addicts from avid players. The objective of the research is to test our questionnaire determining the types of involvement in video games and the degree of its severity according to certain parameters, such as representativeness, instant reliability (internal consistency), content and construct validity. Thus, the article presents the results constituting the development and primary validation of the questionnaire measuring the involvement of young men and adults in video games. The study hypothesizes that the proposed questionnaire is representative and valid (content and construct validity). In the course of the study, which involved respondents aged 18 to 30 years (N = 124, M = 25.8), the structure of the questionnaire was determined. The factor analysis procedure determined that there are six types of involvement in video games: “Addiction”, “Feeling of Community”, “Emotional Support”, “Immersion”, “Streaming” and “Identification”. The obtained Cronbach's alpha coefficients for all the scales of the questionnaire and the final indicator demonstrated satisfactory consistency of the questionnaire (0.45- 0.83). To check the construct validity, there have been used such tools as the CIAS scale, a test questionnaire of the degree of involvement of younger adolescents in video games (A. V. Grishina) adapted for a more adult sample and the Internet addiction methodology (T. A. Nikitina, A. Yu. Egorov). The obtained correlations confirm the construct validity of the questionnaire. The practical significance of the study lies in the fact that the diagnostic method proposed by us can be used to distinguish addicts from the general array of people who are highly enthusiastic about video games.

Neuroleptic Malignant Syndrome: Typical Antipsychotic Drugs Versus Atypical Antipsychotic Medications

Introduction: Neuroleptic malignant syndrome is an idiosyncratic reaction and a severe disorder caused by an adverse reaction to drugs with dopamine receptor- antagonist properties and is characterized by a tetrad of rigidity, fever, altered mental status, and autonomic instability. In the present assessment, typical or conventional antipsychotics have been contrasted with atypical antipsychotics with respect to recorded cases of neuroleptic malignant syndrome among a sample of nonwestern psychiatric inpatients. Methods: For assessment, all the cases with a diagnosis of neuroleptic malignant syndrome during the last sixty-two months, after exclusion of other conceivable differential diagnoses, were incorporated in the current retrospective, record-based evaluation. The clinical diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. The valuation of independent variables was analyzed by ‘Compression of proportions. Statistical significance is defined as p value ≤0.05. Results: Amongst 19814 psychiatric inpatients, in the course of sixty-two months, eighteen cases received the diagnosis of neuroleptic malignant syndrome. As said by the findings, neuroleptic malignant syndrome was meaningfully more frequent among males, in comparison with females, and it was importantly more prevalent among cases suffering from schizophrenia, in comparison with bipolar disorder. Also, the highest risk of neuroleptic malignant syndrome was found in the age group of 30-39. In the current assessment, only one of the patients, who had received haloperidol, died due to aspiration pneumonia and respiratory failure, and the most prevalent symptom was fever, which was observable in one hundred percent of cases. In addition to a similar clinical profile, ‘Compression of proportions’ did not show any significant difference between the conventional (typical) antipsychotics versus the atypical antipsychotic medications with respect to the occurrence of neuroleptic malignant syndrome. Conclusion: As said by the findings, no significant difference was evident between the typical antipsychotic drugs versus the atypical antipsychotic medications, with respect to incidence and clinical profile of neuroleptic malignant syndrome.

Adult Attention Deficit and Hyperactivity Disorder Symptoms and Internet Addiction in College Students: Prevalence and Differential Associations

<p style="text-align:justify">This paper presents an investigation that aims to: 1) explore the relations between core symptoms of adult Attention Deficit and Hyperactivity Disorder (ADHD) and several typical Internet activities, and 2) compare the predictive power of two core symptoms of ADHD- inattention and hyperactivity/impulsivity- in predicting Internet addiction. Methods: A total of 2016 Chinese college students participated in this study. The ADHD symptoms were assessed using Conners self-rating scales and DSM-5 semi-structured interviews. Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (SCID-5) was used to exclude other psychiatric disorders. Chen’s Internet addiction scale (CIAS) was used to evaluate Internet addiction. Information about Internet activities (e.g., online gaming) was collected through a self-constructed questionnaire. Results: The ratio of Internet addiction problems among individuals with ADHD symptoms is significantly higher than in ordinary individuals (48.9% vs. 14.3%). Further, each core ADHD symptom has unique relations with different types of Internet activities. Specifically, both core ADHD symptoms are negatively associated with information downloading and online learning, and positively associated with online gaming, while online shopping is only associated with hyperactivity/impulsivity. Furthermore, both core ADHD symptoms are significant predictors of Internet addiction, especially inattention. Conclusion: College students with ADHD symptoms are at a higher risk of having Internet addiction than peers without ADHD symptoms. For individuals with ADHD symptoms and excessive online gaming and/or online shopping behaviors, the probability of having Internet addiction is even higher. These findings have important implications for identifying risk factors of Internet addiction and preventing Internet addiction in Higher Education settings.</p>

Pedagogical Strategies for Teaching the DSM

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition presents numerous ethical challenges for social workers. As social work educators, we are tasked with preparing students for clinical social work practice, which includes not only instructing students in the use of the DSM-5, but also emphasizing the importance of pursuing social justice and equity in clinical work. With the most recent revision, the DSM-5 Task Force attempted to improve cultural awareness and sensitivity – efforts that yielded mixed results. This article explores the changes, benefits, and shortcomings of these efforts to address cultural diversity and highlights pedagogical approaches for bringing this knowledge to the MSW classroom. We describe specific teaching strategies that underscore the importance of a strong cultural formulation of client problems and are designed to inspire critical thinking about the process of diagnosing. Social workers are encouraged to adopt these strategies for using the DSM-5 not only to better inform their clinical decision-making but also to better align their clinical practice with social work values and ethics.

Revisiting the Brief Jail Mental Health Screen in a Rural Jail Sample

ABSTRACT The Brief Jail Mental Health Screen (BJMHS) is one of the most popular screening tools used at the time of jail admission to identify adults with current mental health needs. Prior work has documented the accuracy of the screen primarily in large urban or semi-urban correctional facilities according to diagnostic criteria established in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The current study was designed to evaluate the precision of the BJMHS in a smaller rural jail setting according to the current DSM-5 criteria in a sample of 210 adults. Responses from the BJMHS were collected and merged with diagnostic indications gathered from the Comprehensive Addictions and Psychological Evaluation. Mental health conditions were highly prevalent with 80% of participants presenting symptoms. The BJMHS accurately identified less than half (40%) of those with a mental health condition. The high false-negative rate of the BJMHS left many adults in need of services without the necessary diagnostic evaluation. Recommendations are provided to help increase the accuracy needed to correctly identify these needs in rural jail populations, which represent those incarcerated in most local detention centers in the U.S.

"High sensitivity and specificity screening for clinically significant intimate partner violence": Correction.

Reports an error in "High sensitivity and specificity screening for clinically significant intimate partner violence" by Richard E. Heyman, Katherine J. W. Baucom, Shu Xu, Amy M. Smith Slep, Jeffery D. Snarr, Heather M. Foran, Michael F. Lorber, Alexandra K. Wojda and David J. Linkh (Journal of Family Psychology, 2021[Feb], Vol 35[1], 80-91). In the article, the affiliation of Heather M. Foran was incorrectly listed as "Family Translational Research Group, New York University." Her correct affiliation is "Institute for Psychology, University of Klagenfurt, and Institute for Psychology, University of Braunschweig." In addition, there were two errors in Table 3 whereby the last row of column 1 should have been labeled "Any of the two items" rather than "Both items," and the final subheading should have read "Female → Male psychological CS-IPV (Male report)a " rather than "Male → Female psychological CS-IPV (Male report)a." Finally, in the Supplemental Material, the second item of the "Screener for Clinically Significant IPV-Psychological" questionnaire should have been deleted. The online version of this article has been corrected. (The following abstract of the original article appeared in record 2020-51524-001). The U.S. Preventive Services Task Force has recommended that clinicians screen patients for intimate partner violence (IPV). This article aims to develop and test the first screeners for clinically significant physical and psychological IPV (i.e., acts meeting criteria in the International Classification of Diseases (11th ed.; ICD-11; World Health Organization, 2019) and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). The goal was to derive screeners that (1) are maximally brief, while still achieving high sensitivity and specificity; (2) assess perpetration and victimization when either men or women are reporting; and (3) use ICD-11/DSM-5 criteria as the reference standard. Random samples of active duty service members at 82 installations worldwide were obtained via e-mail invitation (2006: N = 54,543; 2008: N = 48,909); their response rates were excellent for long general population surveys with no payment (2006: 44.7%, 2008: 49.0%). The population of spouses at the participating installation was invited by mailed postcard (2006: N = 19,722; 2008: N = 12,127; response rates-2006: 12.3%, 2008: 10.8%). Clinically significant physical intimate partner violence can be effectively screened with as few as four items, with sensitivities > 90% and specificities > 95%; clinically significant psychological intimate partner violence can be screened with two items. Men and women can be screened with equivalent accuracy, as can those committing the violence and those victimized by it. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Management of older and senile patients with a high risk of delirium when providing inpatient care. Clinical protocol

Delirium is an acute, life-threatening condition manifested by disturbance in consciousness, attention and cognition, which has a multifactorial genesis, severe consequences and commonly seen in older and senile people inpatient. Clinical experience in domestic practice shows that delirium diagnosis in older and senile patients is often missed, and its signs may be considered as manifestations of other diseases, while the state of delirium is often perceived only as an alcohol withdrawal. The article presents a clinical protocol developed and based on the firsthand experience and modern ideas by a multidisciplinary team of the Russian Gerontology Research and Clinical Centre, in which the delirium in older and senile people is considered as a geriatric syndrome. The article shows the latest diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the main diagnostic tools are given — Confusion assessment method (CAM), diagnostic and differential diagnostic algorithms; clinical subtypes, management tactics, non-drug and drug approaches to treatment, as well as principles for the prevention of geriatric delirium are described.

Prevalence, Factor Structure and Correlates of DSM-5-TR Criteria for Prolonged Grief Disorder.

BackgroundProlonged Grief Disorder (PGD) is now included in Section II of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR). To understand the health burden and then allocate economic and professional resources, it is necessary to provide epidemiological data for this new disorder. This is especially relevant since the new diagnostic criteria differ from its predecessors, which may affect the generalizability of previous findings. More information on the characteristics of people suffering from PGD is also beneficial to better identify individuals at risk. This study, therefore, aimed to estimate the prevalence of the new PGD criteria in a representative population-based sample, evaluate the factor structure, sociodemographic, and loss-related correlates of PGD caseness and explore possible predictors.MethodsOut of a representative sample of the German general population (N = 2,531), n = 1,371 (54.2%) reported to have experienced a significant loss throughout lifetime. Participants provided sociodemographic data and loss-related characteristics. PGD symptoms were measured using items from the German versions of the Prolonged Grief Scale (PG-13) and the Inventory of Complicated Grief (ICG), which could be matched to the DSM-5-TR criteria for PGD.ResultsThe conditional prevalence of PGD was 3.4% (n = 47). The most frequently reported symptoms were intense emotional pain and intense yearning or longing for the deceased. The confirmatory factor analysis confirmed a unidimensional model of PGD. Regression analysis demonstrated that time since the death, the relationship to the deceased, and unpreparedness for the death were significant predictors of PGD.ConclusionAlthough the prevalence of 3.4% using the new diagnostic criteria is lower than the prevalence previously suggested by a meta-analysis, PGD remains a substantial disorder in the general population. In particular, the loss of a partner or child increases the risk for PGD, as does unpreparedness for the death of a loved one. Clinicians should pay particular attention to these high-risk groups. Further clinical implications are discussed.

Disrupted Causal Connectivity Anchored on the Right Anterior Insula in Drug-Naive First-Episode Patients With Depressive Disorder.

ObjectMajor depressive disorder (MDD) has been demonstrated to be associated with abnormalities in neural networks. However, few studies examined information flow in the salience network (SN). This study examined abnormalities in the causal connectivity between the SN and whole brain in drug-naive first-episode patients with MDD in the resting state.MethodsBased on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria, 23 drug-naive first-episode MDD patients and 20 matched healthy individuals were recruited and underwent a resting-state magnetic resonance scan. The acquired functional image data were preprocessed using resting-state functional magnetic resonance imaging (rs-fMRI) data analysis toolkit plus (RESTplus). Then, using the data processing & analysis for brain imaging (DPABI) software and a coefficient-based general component analysis method with the right anterior insula (rAI) as the region of interest (ROI), the causal connectivity of the SN with the whole brain and its correlation with cognitive and mental performance were examined in the resting state.Results(1) The MDD group showed a significantly higher Hamilton Depression Rating Scale total score and significantly higher scores for anxiety, cognitive disturbance, and block factors compared with normal controls. (2) Compared with control: from whole brain to the rAI, the MDD group showed a lower causal connectivity in the left inferior frontal gyrus; from the rAI to the whole brain, the MDD group showed a lower causal connectivity in the right cingulate gyrus, the right precuneus, and extending to paracentral lobule but higher causal connectivity in the left inferior and middle frontal gyrus. (3) In the MDD group, from rAI to the whole brain, the causal connectivity values for the right cingulate gyrus/precuneus were negatively correlated with the score of Stroop Color-Word Test A, B, and C as well as interference times.ConclusionOur results indicated disrupted causal connectivity among the default mode network (DMN), the central executive network (CEN), and SN in drug-naive first-episode MDD patients. Especially, our results suggest a unique role for rAI in the ordered or hierarchical information processing, presumed to include bottom-up and top-down reciprocal influences among the three networks in MDD.

Symptoms of post-traumatic stress and associations with sexual behaviour and PrEP preferences among young people in South Africa, Uganda and Zimbabwe

BackgroundIt is not known whether post-traumatic stress disorder (PTSD) increases HIV-risk behaviours among young people in sub-Saharan Africa. We assessed associations of PTSD symptoms with sexual behaviour, HIV risk perception, and attitudes towards PrEP among young people taking part in the CHAPS community survey. We hypothesised that PTSD symptoms would increase sexual behaviours associated with HIV risk, hinder PrEP uptake and influence preference for daily versus on-demand PrEP.MethodsYoung people without HIV, aged 13–24 years, were purposively recruited in Johannesburg and Cape Town in South Africa, Wakiso in Uganda, and Chitungwiza in Zimbabwe, and surveyed on socio-demographic characteristics, PrEP knowledge and attitudes, sexual behaviour, HIV perception and salience, and mental health. PTSD symptoms were measured using the Primary Care PTSD Screen for the Diagnostic and Statistical Manual of Mental Disorders 5 (PC-PTSD-5). Logistic and ordinal logistic regression was used to assess associations between PC-PTSD-5 score and socio-demographic characteristics, sexual behaviour, HIV risk perception, PrEP attitudes, and substance use, adjusting for age, sex, setting, depression and anxiety.ResultsOf 1330 young people (51% male, median age 19 years), 522 (39%) reported at least one PTSD symptom. There was strong evidence that having a higher PC-PTSD-5 score was associated with reported forced sex (OR 3.18, 95%CI: 2.05–4.93), self-perception as a person who takes risks (OR 1.12, 95%CI: 1.04–1.20), and increased frequency of thinking about risk of HIV acquisition (OR 1.16, 95%CI: 1.08–1.25). PTSD symptoms were not associated with willingness to take PrEP, preference for on-demand versus daily PrEP, or actual HIV risk behaviour such as condomless sex.ConclusionsSymptoms consistent with probable PTSD were common among young people in South Africa, Uganda and Zimbabwe but did not impact PrEP attitudes or PrEP preferences. Evaluation for PTSD might form part of a general assessment in sexual and reproductive health services in these countries. More work is needed to understand the impact of PTSD on HIV-risk behaviour, forced sex and response to preventive strategies including PrEP.

The Development and Treatment of Conduct Disorder: A Hypothetical Applied Behavior Analytic Perspective

This paper discusses conduct disorder-312.8x (F91.x) as a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Axis 1 condition from an applied behavior analytic perspective. It explores the definition, development, causes, consequences, and coexisting conditions of conduct disorder. The paper also reviews a theoretical intervention treatment approach that utilizes parent management training (PMT) to support the view that if conduct disorder is diagnosed early, the child can live a “normal” life, especially with appropriate parental training and support. This intervention utilizes an applied behavior analytic perspective to provide training that targets socially unacceptable behavior, parent buy-in, and parental willingness to learn and use parent management training.

TRICHOTILLOMANIA WITH GIANT GASTRIC TRICHOBEZOAR IN A FEMALE CHILD: A CASE REPORT

Trichotillomania is defined by the Diagnostics and Statistic Manual of Mental Disorders (DSM-5) as an individual repetitively pulling of their own hair, which may be an unconscious action or intentional. The disease is considered one of the anxiety disorders as it has some obsessive-compulsive features. Many patients with this disorder go to a dermatologist for the first time with a complaint of hair loss (alopecia), and many of them deny the self-pulling behaviour. In rare circumstances, this psychological problem may coexist with a complication called gastric trichobezoar, like in this unusual case presentation, which is an accumulation of the patient’s hair in their stomach. It can be huge, presenting as a ‘tail’ extending into the duodenum and leading to what is referred to in the literature as ‘Rapunzel syndrome’. Gastric trichobezoars are most often seen in teenage females. Trichophagia has only been previously confirmed in one-third of these patients, but this is usually a late presentation, occurring after much hair eating for many years.