Signs Of Mental Disorders Research Articles

The Underestimated Role of the Sports Psychiatrist in Athletic Performance Restoration, Maintenance, and Enhancement in Sports

ABSTRACTIn competitive and elite sports, mental health and athletic performance cannot be considered separately. Mental disorders in sports are bidirectionally associated with reduced athletic performance. A decline in performance, both within and outside of sport, can be a sign of mental disorder. Additionally, poor athletic performance is a potential risk factor for mental disorders in athletes. The central role sports psychiatrists play in the mental health of athletes is well‐established. However, their role in athletic performance is less well‐described and more controversial, perhaps due to a perception that performance is purely a secondary outcome of good mental health. This paper discusses the role that sports psychiatrists can play in athletic performance within competitive and elite sports. Performance can be distinguished into three key focus areas for sports psychiatrists: (i) performance restoration, (ii) performance maintenance, and (iii) performance enhancement. These should be considered throughout the continuum of mental health care, from prevention, treatment, to ongoing care for mental disorders. When reduced performance is due to a mental disorder, psychiatric treatment should purposefully aim to restore functioning and performance as part of management. Maintenance of performance is, similarly, an important element of the prevention, psychiatric treatment, and ongoing care of mental disorders. Holistic sports psychiatrists may also choose to aim for athletic performance enhancement beyond the context of mental health symptoms and disorders, to help athletes flourish and achieve their goals.

Physical healthcare gap among patients with severe mental illness through the COVID-19 pandemic. Preliminary results from a real-world investigation in Lombardy, Italy

IntroductionPatients suffering from mental disorders tend to be less adherent to the recommended therapies. Moreover, the COVID-19 pandemic had a global impact on physical and social well-being, which turned out stronger in the most fragile patients, like those with a mental condition.ObjectivesTo assess whether the COVID-19 pandemic influenced the physical healthcare gap between patients with and without severe mental illness (SMI) treated for chronic conditions.MethodsData were retrieved from Healthcare Utilization Databases of Lombardy region (Italy). Prevalent users of antihypertensive drugs, statins or antidiabetic drugs, receiving healthcare in Lombardy during 2020, were identified. Among them, those with a previous diagnosis of schizophrenic or bipolar disorder were selected and matched with up to 3 patients without any sign of mental disorder by sex, age and number of contacts with the NHS during the previous year. 3 cohorts (not necessarily independent) were formed.High adherence to specific recommended drug therapies and discontinuation during 2020 were evaluated.Association between presence of SMI and high adherence was evaluated by using a log-binomial model (risk ratios, RR with 95% CI); a Cox model (hazard ratios, HR) was used for discontinuation.As comparison, same analyses were performed to the cohorts of prevalent users in 2019, to evaluate the impact of the COVID-19 pandemic. Results were stratified according to the type of mental disorder.Results36'436, 14'136 and 12'597 prevalent users of antihypertensives, statins or antidiabetics respectively were identified, of which 25% with SMI (9'109, 3'536 and 3'152 respectively).During the pandemic period, for all the three cohorts, patients with mental illness had 10% lower probability of being adherent to the recommended drug therapies.The association between SMI and discontinuation was significant and varied among the three cohorts, with HR (95% CI): 1.27 (1.21; 1.33) for antihypertensives users, 1.16 (1.07; 1.26) for antidiabetics users and 1.08 (1.01; 1.16) for statins users.Compared with 2019 the gap remained similar, except for discontinuation of antidiabetics, where the gap diminished from 34% in 2019 to 16% in 2020.No differences between the two mental disorders were found.ConclusionsResults show that suffering from a mental disorder in people with chronic physical conditions affects their adherence to recommended drug therapies. During the pandemic period, the restrictive measures adopted may have led to a better care by family members, counteracting any increase in the gap.The healthcare gap in patients suffering from mental illness remains an unsolved problem of primary importance for public health.Disclosure of InterestNone Declared

Mental disorders in internally displaced persons: clinical features, therapy, prevention

IntroductionMilitary aggression significantly worsens the mental health of the population due to losses: human, economic-financial, social-psychological, ecological. One of the negative consequences of military aggression is migration, the movement of the population within the country and outside its borders, which disrupts adaptation and leads to the formation of a wide range of psychological and mental disorders.ObjectivesTo study the state of mental health of internally displaced persons (IDPs) and to develop, on this basis, a system of therapy and prevention of mental disorders.MethodsA combination of clinical-psychopathological and psychodiagnostics methods of studying were used to identify peculiarities of the mental state and various forms of mental pathology.Results270 IDPs were examined. It was established that the group of IDPs is heterogeneous and includes 3 categories: 1 group of IDPs who do not have signs of mental disorders (conditionally healthy) (34.81%), 2 group of IDPs who have separate symptoms of mental disorders (risk group) (25.19 %) and the 3 group of IDPs with established mental disorders (40.00 %). The assessment of the general condition of the IDPs of the 1 group shows that they have various somato-neurological disorders and the absence of mental disorders. The assessment of the emotional state of the IDPs of the 2 group indicates the presence of various emotional disorders that include asthenic syndrome (41.18 ± 5.97) %, agripnic syndrome (45.59 ± 6.04) %, somato-vegetative syndrom (30.88 ± 5.60) %, anxiety-depressive syndrome (20.59 ± 4.90) %). That separate syndromеs do not meet the criteria of ICD-10 and were subthreshold. The general features of mental disorders in group 3 IDPs are characterized by the predominance of disorders of the anxiety-depressive spectrum and includes adjustment disorders (F43.2) in 35,18%; post-traumatic stress disorder (F43.1) in 17.59%; a moderate depressive episode (F32.1) in 16, 67%; organic affective (depressive) disorder (F06.3) in 14.81%; organic anxiety disorder (F06.4) in 9.28%; recurrent depressive disorder (33.1) in 6.48%.ConclusionsA system of treatment of mental disorders in IDPs has been developed, which includes pharmacotherapy (the usage of antidepressants, anxiolytics and, if necessary, antipsychotics), cognitive-behavioral and family psychotherapy. For prevention mental disorders among IDPs of groups 1 and 2, a psychoeducational program was created, aimed at forming awareness of clinical manifestations of mental disorders, opportunities to prevent their formation, and necessary actions in conditions of exacerbation of the mental state. Evaluation of the effectiveness of the developed system of therapy and psychoeducation has testified to their effectiveness.Disclosure of InterestNone Declared

An Experiment Using a Sexual Strategies Explanation to Alleviate Internalized Homophobia Among Men Who Have Sex With Men in China.

Some men who have sex with men (MSM) having more casual sex and sexual partners is interpreted to be a sign of mental disorder and used to justify negative attitudes toward them by some. MSM may internalize this attitude causing internalized homophobia (IH). According to the sexual strategies theory, MSM having more casual sex is the result of differences between men's and women's sexual strategies and is unrelated to sexual orientation. We investigated whether this explanation would reduce IH and improve mental health in MSM. We recruited 255 Chinese MSM online using Wenjuanxing, Douban, Weibo, Tieba, and Blued and divided them using simple randomization into an experimental group (n = 77; sexual strategies explanation provided), an active control group (n = 99; minority stress explanation provided), and a control group (n = 79; no intervention) with pretest (N = 255); a 1 week post-test (n = 195); and a 1 month follow-up test (n = 170) of outcome measures. IH, mental distress (MD), sort-term mating orientation, and risky sexual behaviors were measured online. The data were analyzed by SPSS 28. IH was associated with MD while being married was associated with IH and sexual contact with women with both more IH and MD as were not being masculine and self-identifying as straight. The sexual strategies explanation reduced IH related to pathologizing sexual behaviors and high-risk sexual behaviors while the minority stress explanation reduced MD. Providing a sexual strategies explanation may be used to de-stigmatize casual sex among MSM.

Life-time anxiety disorders in patients with late-onset psychosis

BACKGROUND. Anxiety disorders are frequently observed in patients with schizophrenia. Meanwhile lifetime frequency of these disorders in late-onset schizophrenia remains unknown.
 AIM. The aim of the study was to investigate frequency of anxiety disorders in patients with late-onset psychosis.
 MATERIAL AND METHODS. 85 patients with late-manifesting psychoses (after 40 years) aged 45 to 86 years (average age 66.5=9.5 years) were examined. Patients with late schizophrenia (n=42), late schizoaffective disorder (n=12), late chronic delusional disorder (n=15), organic schizoform psychosis (n=8), recurrent depression with psychotic symptoms (n=8) underwent psychiatric examination (PANSS, HDRS-17, MMSE, MoCA) and standard interviews. The diagnosis was carried out according to the criteria of the International Classification of Diseases of the 10th revision. The control group included 24 people over 45 years old without signs of mental disorders (average age 57.68.8 years). Statistical analysis included nonparametric criteria.
 RESULTS. Results. Patients with late schizophrenia were distinguished by certain premorbid features in the form of an increased frequency of social phobia, more animal phobias and multiple polysymptomatic habitual anxiety reactions. Patients with late schizoaffective disorder were characterized by a tendency to hypochondriac fears and multiple polysymptomatic habitual anxiety reactions. Patients with late delusional disorder were characterized by an increased frequency of animal phobias. Patients with late mental depression are characterized by the presence of multiple undeveloped anxiety reactions and hypochondriac fears. Patients with endomorphic organic psychoses were distinguished by a low frequency of hypochondriacal fears in the anamnesis.
 CONCLUSION. High frequency of anxiety disorders in patients with late-onset schizophrenia was detected. This data could improve diagnostics of late-onset psychosis.

Early detection of mental disorder signs using photoplethysmogram : A review

Mental disorder is defined as psychological disorders that involve instabilities in brain function. This paper aims to provide an overview of photoplethysmogram (PPG) for detecting early symptoms of mental disorders encompassing physiology using different stimuli. This paper discusses mental disorder studies that have been highlighted in the previous literature. The contribution of the PPG is summarized through feature extraction and its accuracy classified using machine learning. Moreover, research challenges and recommendations in the field are discussed. In conclusion, there were significant changes against the early signs of mental disorders through emotional and stress levels from PPG signal morphology.

Assessing the physical healthcare gap among patients with severe mental illness: large real-world investigation from Italy

Background One critical barrier to the uptake of mental health programmes is the so-called physical healthcare gap, a concern raised by the unattended physical comorbidity and early mortality of persons with severe mental illness. Aims To evaluate the extension of physical healthcare gap among persons with severe mental illness under chronic drug therapies. Method A population-based cohort study was carried out, using Lombardy healthcare utilisation databases. Prevalent patients treated with blood pressure-, lipid- or glucose-lowering agents were identified in January 2017. Among these, those who were receiving care for depression, schizophrenia, bipolar disorder or personality disorder formed the study cohort. A reference cohort was randomly selected from prevalent patients treated with chronic therapies without signs of severe mental disorders, to be matched with study cohort members for gender, age and number of previous contacts with the National Health System. One-year adherence to healthcare was measured through the proportion of days covered (drug adherence), and exposure to selected recommendations (clinical control adherence). Results The 55 162 patients with severe mental illness were less likely to have high adherence to blood pressure-lowering, lipid-lowering or antidiabetic agents than the reference cohort by −24% (95% CI −26 to −22%), −10% (95% CI −14 to −6%) and −25% (95% CI −29 to −21%), respectively. The 9250 patients with diabetes and severe mental illness had −18% (95% CI −22% to −13%) reduced likelihood to meet recommendations for the clinical management of diabetes, compared with the reference cohort. Conclusions Adherence to chronic drug therapies was sensibly worse among patients living with mental illness than those without signs of mental disorders.

Prison psychiatry and faking symptoms

Faking symptoms is not an unusual finding in psychiatry; As a such is not a symptoms o sign of mental disorder; we could say that lying is frequent in the normal life of people. In psychiatry, in the community has been widely reported (), mainly related to legal psychiatry (getting some social benefits, avoiding legal obligations, etc). From forensic psychiatry, this topic have a special relevance as they have more serious consequences (to avoid prison, child custody, etc)(Resnick 2003, Gunn 2014). Another topic of paramount importance is that in psychiatry we have not complementary examinations (RMN, TAC, blood tests, etc) that help to discard some symptoms. Some test are used for detecting feigned symptoms as SIMS, The most important psychological episodes in prison are those related to disruptive / bizarre behaviour, suicide ideation and psychotic symptoms that create a great nuisance to Prison Governors. To get an accurate diagnosis is very important because this could have a psychiatric approach or a prison sanction. Sometimes a previous feigned symptom does not mean to have new episode with psychiatric symptomatology that should be treated. In this paper we´ll focus in the prison psychiatry (that probably include all the situations that has been describe above.) and to give some clinical tips to deal with this kind of situation in the everyday work and casualty job.DisclosureNo significant relationships.

Psychological burden of psoriatic patients in a German university hospital dermatology department.

Psoriasis has a strong impact on patients' lives and is closely linked to psychiatric disorders such as depression, anxiety and substance-related disorders, especially dependence on alcohol and nicotine. The aim of our study was to systematically assess the psychiatric comorbidity and possible associations between psychological factors, disease severity and dermatology-related quality of life in psoriatic patients from a high-need university hospital dermatology department. Consecutive psoriatic patients (new and permanent patients) at the Department of Dermatology, University Hospital Essen, Germany, were asked to fill out a paper-based questionnaire. In the first part of the questionnaire, baseline demographics, pre-existing mental disorders and data on substance abuse were collected. In the second part of the questionnaire, mental and physical health was explored using different validated self-rating tests. The current Psoriasis Area and Severity Index (PASI) was documented by a dermatologist. Patients with signs of mental disorders were offered an appointment with a board-certified psychiatrist. Between August 2016 and February 2019, 228 consecutive psoriatic patients (138 men [60.5%], 90 women [39.5%]; mean age, 48.3years [standard deviation, 13.6; range, 18-80]) participated in the study. Approximately 50% of the patients had evidence of suffering from mental health problems, mostly depression and anxiety, as well as alcohol dependence. Patients with a PASI of 3 or more showed a statistically significant reduced Dermatology Life Quality Index (DLQI) and a significantly impaired psychological as well as physical quality of life. DLQI correlated with all psychological test results. The data indicate a significant psychological burden in a tertiary psoriatic population. Our findings underscore the importance of screening psoriatic patients for psychiatric disorders, with a focus on depression, anxiety as well as alcohol and nicotine dependence, in a multidimensional approach involving psychiatrists and psychologists.

Setting the scene: controversies on trends in mental health among adolescents in the Nordic countries

Abstract At present there are different positions regarding trends in adolescent mental health. Can we trust trend data on the mental health among adolescents in the Nordic countries? Some question the trustworthiness of adolescent self-reports, which describe ordinary daily hassles as health complaints, which cannot be interpreted as signs of mental disorders. In addition, today there is a more open climate for talking about mental issues, which can lead to an overestimation of the prevalence of mental disorders. Statistics on mental health services statistics report increased psychopharmaceutic prescriptions as well as consumption of professional care. Such data argues for increased governmental investment in adolescent mental health services. Is this pattern due to increased availability of mental health services and/or increased prevalence of mental health problems in the adolescent population? A concern is that data availability influences policymaking and allocation of resources. If there is an emphasis on self-reported data from adolescents that may an increased risk of medicalization of young people's dealing with their daily lives. If on the other hand the reported problems among young people is disregarded, this would be against the UN Child Convention. The survey data has important qualities especially if the data is analysed and reported properly. The validation of survey measure has been done both regarding psychometric quality and content validity. Advanced analysis of the data can draw a more nuanced picture. Moreover, some screening instruments have been developed as a first step towards making diagnosis. Instead the HBSC surveys ask boys and girls about their health and well-being, social environment and health behaviours. HBSC uses findings at national and international levels to gain new insights into young people's health and wellbeing, understand the social determinants of health, and inform policy and practice to improve young people's lives.

Research domain criteria from neuroconstructivism: A developmental view on mental disorders.

Neuroconstructivism can provide Research Domain Criteria (RDoC) with a developmental framework to understand mental disorders. Neuroconstructivism proposes that mental disorders are the outcome of a developmental trajectory. Based on this assumption, symptoms would reveal the system's adaptation to optimize functioning according to the system's experience of the physical and social contexts. RDoC adopts a translational research approach with the aim of detecting, curing, and preventing mental illness. More specifically this involves to: (a) identify early signs of mental disorders, (b) find the optimal patient-treatment fit, and (c) design efficient interventions to prevent the system's eventual pathological functioning. We propose that meeting RDoC's threefold objective necessarily involves predicting the system's developmental trajectory. Such endeavor requires counting with assessment tools that are sensitive to both the process of development and its different contexts; the measures provided by these tools will allow identifying the risk and protective factors that make the system vulnerable to depart from a typical developmental trajectory. Including vectors relative to time and contexts in a relevant part of the matrix will make of RDoC a truly integrative model, which considers the relationships between behavior and neural circuits throughout the developmental pathway. This article is categorized under: Psychology > Brain Function and Dysfunction Neuroscience > Clinical Neuroscience Neuroscience > Development.

A randomised controlled trial of a cognitive skills programme for offenders with mental illness.

Interventions for offenders with mental illness have tended to be confined to treatment of illness, with the expectation that symptom reduction will be accompanied by reduced criminal recidivism, but recent evidence suggests that other treatment targets may be more effective against recidivism. The aim of this study was to examine the effect of a cognitive skills programme (Reasoning and Rehabilitation 2: Short Version for Adults [R&R2]) among offenders with mental illness. Our first hypothesis was that participation in this programme would result in significantly greater improvement in antisocial attitudes than among similar prisoners who did not participate; both groups received "treatment as usual" (TAU). Our second hypothesis was that those receiving R&R2 would show less post-treatment violent or general recidivism than those receiving TAU alone. Incarcerated offenders with serious mental illness (N=101) were randomly assigned to R&R2 or TAU alone. Criminal attitudes and mental state were examined before and after treatment. Violent and non-violent recidivism was measured, on average, 18months after release. In both intervention and TAU alone trial arms, there were significant pre- to post-treatment changes in criminal attitudes and symptoms or signs of mental disorder. There was no difference between groups in these respects. These pre/post changes were not associated with reductions in recidivism over time, whether or not controlling for baseline risk. Although there was no demonstrable advantage of R&R2 over TAU alone, non-significant trends towards lower violent recidivism in the R&R2 group and general recidivism in the TAU group suggest that it may be worth repeating the trial in a larger sample with more differentiated control groups.

Feedback from American participants of a Mental Health First Aid training course

Purpose – Mental Health First Aid (MHFA) is a course meant to train participants in how to identify and respond to signs of mental disorders and crises. The purpose of this paper is to conduct a qualitative study of MHFA participants to get a sense of some values and challenges associated with the training. Design/methodology/approach – Results from an online survey of 143 participants yielded 24 discrete themes. Survey responses were gathered into a single data set and coded by two independent raters. Findings – Themes were sorted into four categories: MHFA benefits, training limitations, challenges to MHFA, and resources that facilitate MHFA. Several benefits emerged, consistent with findings from Australian studies. Research limitations/implications – Findings represent a sample of people who completed the program in Chicago; research needs to determine how perceived benefits and limitations vary by geographic area. Originality/value – Findings echoed many of the benefits found in studies conducted outside the USA and can be used to further improve MHFA training as it expands in the US market.

Legal and Psychological Aspects of the Protection of the Victim's Rights Showing Signs of Mental Illness in the Criminal Proceedings.

Research of the offender by expert psychiatrists and psychologists is a regular part of the criminal proceedings. The necessity for a suspect present research is one part of the protection of his rights. In any situation where there is doubt as to the sanity of a suspect at the time of the offense, the examination is mandatory. The study of victims of crime by expert psychiatrists or psychologist is carried out in exceptional cases. Analysis of records of criminal cases in which the victim showed signs of mental disorder or mental illness leads to the conclusion that it is necessary to introduce mandatory participation expert psychiatrists or psychologists in the event of doubt as to the mental health of the victim. Psychiatric or psychological opinion is essential for assessing the reliability, suitability testimony of victims of crime. It also allows you to provide appropriate support, allowing the elimination of re-victimization of the victim. Research has shown that the participation of psychiatrists or psychologist during the preparatory proceedings, allows the elimination of unjustified accusations before the case goes to court.

Do prior histories of violence and mental disorders impact on violent behaviour during encounters with police?

Despite sustained large-scale educational campaigns, public attitudes towards mental illness have remained persistently negative. Associated with this, recent research from Victoria, Australia, reported that police commonly associated violent behaviour with mental illness. The present study examined 4267 cases of police use of force and considered what differentiated and characterised violent from non-violent behaviours reported by police in the context of a use of force incident. The specific focus was to examine the effects that historical variables such as age, gender, prior violent offending and having a prior diagnosis of mental disorder, as well as incident specific factors such as exhibiting signs of mental disorder and substance intoxication have on violent behaviour during the use of force incident. The proximal factors of apparent mental disorder and alcohol intoxication were significantly associated with violent behaviour towards police, whilst having a history of prior violence and prior mental disorder diagnoses was not associated with violence. The results challenge traditional stereotyped views about the violence risk posed by people with prior contact with mental health services and those with prior violent offending histories. A service model that allows for psychiatric triage would be able to assist with streamlining police involvement and facilitating timely access to mental health services.

Vice, Disorder, Conduct, and Culpability

Vice, Disorder, Conduct, and Culpability Stephen J. Morse (bio) Keywords vice, conduct, culpability, mental disorder Dr. John sadler’s interesting paper raises an important issue. It defines vice as criminal, wrongful or immoral behavior. He claims that the Diagnostic and Statistical Manual of Mental Disorders (DSM) “confounds the concepts of vice and mental illness” and that this confounding has “important implications . . . for the relationship between crime, criminality, wrongful conduct, and mental illness.” The paper correctly notes that disorders for which vice is the primary criterion tend to be impoverished diagnostically and are probably less valid than non–vice-related disorders. Dr. Sadler wonders if the subjects of his case studies are “involved in sick behavior, immoral behavior, both, neither, or some other metaphysical kind altogether.” This is an excellent question that this comment will seek to clarify. It will also consider the moral and legal implications of the answer. The domain of immoral, wrongful, and criminal behavior is essentially action. Some moral and religious traditions evaluate the content of an agent’s thoughts, desires, and character, but the dominant view is that vice primarily describes action that is wrongful because it violates the rights of others or it is wrong in itself. The rules of morality and law create value, but their essential task is to guide the action of agents who must live together. Dr. Sadler does not explicitly recognize that the diagnostic criteria that are vice are all actions, and not simply abnormal perceptions, desires, thoughts, or moods. His three case studies of conduct disorder, factitious disorder, and paraphilia confirm this point. Even pedophilia, which can be diagnosed simply on the basis of urges or fantasies that cause marked distress or interpersonal difficulty, would not be considered a vice unless the agent acted on these sexual urges. Those individual actions that meet Dr. Sadler’s criteria for vice I will term “vice actions.” Actions, including vice actions, may be evaluated medically and morally. There is no logical or conceptual reason why the same action cannot be both a sign of mental disorder and wrongful and potentially blameworthy. Actions can be just mad, just bad, or mad and bad. Also, the same action may sometimes be a sign of disorder and sometimes not. No general argument suggesting the contrary is provided. Consequently, there is no confound between the concepts of vice and mental disorder unless vice actions fail to satisfy the generic criteria for being a sign of mental disorder. Dr. Sadler seems to implicitly recognize [End Page 47] this when he asks whether vice–mental disorder relationship criteria are impoverished because there is a lack of consensus about “the minimum requirements for an acceptable set of descriptive criteria for a mental disorder category,” or when he asks “where criminal syndromes . . . fit into a classification of mental disorders.” No consensual, generic definition of mental disorder exists, and deciding whether actions should be signs of mental disorder is particularly fraught because cultural context and values always play a role in the definition of mental disorder. The other potential signs and symptoms of mental disorder are virtually all phenomena that simply happen to people and are not products of agency. Actions are by definition the product of agency, however, and vice actions affect by definition the rights and interests of others. The latter is true whether or not the agent is “vicious.” Even if an agent who has done wrong is excused, the rights of the victim have been violated. Moral, political, and legal evaluation is largely beside the point for non-action signs and symptoms, but it is always on point for vice actions. This is the primary potential source of the confound between vice and disorder. To claim that a vice action is a sign of disorder because it is vice begs the question and is indeed a confound. Even the presence of a biological marker will not save this claim. All human action presumably has biological markers and one cannot say that a marker is of a disorder without first having an independent definition of disorder that the vice action satisfies. Until a robust theory of mental disorder is provided, we cannot determine whether a vice action is...

某アパレル企業のメンタルヘルスの現状と対策，およびその効果

We speculated that there would be more occupational stress in an apparel company than in other areas of business, because employees work long hours and under poor conditions. We investigated 66 employees of an apparel company who visited an occupational physician to consult about their mental health. There were 561 male and 387 female employees in that company. The employees who had visited an occupational physician had worked long every day under poor conditions, and they had been required to be more artistic than other employees in that company. Female employees visited occupational physicians more than males. Apparel companies, use a system of "specialty store retailer of Private-label Apparel (SPA)", and several sections make special trademark "brands". These sections compete with each other. Employees must plan, design, make patterns, and sew new dresses in a 7-day cycle. They are extremely busy and this therefore creates stress. We came to the conclusion that many apparel companies were stressful workplaces. It is important that a psychiatrist examines employees who occupational physicians have diagnosed as unhealthy. Frequent consultation with occupational physicians is as important as a psychiatrists examination. Managers must manage absence, efficiency, and written correspondence of all employees. These are useful signs of mental disorder. When employees return to work after sick leave, rehabilitation in the workplace after absence is useful. The employee should work for only two hours a day at first. Working hours are then extended gradually. The employee can then return to work easily if this rehabilitation program is followed.

Reduction in psychopathology following bariatric surgery for morbid obesity.

Although there has been some disagreement, there is growing evidence now that psychopathology is a comorbidity of morbid obesity among patients seeking bariatric surgery. The aim of this study was to determine whether psychopathology decreases following this surgery. Utilizing a national sample, this study focused on pre- and post-surgery scores on the Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2). The MMPI-2 was administered first during the pre-surgery medical examination, and again between 6 months and 1 year following surgery. Validity scale scores on the pre- and post-surgery MMPI-2s indicated that there was no impediment to interpreting the clinical scale scores of these tests. There was a pervasive pattern of statistically significant decreases in pre- to post-surgery clinical scale scores. Further, comparison of MMPI-2 clinical scale scores to available test norms showed that the number of participants showing signs of mental disorders was unusually high before surgery, and at or below the test norms following surgery. There is clear evidence in this study that psychopathology declines following bariatric surgery. The unusually high levels of psychopathology before surgery may be a joint function of the factors producing the morbid obesity, and a reaction to the obesity itself. That psychopathology declines following surgery to levels expected in the general population indicates that the patients were becoming more positive about their lives.

Social Symptoms of Mental Disorder

Diagnosing mental disorders involve several processes. However, it is common practice to judge if one is suffering from mental disorder by first looking for signs and symptoms in a person's social behavior. We call the symptoms “social symptoms” of mental disorder. Psychiatry tends to trace social symptoms back to the etiological factors of a mental disorder, but there is an inevitable paradox in this method. Similarly, while narrative therapy and social constructionism tend to claim that social symptoms are themselves the cause of mental disorders, that too leads inevitably to a second paradox. Realism, on which these methods are based, is the cause of such paradoxes.This paper explores the “Internal Observation Theory” -a theory that is independent of realism proposed by the biologist Yukio-Pegio Gunji in the study of mental disorders. The “Internal Observation Model”, or “Ontological Observation Model”, claims that the observer and the subject are inseparable since the subject is not free of influence from the observer. In this model, a turning point exists where universal observations (universal language games) are inferred from specific observations (specific language games). According to the theory, social symptoms can be taken as signs of mental disorder only within the workings of specific language games. In contrast, “realist theories” confuse specific language games with universal language games while trying to explain the cause of the symptoms. This paper aims to present a “Pegiotic deconstruction” of such a mistake and to propose internal observation as a means to avoid similar mistakes in the study of mental disorders.

Suicidal behavior—symptom or disorder?

This article examines the diagnostic status of suicidal ideation with and without additional signs of defined or subthreshold mental disorders. Data from the World Health Organization (WHO) study on Psychological Problems in General Health Care (PPGHC) show that 8.8% of all general practice patients report that they recently had a wish to be dead. Among patients with acute depressive episodes, the rate is 34.5%, as compared with 1.3% in persons without any sign of mental disorder. Rates of suicidal ideation in persons with subthreshold disorders (10.4%) are similar to the rate in persons with other, nondepressed forms of mental disorders (12.9%). Still, 30.1% of all persons with suicidal ideation do not have a defined mental disorder, and 21.5% do not even have subthreshold disorders. But in these persons also, suicidal ideation is associated with an increased rate of depressive complaints. Suicidal ideation therefore, in any case, can be seen as an indicator of mental problems. But it seems impossible to lower the thresholds of defined mental disorders so that all forms of suicidal ideation will be covered. Instead, suicidal thoughts must be regarded as a symptom with the status of a disorder itself which should be handled as a comorbid condition if other mental disorders co-occur.