Standardized Diagnoses Research Articles

Phenotype harmonization and analysis for The Populations Underrepresented in Mental illness Association Studies (the PUMAS Project).

The Populations Underrepresented in Mental illness Association Studies (PUMAS) project is attempting to remediate the historical underrepresentation of African and Latin American populations in psychiatric genetics through large-scale genetic association studies of individuals diagnosed with a serious mental illness [SMI, including schizophrenia (SCZ), schizoaffective disorder (SZA) bipolar disorder (BP), and severe major depressive disorder (MDD)] and matched controls. Given growing evidence indicating substantial symptomatic and genetic overlap between these diagnoses, we sought to enable transdiagnostic genetic analyses of PUMAS data by conducting phenotype alignment and harmonization for 89,320 participants (48,165 cases and 41,155 controls) from four cohorts, each of which used different ascertainment and assessment methods: PAISA n=9,105; PUMAS-LATAM n=14,638; NGAP n=42,953 and GPC n=22,624. As we describe here, these efforts have yielded harmonized datasets enabling us to analyze PUMAS genetic variation data at three levels: SMI overall, diagnoses, and individual symptoms. In aligning item-level phenotypes obtained from 14 different clinical instruments, we incorporated content, branching nature, and time frame for each phenotype; standardized diagnoses; and selected 19 core SMI item-level phenotypes for analyses. The harmonization was evaluated in PUMAS cases using multiple correspondence analysis (MCA), co-occurrence analyses, and item-level endorsement. We mapped >6,895 item-level phenotypes in the aggregated PUMAS data, in which SCZ (44.97%) and severe BP (BP-I, 31.53%) were the most common diagnoses. Twelve of the 19 core item-level phenotypes occurred at frequencies of > 10% across all diagnoses, indicating their potential utility for transdiagnostic genetic analyses. MCA of the 14 phenotypes that were present for all cohorts revealed consistency across cohorts, and placed MDD and SCZ into separate clusters, while other diagnoses showed no significant phenotypic clustering. Our alignment strategy effectively aggregated extensive phenotypic data obtained using diverse assessment tools. The MCA yielded dimensional scores which we will use for genetic analyses along with the item level phenotypes. After successful harmonization, residual phenotypic heterogeneity between cohorts reflects differences in branching structure of diagnostic instruments, recruitment strategies, and symptom interpretation (due to cultural variation).

Visual reading for [18F]Florzolotau Tau PET scans in progressive supranuclear palsy.

The identification of tau accumulation within living brains holds significant potential in facilitating accurate diagnosis of progressive supranuclear palsy (PSP). While visual assessment is frequently employed, standardized methods for tau positron emission tomography (PET) specifically in PSP are absent. We aimed to develop a visual reading algorithm dedicated to the evaluation of [18F]Florzolotau PET in PSP. 148 PSP and 30 healthy volunteers were divided into a development set (for the establishment of the reading rules; n = 89) and a testing set (for the validation of the reading rules; n = 89). For differential diagnosis, 55 α-synucleinopathies were additionally included into the testing set. The visual reading method was established by an experienced assessor (Reader 0) and was then validated by Reader 0 and two additional readers on regional and overall binary manners. A positive binding in both midbrain and globus pallidus/putamen regions was characterized as a PSP-like pattern, whereas any other pattern was classified as non-PSP-like. Reader 1 (94.4%) and Reader 2 (93.8%) showed excellent agreement for the overall binary determination against Reader 0. The regional binary determinations of midbrain and globus pallidus/putamen showed excellent agreement among readers (kappa > 0.80). The overall binary evaluation demonstrated reproducibility of 86.1%, 94.4% and 77.8% for three readers. The visual reading algorithm showed high agreement with regional standardized uptake value ratios and clinical diagnoses. Through the application of the suggested visual reading algorithm, [18F]Florzorotau PET imaging demonstrated a robust performance for the imaging diagnosis of PSP.

The genus Polistes Latreille, 1802 (Hymenoptera: Vespidae) of Brazil: morphological diagnoses, identification key, and geographical distribution

Polistes Latreille, 1802 is a genus with cosmopolitan distribution, with 238 species in the world, 94 in the New World. Brazil has 43 species but there is not a complete understanding of the distribution of these species in the country, making it difficult to estimate the diversity of the genus for each region. Species descriptions in Polistes are typically short, and some diagnostic characteristics are subtle, making it difficult to identify and differentiate species of Polistes. To facilitate the identification and differentiation of species, standardized diagnoses, illustrations, geographic distribution, and a dichotomous key are proposed for all Polistes species occurring in Brazil.

Performance of ChatGPT in classifying periodontitis according to the 2018 classification of periodontal diseases

ObjectivesThis study assessed the ability of ChatGPT, an artificial intelligence(AI) language model, to determine the stage, grade, and extent of periodontitis based on the 2018 classification.Materials and methodsThis study used baseline digital data of 200 untreated periodontitis patients to compare standardized reference diagnoses (RDs) with ChatGPT findings and determine the best criteria for assessing stage and grade. RDs were provided by four experts who examined each case. Standardized texts containing the relevant information for each situation were constructed to query ChatGPT. RDs were compared to ChatGPT's responses. Variables influencing the responses of ChatGPT were evaluated.ResultsChatGPT successfully identified the periodontitis stage, grade, and extent in 59.5%, 50.5%, and 84.0% of cases, respectively. Cohen’s kappa values for stage, grade and extent were respectively 0.447, 0.284, and 0.652. A multiple correspondence analysis showed high variance between ChatGPT’s staging and the variables affecting the stage (64.08%) and low variance between ChatGPT’s grading and the variables affecting the grade (42.71%).ConclusionsThe present performance of ChatGPT in the classification of periodontitis exhibited a reasonable level. However, it is expected that additional improvements would increase its effectiveness and broaden its range of functionalities (NCT05926999).Clinical relevanceDespite ChatGPT's current limitations in accurately classifying periodontitis, it is important to note that the model has not been specifically trained for this task. However, it is expected that with additional improvements, the effectiveness and capabilities of ChatGPT might be enhanced.

Post-cessation interventions for preeclampsia

Preeclampsia is characterized by high blood pressure associated with proteinuria or hypertension with or without proteinuria, it can complicate pregnancy affecting multiple organs and systems, being a high risk for the mother and fetus. They generally conclude in abdominal surgical delivery called cesarean section, which leads to various alterations in the patient's health. Objective: Expose the nursing interventions in the maintenance of tissue perfusion in post-cesarean patients due to preeclampsia.Methodology: Study qualitative clinical case, 15-year-old patient selected for convenience; In which the Nursing Care Process (PAE) was applied as a methodology and the data collection instrument was the assessment sheet according to the eleven functional patterns of Marjory Gordon. Results: Twelve nursing diagnoses were recognized, among them the main diagnosis was prioritized: ineffective tissue perfusion associated with M / P hypertension, alteration of skin characteristics and edema. Therefore, scientifically supported nursing interventions were planned that achieved favorable results in the patient. With regard to the main CR, malignant hypertension, an adequate health condition has been maintained but the risk remains in the following hours. Conclusions: The clinical condition of the post-cesarean patient with preeclampsia and eclampsia was identified, considering nursing interventions according to standardized diagnoses, achieving favorable results. The patient is being cared for because the risk of malignant hypertension persists.

Nursing diagnoses in patients with COVID-19 admitted to the intensive care unit: CROSS-MAPPING

ObjectiveTo identify and analyze the nursing diagnoses listed in the medical records of COVID-19 patients admitted to an intensive care unit using Taxonomy II of NANDA-I. Background: COVID-19 is a complex disease with heterogeneous behaviors, and the role of intensive care nurses in accurately identifying related signs and symptoms has become even more critical during the pandemic. Nurses rely on classification systems or taxonomies to standardize concepts and language in practice. Method: This quantitative study employed a descriptive and individual approach, utilizing the cross-mapping method. Data were collected from 57 medical records of critical care patients in a hospital in northeastern Brazil between July 2020 and March 2021. Three researchers analyzed the mapped diagnoses, and agreement was assessed using the Content Validation Index and Fleiss' Kappa. Results: Among the listed nursing diagnoses, 54.28% were found to be standardized, 45.71% had corresponding nursing diagnoses, and 5.71% did not have an equivalent diagnosis in the reference taxonomy used in the study. Due to the possibility of multiple nursing diagnoses in the same patient, the most frequent diagnoses were Risk of pressure injury in adults (66.66%), Risk of falls in adults (64.91%), and Risk of infection (45.61%). Among the 37 diagnoses mapped, the risk diagnoses were the most prevalent and could be prevented if identified early. Conclusions: The study highlights the importance of standardized nursing diagnoses in the ICU for COVID-19 patients and the need for accurate identification and prevention of risk diagnoses to enhance patient care and improve outcomes.

MULTIMORBIDITY PREDICTS REMAINING LIFESPAN IN NONHUMAN PRIMATE MODEL OF ACCELERATED AGING

Abstract Multimorbidity is common among older adults and linked to shorter lifespans, but it is unclear how naturally-occurring multimorbidity impacts lifespan in non-human primate models of aging. We developed a clinical multimorbidity index based on standardized veterinary diagnoses in 288 rhesus macaques (Macaca mulatta) from the Wake Forest Radiation Late Effects Cohort, animals that survived an early-life insult from whole-body radiation and controls (73 female, 237 irradiated, ages 2-24). Our index is based on diagnosis of arthritis, low bone density, cataracts, diabetes, gastrointestinal disorders, heart disease, hepatic dysfunction, hypertension, kidney disease, lung fibrosis, skin disorders, tumors, and overweight/underweight. All diseases were seen in both control and irradiated animals and there was a broad distribution of multimorbidity trajectories across the lifespan both in number and combinations of diseases. On average, the first diagnosis occurred at age 9.0 (equal to 35% of median lifespan) and the second at age 10.7. However, 20% of animals that lived to age 12 were without any diagnoses while others had as many as 9 comorbidities, highlighting broad variability in multimorbidity with aging. Cox proportional-hazard ratios (HR) show significant negative associations (p < 0.05) between survival and multimorbidity. Ages 3-6 years, each additional morbidity doubles likelihood of death (HR > 2) with HR falling from 1.9 to 1.4 from ages 6-15. Based on receiver operating characteristic (ROC) curves, multimorbidity predicts 2-year mortality with AUC > 0.65 from ages 7-14. Our findings suggest multimorbidity is prevalent and predicts lifespan in NHP survivors of radiation. Research was funded by NIHU01AI150578.

Understanding Frailty in Older Adults: Examining Attributes, Antecedents, and Consequences

Background: Frailty has been debated in the literature for three decades, necessitating a comprehensive understanding to guide future research. This study conducts a concept analysis using Walker and Avant's (2011) framework, examining the attributes, antecedents, consequences, and empirical referents of frailty based on a literature review. Aims: This study aims to elucidate the multidimensional nature of frailty, encompassing physical, psychological, and social aspects of older adults' perceptions in later life. The analysis contributes to the conceptual definition of frailty and informs future research. Methods: A concept analysis approach following Walker and Avant's (2011) guidelines was utilized. A thorough literature review was conducted, synthesizing the findings in a matrix. The analysis focused on identifying the attributes, antecedents, consequences, and empirical referents of frailty. Results: Frailty is a multidimensional concept encompassing physical vulnerability, cognitive decline, emotional distress, social isolation, and functional impairment. Antecedents include age-related changes, chronic illnesses, and psychosocial factors. Consequences involve increased healthcare utilization, decreased quality of life, and higher mortality rates. Empirical referents include standardized assessment tools, clinical diagnoses, and self-report measures. Conclusion: Frailty should be understood holistically, addressing physical, psychological, and social dimensions in older adults' lives. This understanding is vital for developing comprehensive interventions and policies to enhance their well-being. The findings establish a foundation for further research on the conceptual definition of frailty and its implications for clinical practice and public health. Implications for Nursing: This conceptual analysis has implications for researchers, healthcare professionals, and policymakers. Recognizing the broader dimensions of frailty enables the development of interventions addressing the complex needs of older adults. Refining assessment tools can capture the multidimensional aspects of frailty accurately. A holistic approach to frailty management should be adopted, guiding the development of targeted interventions to improve older adults' overall well-being. Keywords: Frailty, Older adults, Attributes, Antecedents, Consequences.

Implementation of the Nutrition Care Process and the Nutrition Care Process Terminology among German- and French-Speaking Dietitians in Switzerland: A Secondary Analysis of the Swiss International Nutrition Care Process and Terminology Implementation Survey Data.

Successful implementation of the Nutrition Care Process (NCP) and the Nutrition Care Process Terminology (NCPT) depends on many factors, one of which is the spoken language of the users. Exploring implementation barriers and enablers in a multilingual country such as Switzerland, with a specific focus on dietitians speaking German and French, may provide valuable insights for successful implementation in other multilingual countries. The aim of this study was to compare the enablers and barriers encountered by Swiss German- and French-speaking dietitians in the implementation of NCP and NCPT in their daily work. The multinational observational INIS study was conducted between February-April 2017 using an online survey. Swiss data from the study were analyzed in a secondary analysis in August2021. In Switzerland, 237 registered dietitians participated in the INIS study. In this secondary analysis, a total of 228 (German-speaking n= 144, French-speaking n= 84) questionnaires were included. Nine participants were excluded because either they had incomplete surveys or had not completed dietetics training. Primary variables were barriers and enablers to the use of NCP and NCPT in their daily work. Furthermore, characteristics, familiarity with NCP and NCPT, and the extent of implementation of standardized nutrition diagnoses according to NCPT were analyzed. Descriptive statistics, including summary statistics with percentages, were used. Differences between the two groups were analyzed using the Fisher exact test. The most common barrier was lack of time; no significant differences were found between the two groups regarding implementation barriers. Some statistically significant differences were found in the frequency of mentioning enablers, such as "recommendation by the association to use NCP and NCPT" (German-speaking 89%, French-speaking 77%; P < 0.05), "requirement by the workplace" (German-speaking 75%, French-speaking 53%; P < 0.01), "allocated time to practice" (German-speaking 63%, French-speaking 43%; P < 0.05), and "electronic healthcare records" (German-speaking 81%, French-speaking 44%; P < 0.001). Some differences in enablers were found between German- and French-speaking dietitians, although the two groups were similar for all barriers and many enablers. In multilingual countries such as Switzerland, implementation strategies may need to be adapted to the language and the dietitians' specific experiences of using NCP and NCPT to ensure optimal use throughout the country.

Propensity score matched analysis of major adverse cardiac events in patients with localized prostate cancer receiving short term vs long term ADT.

12096 Background: ADT is often used with radiation for dose-intensification in intermediate-risk prostate cancer (PrCa). ADT includes gonadotropin-releasing hormone (GnRH) agonists, often started with antiandrogens to prevent the initial surge in serum testosterone as well as GnRH antagonists. Studies have reported associations of ADT with increased risks of cardiovascular events. This is thought to be related to atherosclerosis, dyslipidemia and insulin resistance. Therefore, there is an opportunity to individualize ADT use to balance risk of PrCa specific outcomes with risk of MACE. To address this, we assessed whether there is a difference in major adverse cardiac events (MACE) between ST-ADT ( &lt; 6 months) or LT-ADT ( &gt; 6 months) in patients with localized PrCa. Methods: A nationally representative EHR-derived dataset was queried for patients with at least 90 days of longitudinal records and 90 days of continuous follow up. The inclusion criteria was a diagnosis of PrCa based on standardized diagnoses codes (ICD9 and ICD10). Patients who had a history of MACE (defined as combination of diagnosis and procedure codes associated with CAD, MI, unstable angina, CABG, PCI, catheterization) metastases, PSA above 10ng/mL, imaging for metastatic PrCa, or having received abiraterone or docetaxel within 3 months of inclusion were excluded. Patients were defined as receiving ADT if they received leuprolide, goserelin, bicalutamide, triptorelin, degarelix, flutamide, or nilutamide. The primary outcome of risk of any new MACE was compared between arms with Cox proportional hazards regression. Secondary outcomes including 10 year rates of new diagnoses of CAD, metastases, and new heart procedures were compared between arms with the Chi-square test. Significance was set at a two sided p-value of 0.05. All analyses were performed without matching, with age and gender matching, and high dimensional propensity-score matching (hdPS) using R version 4.05. Results: We identified 1209 patients with local PrCa and no prior MACE or use of abiraterone or docetaxel within 3 months of diagnosis. 385 patients received ST-ADT and 824 received LT-ADT. Baseline characteristics were comparable between the two arms with similar ages, and comorbidity scores. There was no significant difference in metastatic recurrence between arms in hdPS-matched analysis HR 0.95 [0.64-1.38] p = 0.8. There was also no significant difference in the composite endpoint of MACE HR 1.42 [0.86-2.36] p = 0.173. More patients in the LT-ADT arm had new CAD, which was significant after hdPS-matched analysis OR 1.84 [1.07-3.14], p = 0.024. Conclusions: In a national dataset analysis of patients with local PrCa and no history of MACE or abiraterone or docetaxel within 3 months of diagnosis LT-ADT was associated with increased odds of CAD but there was no difference in the composite endpoint of MACE or metastatic recurrence.

National Brain Tumour Registry of China (NBTRC) statistical report of primary brain tumours diagnosed in China in years 2019–2020

The lack of a well-designed brain tumour registry with standardized pathological diagnoses in underdeveloped countries hinders the ability to compare epidemiologic data across the globe. The National Brain Tumour Registry of China (NBTRC), created in January 2018, is the first multi-hospital-based brain tumour registry in China. Patient data reported to the NBTRC in years 2019-2020 were assessed. Tumour pathology was based on the 2016 World Health Organization (WHO) classification of tumours of the central nervous system and ICD-O-3. The anatomical site was coded per the Surveillance, Epidemiology, and End Results (SEER) solid tumour module (version of July 2019). The cases were tabulated by histology and anatomical site. Categorical variables were reported as numbers (percentages). The distribution of tumours by age (0-14, 15-19, 20-39, 40-64, and 65+ years) was analysed. There were a total of 25,537 brain tumours, foremost among them meningioma (23.63%), followed by tumours of the pituitary (23.42%), and nerve sheath tumours (9.09%). Glioblastoma, the most common and lethal form of primary brain cancer in adults, represented 8.56% of all cases. Of note, 6.48% of the malignant tumours were located in the brain stem. The percentage of malignant brain tumours decreased with increasing age, 24.08% in adults (40+ years), 30.25% in young adults (20-39 years), 35.27% in adolescents (15-19 years), and 49.83% in children (0-14 years). Among the 2107 paediatric patients, the most common sites were ventricle (17.19%), brainstem (14.03%), pituitary and craniopharyngeal duct (13.4%), and cerebellum (12.3%), a distribution that differed from that of the entire cohort. The histology distribution was also unique in children, with glioblastoma much less incident compared to the whole cohort (3% vs. 8.47%, p<0.01). 58.80% of all patients chose higher-level neurosurgical hospitals outside of their province of residence. The median in-hospital length of stay (LOS) for the various pathologies ranged from 11 to 19 days. The histological and anatomical site distribution of brain tumours in the NBTRC was statistically different in the subgroup of children (0-14 years). Patient choice of pursuing trans-provincial treatment was common and the in-hospital LOS was longer compared to that reported in similar European and American patient populations, which merits further attention. The National Key Research and Development Program of China (2015BAI12B04, 2013BAI09B03, 2014BAI04B01, and 2021YFF1201104) and Chinese National Natural Science Foundation of China (81971668).

A Brief Overview Of Hantavirus Infections

Hantaviruses belong to the Bunyaviridae family as a separate genus. It is currently known that there are over 20 serogenotypes/ seroserotypes and that a number of new types are under investigation. The types of Hantaviruses which infect rodents tend to be specific to specific hosts and are primarily found in specific rodent species. As a result of the various types of Hantaviruses and their target organs, Hantaviruses can cause a variety of diseases. There are two major diseases in the world: hemorrhagic fever with renal syndrome (HFRS) and hemorrhagic fever with the syndrome (HPS). A new strain of Hantavirus has been observed in progressively increasing numbers within the world as a result of an accelerating increase in Hantavirus cases throughout the world, which represents an issue of public health of great concern across the globe. Hantavirus disease is a relatively new disease, however, its spectrum continues to expand as the number of recognized virus types continues to rise. It has been reported that Hantavirus causes human disease in the British Isles, but at this point, the disease is largely unknown. Hanta viral infection may be underestimated, especially in developing countries, due to its mild asymptomatic nature and lack of standardized laboratory diagnosis in hospitals. There are no simple standardized laboratory diagnoses in hospitals due to its asymptomatic and non-specific nature. Presented is an overview of what is currently known about hantaviruses and hantavirus infections, including their properties, classification, laboratory diagnostics, treatment, and prevention.

The quality of nursing documentation and standardized nursing diagnoses in the children's hospital electronic nursing records.

The aim of the paper is to compare the quality of nursing documentation in the Children's Hospital before and after the NANDA-I nursing diagnoses training. Research employed the interventional study design, and pre-post study design. Before and after the NANDA-I nursing diagnoses training, 50 nursing records were analyzed in the interventional pre-post study, using D-Catch instrument. The most often documented problem-centered nursing diagnosis before training was anxiety and after the training, hyperthermia. The most common risk diagnoses before and after the training was risk of infection. Before the training, one health promotion diagnosis was determined in the nursing records, and after the training the number increased to four. The highest value was given to readability of the nursing documentation both before and after the training. The lowest score before the training was given to the quality determiners of the accurate nursing diagnoses and after the training given to the determiners of the results' quantity. The sum score of documenting the nursing interventions was the most inconsistent before the training and after the training. The most consistent was the readability of the nursing records before and after the training. Statistically significant differences in the improvement of quality were revealed in all areas except for the readability of the nursing documentation and the quantity of nursing assessment. The results of the study revealed that following the training, the quality of nursing documentation improved, the wording of the nursing diagnoses improved, and the number of accurate nursing diagnoses had increased. Results of the research provide an overview of the importance of the training in improving the quality of nursing documentation and aid the educators in planning the trainings, focusing more on the challenges in the documentation.

DSM: A History of Psychiatry's Bible by Allan V. Horwitz

Reviewed by: DSM: A History of Psychiatry's Bible by Allan V. Horwitz Margaret Leggatt (bio) Allan V. Horwitz, DSM: A History of Psychiatry's Bible (Baltimore: Johns Hopkins University Press, 2021). ISBN: 9781421440705 (HC). 6 B&W photographs, x+ 215 pp. This book is a detailed, thoroughly researched, and comprehensive account of attempts to use the Diagnostic and Statistical Manual of Mental Disorders {DSM) to legitimise psychiatry as a profession with a solid scientific evidence base. As mental health issues are becoming increasingly acknowledged and accepted as distressing states of mind needing to be competently 'treated', understanding the history of what has gone before is important for future progress. Horwitz's book on the pros and cons (mainly cons!) of the DSM should, and hopefully will, help us towards finding better outcomes for those who are labelled 'mentally ill'. The DSM, owned by the American Psychiatric Association, was first published as a small booklet in 1952. By 2013, the manual had been revised to its fifth edition. The first two versions—DSM I and DSM II, published in 1952 and 1968 respectively—presented brief [End Page 144] descriptions of the major mental disorders. However the manual gained much wider recognition in 1980 after publication of its third version—DSM III—an imposing hardback volume of nearly 500 pages. It contained 'detailed and clear-cut symptom lists as well as decision rules that yielded standardized diagnoses', suggesting 'a confident, well-informed scientific grasp of mental illness, a physical embodiment of psychiatry in the scientific image' (p. 64). While the first two DSMs focussed on a small number of distinct entities, DSM III contained nearly three hundred separate diagnoses, many of which overlapped. The vastly greater role of observable symptoms—focussed on patients' current presentation of their problems—distinguished DSM III from the earlier manuals which gave far more importance to the way psychodynamics from past experiences produced symptoms. The changes in DSM III and, also, DSM IVwere not changes to the diagnoses. The major transformations came about as many outside advocates became involved—other mental health professionals, mental health advocacy organisations and feminist groups—making the DSM much more inclusive of cultural phenomena as aspects of mental illness. The extensive descriptive criteria in DSM III also allowed epidemiologists to estimate rates of particular mental disorders in untreated groups, and the enormous approximations that these studies provided became powerful marketing tools for psychiatry and other mental health professions. If clinicians were to live up to their medical credentials they should be able to prescribe medications for a specific disease regardless of the particular circumstances of the person who had it. Treat the disease and not the patient, and if your symptoms weren't recognised as a particular disease, then your insurance wouldn't pay for help. The application of DSM diagnoses to a broader society seemed to indicate that very many more people, not just psychiatric patients, suffered from a mental disorder at some point in life. The DSM III not only transformed the process of psychiatric diagnosis but also thrust the manual into cultural prominence. One suspects that this also became a field day for Big Pharma as more and more people resorted to medications to solve their behavioural, interpersonal, and social dilemmas. Each iteration of the DSM was eventually criticised on a range of different issues, meticulously explicated in this book. For example, after about two decades psychiatric researchers came to the conclusion that there were serious problems with DSM III. [End Page 145] They claimed that the basic characteristics of mental disorders were virtually the opposite of those portrayed in the manual. The categories were 'overlapping rather than discrete, dimensional more than categorical, generalised and not specific, and reflective of a small number of basic processes as opposed to hundreds of distinct conditions' (p. 84). Horwitz explains that even before these issues were taken into consideration, the DSM process would go through two further revisions. Interestingly, comments throughout this book suggest that clinicians were sceptical about the validity of many specific diagnoses. So even though the DSM was 'Psychiatry's bible', the diagnoses seemed to be used extensively as codes to obtain reimbursement from insurance companies for...

Key demographic and mental disorder diagnostic differences between Australian First Nations and non-First Nations clinic-referred children and adolescents assessed in a culturally appropriate and safe way.

Increased point prevalence rates of oppositional defiant disorder and conduct disorder have been reported in American Indian and Canadian First Nations children and adolescents. To date, in Australia, there has been no published examination of standardized Diagnostic and Statistical Manual mental disorder diagnoses in First Nations children and adolescents, determined after addressing key cultural methodological issues. In all, 113 First Nations children and adolescents and 217 non-First Nations young people, aged 6-16 years, age, gender, mental disorder symptom severity, symptom-linked distress and impairment matched were recruited in a case control study. Also, 112 typically developing non-First Nations participants, age and gender matched to the other two clinical groups as a second comparison group were recruited. Diagnostic and Statistical Manual mental disorder diagnoses via semi-structured clinical interview, social adversity status and full scale IQ were determined in all participants with cultural validity and reliability of the impairing patterns of symptoms in First Nations young people determined by First Nations mental health staff and Aboriginal Health Liaison Officers. Full scale IQ and social adversity status were appropriately controlled in the Logistic Regression analyses of Diagnostic and Statistical Manual mental disorder diagnoses between the two clinical groups. Oppositional defiant disorder was the only diagnostic and statistical manual mental disorder diagnosis that differed between the First Nations and non-First Nations clinical groups, adjusting for confounding by social adversity status and full scale IQ in the multivariable model. The point prevalence of oppositional defiant disorder was 2.94 times higher (95% confidence interval: 1.14-7.69) among the First Nations compared to the non-First Nations clinical group. Key known risk factors for oppositional defiant disorder can be identified early and holistically managed in First Nations young people. This will prevent oppositional defiant disorder decreasing their access to mental health services and increasing their involvement in the criminal justice system. In addition, the resilience building aspects of oppositional defiant disorder that may enhance self-respect need to be nurtured.

Burnout Subtypes: Psychological Characteristics, Standardized Diagnoses and Symptoms Course to Identify Aftercare Needs.

To better understand individual differences between burnout inpatients and improve individually tailored treatments in a psychiatric hospital, cluster analysis based on a number of self-report measures was used to investigate psychosocial characteristics of 96 participants. Group membership was analyzed regarding associations with standardized measures of psychiatric and personality disorders. Moreover, symptom levels of burnout, depression, and general mental health were used to characterize the groups and to observe differential trajectories at admission, discharge, and follow-up. As in previous research, we identified four subtypes that differed in comorbidity, psychological characteristics and treatment outcome. This calls for tailored interventions for the more vulnerable patients. The replicated and enriched characterization of burnout inpatients can help to optimally meet the differential needs of burnout patients.

Treatment outcomes in individuals diagnosed with comorbid opioid use disorder and Posttraumatic stress disorder: A review

ObjectivesOpioid use disorder (OUD) is a public health emergency. Evidence suggests that posttraumatic stress disorder (PTSD) is common among individuals with OUD; however, few studies evaluate whether concurrent diagnoses affect treatment outcomes. This review examines the impact of concurrent diagnoses of OUD and PTSD on treatment outcomes. MethodsA search was performed using articles identified through June 30, 2020 in PubMed, PsycINFO, and EMBASE. Included peer-reviewed articles evaluated individuals with OUD and a PTSD diagnosis via standardized assessment and/or medical record diagnoses, and reported relationships between diagnosis and treatment outcomes and/or other psychiatric conditions. ResultsOut of 412 articles, 17 studies met inclusion criteria for this review (from 13 databases). Articles included had a total of n = 2190 with OUD, with n = 79 non-OUD comparison participants. Studies examining individuals with OUD revealed comorbid PTSD was associated with more severe addiction, higher rates of depression, attempted suicide, and psychosocial problems. ConclusionsAmong individuals with OUD, presence of PTSD is associated with multiple mental health problems. The impact of PTSD on drug use is inconclusive. Although only 5 studies examined psychosocial PTSD treatment, all found PTSD-focused treatment to be effective for those with comorbid OUD. Overall, results suggest the need to better identify PTSD among those with OUD, and to develop and evaluate interventions that are brief, integrative, and easy to implement in clinical settings.

Glaucoma and mortality risk: findings from a prospective population-based study

Glaucoma is a neurodegenerative disease with a structural change of the optic nerve head, leading to visual field defects and ultimately blindness. It has been proposed that glaucoma is associated with increased mortality, but previous studies had methodological limitations (selective study samples, lack of data on potential confounders, self-reported or secondary data on glaucoma diagnoses). We evaluated the association between diagnosed glaucoma and mortality in the population-based National Health and Nutrition Examination Survey (NHANES), a representative health survey in the United States. The survey cycles 2005–2006 and 2007–2008 included an extensive ophthalmic examination with fundus photography, which were used to derive standardized glaucoma diagnoses. Risk of all-cause mortality was assessed with multivariable Cox proportional hazards regression models accounting for the complex survey design of NHANES. Time to death was calculated from the examination date to date of death or December 31, 2015 whichever came first. 5385 participants (52.5% women) were eligible, of which 138 had glaucoma at baseline, and 833 died during follow-up. Participants with glaucoma were more likely to be older than those without glaucoma (mean age 69.9 vs. 56.0 years). Mean follow-up time was 8.4 years for participants with glaucoma, and 8.6 years for participants without glaucoma. Glaucoma was associated with increased mortality in an unadjusted Cox regression model (hazard ratio 2.06, 95% confidence interval 1.16 to 3.66), but the association was no longer statistically significant after adjusting for age and sex (hazard ratio 0.74, 95% confidence interval 0.46 to 1.17). Additional adjustment for a range of potential confounders did not significantly change the results. In this representative population-based study, we found no evidence of increased mortality risk in glaucoma patients.

Symptoms of Adenomyosis and Overlapping Diseases.

To summarize and update our current knowledge regarding adenomyosis diagnosis, prevalence, and symptoms. Systematic review of PubMed between January 1972 and April 2020. Search strategy included: "adenomyosis [MeSH Terms] AND (endometriosis[MeSH Term OR prevalence study [MeSH Terms] OR dysmenorrhea[Text Word] OR prevalence[Text Word] OR young adults [Text Word] OR adolesce* [Text Word] OR symptoms[Text Word] OR imaging diagnosis [Text Word] OR pathology[Text Word]. Articles published in English that addressed adenomyosis and discussed prevalence, diagnosis, and symptoms were included. Included articles described: pathology diagnosis, imaging, biopsy diagnosis, prevalence and age of onset, symptoms, and concomitant endometriosis. Sixteen articles were included in the qualitative analysis. The studies are heterogeneous when diagnosing adenomyosis with differing criteria, protocols, and patient populations. Prevalence estimates range from 20% to 88.8% in symptomatic women (average 30-35%) with most diagnosed between 32-38 years old. The correlation between imaging and pathology continues to evolve. As imaging advances, newer studies report younger symptomatic women are being diagnosed with adenomyosis based on both magnetic resonance imaging (MRI) and/or transvaginal ultrasound (TVUS). High rates of concomitant endometriosis create challenges when discerning the etiology of pelvic pain. Symptoms that are historically attributed to endometriosis may actually be caused by adenomyosis. Adenomyosis remains a challenge to identify, assess and research because of the lack of standardized diagnostic criteria, especially in women who wish to retain their uterus. As noninvasive diagnostics such as imaging and myometrial biopsies continue to improve, younger women with variable symptoms will likely create criteria for diagnosis with adenomyosis. The priority should be to create standardized histopathological and imaging diagnoses to gain deeper understandings of adenomyosis.

Revision of Fauveliopsidae Hartman, 1971 (Annelida, Sedentaria).

Revision of Fauveliopsidae Hartman, 1971 (Annelida, Sedentaria).