Statistical Manual Of Mental Disorders Research Articles

Association of anxiety, depression and sleep quality with binge-watching behavior in college students – An observational study

Abstract Background: Binge-watching is the habit of watching television or series for extended periods, often involving consecutive viewing of multiple episodes from the same series. This phenomenon is prevalent among adolescents and young adults, often likened to addiction due to its pervasive nature. It is intertwined with detrimental effects on physical health, mental well-being, social engagement, and academic performance. Neither the International Classification of Diseases, eleventh revision nor the Diagnostic and Statistical Manual of Mental Disorders, fifth edition have acknowledged binge-watching as a disorder. Aim: The aim of the study was to study the association of anxiety, depression, and sleep quality with binge-watching behavior in college students. Methodology: This is a cross-sectional study conducted on students belonging to medical, dental, engineering, and arts. Sociodemographic details were taken. Binge-watching Engagement and Symptoms Questionnaire, Beck’s Anxiety Inventory (BAI), Beck’s Depression Inventory (BDI), and Pittsburgh Sleep Quality Index (PSQI) were applied. Data were analyzed using SPSS version 25.0. The Chi-square test and analysis of variance were used. Results: In our study, which included 400 students from various academic specialities, 364 (91%) displayed binge-watching behavior. A significant association was found between binge-watching and measures of anxiety (BAI, P = 0.02), depression (BDI, P = 0.01), and sleep quality (PSQI, P = 0.03). Conclusions: A large proportion of students exhibited binge-watching behaviors. These findings highlight the importance of addressing binge-watching behaviors in promoting overall well-being among students. There is a need to monitor this behavior due to its deleterious effects.

2327 Delirium predicts poor outcomes in Parkinson's disease

Abstract Introduction Reported delirium prevalence in inpatients with Parkinson’s disease (PD) varies widely across the literature and is often underreported. Delirium is associated with an increased risk of institutionalisation, dementia, and mortality, but to date there are no comprehensive prospective studies in PD. We aimed to determine delirium prevalence in PD compared to older adults and its associated risk with adverse outcomes. Method Participants from the ‘Defining Delirium and its Impact in Parkinson’s Disease’ (DELIRIUM-PD) and the ‘Delirium and Cognitive Impact in Dementia’ (DECIDE) studies were included. People with PD (DELIRIUM-PD) or older adults from the Cognitive Function and Ageing Study II – Newcastle cohort (DECIDE) admitted to hospitals in Newcastle were approached to take part. Delirium was assessed prospectively using the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition criteria. Outcomes were determined by medical note reviews and home visits 12 months post discharge. Cox regression or binary logistic regression were used to evaluate the effect of delirium on institutionalisation, dementia, and mortality, independent of covariates. Results Delirium developed in 66.9% (n = 81/121) of PD participants compared to 38.7% (n = 77/199) of controls (p < 0.001). Delirium was associated with a significant increased risk of developing dementia in one year in PD (OR = 6.1 (1.3–29.5), p = 0.024) and in controls (OR = 13.4 (2.5–72.6), p = 0.003). However, in only PD participants, delirium was associated with a significantly higher risk of institutionalisation (OR = 10.7 (2.1–54.6), 0.004) and mortality (HR = 3.3 [95% CI 1.3–8.6], p = 0.014). Conclusion This is the first comprehensive prospective study of delirium in PD, showing that over two-thirds develop delirium during hospitalisation compared to a third of older adults. Delirium in PD is associated with a significant risk of dementia, institutionalisation, and death in one year. Furthermore, this is the first study to show that PD increases the risk of mortality and institutionalisation over and above a delirium in older adults.

From diagnosis to dialogue - reconsidering the DSM as a conversation piece in mental health care: a hypothesis and theory.

The Diagnostic and Statistical Manual of Mental Disorders, abbreviated as the DSM, is one of mental health care's most commonly used classification systems. While the DSM has been successful in establishing a shared language for researching and communicating about mental distress, it has its limitations as an empirical compass. In the transformation of mental health care towards a system that is centered around shared decision-making, person-centered care, and personal recovery, the DSM is problematic as it promotes the disengagement of people with mental distress and is primarily a tool developed for professionals to communicate about patients instead of with patients. However, the mental health care system is set up in such a way that we cannot do without the DSM for the time being. In this paper, we aimed to describe the position and role the DSM may have in a mental health care system that is evolving from a medical paradigm to a more self-contained profession in which there is increased accommodation of other perspectives. First, our analysis highlights the DSM's potential as a boundary object in clinical practice, that could support a shared language between patients and professionals. Using the DSM as a conversation piece, a language accommodating diverse perspectives can be co-created. Second, we delve into why people with lived experience should be involved in co-designing spectra of distress. We propose an iterative design and test approach for designing DSM spectra of distress in co-creation with people with lived experience to prevent the development of 'average solutions' for 'ordinary people'. We conclude that transforming mental health care by reconsidering the DSM as a boundary object and conversation piece between activity systems could be a step in the right direction, shifting the power balance towards shared ownership in a participation era that fosters dialogue instead of diagnosis.

Predictors of Psychiatric Complications in Patients with Pancreatic Cancer: A Retrospective Cohort Study.

The relevant survey has shown a high incidence of psychiatric complications in patients with pancreatic cancer. While some studies have explored the factors influencing psychological complications in pancreatic cancer patients, some factors validated in other populations have not been confirmed in the pancreatic cancer population. This study aims to explore the predictors of psychiatric complications in patients with pancreatic cancer. Patients with pancreatic cancer admitted to Yueqing People's Hospital Affiliated to Wenzhou Medical University, from January 2021 to January 2022 were retrospectively analyzed. The structured clinical interview (SCID-I) based on Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was used by nurses to assess the incidence of psychiatric complications during hospitalization (baseline) and 3 months after the start of treatment. Binary logistic regression was used to identify predictors of psychiatric complications. 80 patients were enrolled in this study and 8 patients were diagnosed with psychiatric complications at base line. Among the rest 72 patients, 8 patients (11.11%) had new-onset psychiatric complications at 3-month follow-up. Gender (Odds Ratio (OR) = 1.674, p = 0.019), monthly income (OR = 1.735, p = 0.023) and sadness (M.D. Anderson Symptom Inventory (MDASI)) (OR = 1.804, p = 0.001) were all predictors for psychiatric complications in patients with pancreatic cancer. Gender, monthly income and MDASI score are predictors of psychiatric complications in patients with pancreatic cancer.

Development of the Food Addiction Symptom Inventory: The first clinical interview to assess ultra-processed food addiction.

Prior research on ultra-processed food addiction (FA) has utilized the self-report Yale Food Addiction Scale (YFAS) measures to identify individuals who experience indicators of substance-use disorders with respect to their consumption of ultra-processed foods. Studies using the YFAS have provided insight into the clinical utility of FA as both a distinct construct and an indicator of more severe psychopathology among individuals with eating disorders. However, the absence of clinician-administered assessment tools for FA has been identified as a barrier to the evaluation of FA as a novel clinical syndrome. Thus, the present study reflects the development of the Food Addiction Symptom Inventory (FASI), a clinician-administered assessment of FA, adapted from the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fifth editon modules for diagnosing substance-use disorders. The psychometric properties of the FASI and its concordance with the YFAS 2.0 were evaluated in a cross-sectional study of adults (n = 53) with binge-type eating disorders. The FASI performed appropriately on indices of reliability and validity. Concordance between the FASI and YFAS 2.0 was established for the symptom scores (r = .53, p < .001), and > 70% agreement was achieved for FA categorization. Using the FASI, 80% of individuals with bulimia nervosa and 91.7% of those with binge eating disorder were identified as exhibiting FA. While the YFAS 2.0 and FASI both lead to similar assessments of FA symptoms, the FASI provides an essential approach for clinician-guided identification of this phenotype, which may be particularly important when participants have high levels of dietary restraint or limited insight into the impact of their eating behavior. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effects of Mandala Coloring and Free Coloring on Mindfulness and the Score of Posttraumatic Stress Disorder in Veterans: A Randomized Controlled Trial.

Due to the nature of the events in war, posttraumatic stress disorder (PTSD) is more difficult to treat in veterans than in other people. Nowadays, using art-making methods such as mandala coloring has attracted the attention of researchers. This randomized controlled trial was conducted with 84 male veterans diagnosed with PTSD. Veterans were recruited by convenience sampling method and randomly assigned to an intervention group (n=42) and a control group (n=42). Participants in the intervention group colored a mandala, whereas the control group colored freely for 15minutes 2 times a week for 3weeks. All participants completed Brown and Ryan's Mindful Attention Awareness Scale and Posttraumatic Stress Disorder Checklist for diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Mean baseline mindfulness scores were not significantly different between the mandala coloring group and the free coloring group (41.73±5.29 vs 40.23±4.59, P =.169). After the intervention, the mean mindfulness score was significantly higher in the mandala coloring group than in the free coloring group (52.23±5.89 vs 46.04±7.28, P <.001). Mean baseline PTSD scores were not significantly different between the mandala coloring group and the free coloring group (65.45±5.89 vs 67.47±4.66, P =.085). After the intervention, the mean PTSD score was significantly lower in the mandala coloring group than in the free coloring group (47.21±5.77 vs 52.38±5.52, P <.001). Both mandala coloring and free coloring increase mindfulness and decrease PTSD symptom severity. However, the mandala coloring method was more effective.

Exploring the Perceptions of Indian Mental Health Professionals Regarding Areca (Betel) Nut Products: A Cross-sectional Study

Background: Areca nut (AN) and AN products (ANPs) are commonly used as psychoactive substances with marked dependence potential. Scant information exists on the Indian mental health professionals’ (MHPs) knowledge of AN-ANPs, attitude toward AN-ANP use/users, and behavior regarding their clients’ AN-ANP use. To address this gap, a survey was undertaken to assess MHPs’ knowledge, attitudes, and behavioral responses toward AN-ANP use and addiction. Methods: We developed a pretested, customized questionnaire and conducted a cross-sectional online survey among a random sample of MHPs. Results: The 209 respondents included 91 psychiatrists, 105 clinical psychologists, and 13 other MHPs from diverse settings. Among them, 46.89% believed that AN-ANP use does not fit the definition of abuse/addiction as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition or International Classification of Diseases 10th Revision (ICD-10)/ICD-11. Among the psychiatrists, clinical psychologists, and other MHPs, 60.4%, 48.6%, and 61.5% were unaware of any AN-ANP cessation protocols. The addictive potential of AN-ANP with tobacco was rated as severe by 68.1% of psychiatrists and 51.4% of clinical psychologists; 46.2% of other MHPs rated it as moderate. The addictive potential of AN-ANP without tobacco was rated as moderate by 50.5% of clinical psychologists and mild by 46.2% of psychiatrists. Of the sample, 67.46% discussed the harmful effects of AN-ANPs with clients, while 74.6% said a few or none of their clients sought help for AN-ANP cessation. Conclusion: Major lacunae were detected in the understanding of Indian MHPs about the addictive potential of AN-ANPs, management aspects, etc. An urgent need has been revealed for sensitization programs on AN-ANPs and the development of evidence-based cessation protocols.

Perspectives of Thai Transgender Adults on Diagnostic Criteria for Transsexualism, Gender Incongruence, and Gender Dysphoria

Objectives Our study aimed to assess perspectives of the Thai transgender adults toward three diagnostic criteria: 1) transsexualism (the World Health Organisation’s International Statistical Classification of Diseases and Related Health Problems, tenth revision; ICD-10), 2) gender incongruence (the International Classification of Diseases, eleventh revision; ICD-11), and 3) gender dysphoria (the Diagnostic and Statistical Manual of Mental Disorders, fifth edition; DSM-5). We also gathered comments and suggestions on these criteria for future refinement, especially specific to Thai sociocultural contexts. Methods During February to November 2023, we conducted a survey among transgender individuals from five major Thai transgender communities. Participants were requested to 1) indicate their agreement whether each criterion could describe their identity and be suitable for the Thai transgender community using ten-point Likert scales, 2) select three keywords from each criterion and one most appropriate criterion, and 3) provide additional suggestions. Results A total of 266 transgender individuals, participated in the study (62.4% and 25.2% transgender men and women, and 12.4% other identities). Both ICD-10 and DSM-5 criteria received the highest levels of agreement, averaging scores of 8.7 across most categories. Suggestions for refining criteria included a sufficiently long duration, using terms indicating inclusivity of all identities as a person, and noting positive outcomes of transitioning within the criteria. Conclusions The DSM-5 criteria garnered the highest levels of agreement in terms of identity description and suitability for the Thai sociocultural contexts. Nonetheless, further refinement can be improved, especially to ensure the inclusivity of transgender individuals with identities beyond the binary.

Do help-seeking adolescents report more psychotic-like experiences than young adults on the 16-item version of the prodromal questionnaire (PQ-16)?

To compare psychotic-like experiences (PLEs) in adolescents and young adults referred to the Mental Health Services (MHSs). Participants scored the 16-item Prodromal Questionnaire (PQ-16) as part of the intake procedure. Data on the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification and demographic data were collected. The PQ-16 was completed by 13 783 respondents (mean age 24.63 years, SD = 6.09; 62.6% female). Overall, the scores on the PQ-16 were not higher for adolescents (11-17 years; m = 4.84, SD = 3.62) than for young adults (18-35 years; m = 5.47, SD = 3.85). On PQ-16 item level, adolescents reported seeing and hearing things more than adults did. Across all age groups, males scored lower on the PQ-16 than females. Specifically, adolescent males scored lower than other participants. For adolescents and young adults alike, PQ-16 scores were higher for participants with borderline personality disorder, PTSD, and mood disorder than for those with other DSM classifications. Although help-seeking adolescents did not score higher on the PQ-16 than help-seeking young adults, more of them reported perceptual anomalies. Irrespective of age, participants with borderline personality disorder, PTSD and mood disorder scored higher on the PQ-16 than those with other DSM classifications.

Modified Dead–Alive Test for the assessment of semantic and episodic memory performance of older patients with neurocognitive disorder

The aim of this study is to provide a test that allows for evaluation of both semantic memory (SM) and episodic memory (EM). The study sought to examine psychometric characteristics of the Modified Dead–Alive Test (M-DAT) in patients with neurocognitive disorders and the healthy elderly (HE). The M-DAT consists of 45 names of celebrities who have died in the remote past (15), died in the last five years (15), and are still alive (15), and participants are asked whether they are alive or dead. The M-DAT performances of patients with Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) major neurocognitive disorder due to Alzheimer’s Disease (MND-AD) (n = 69) and patients with minor neurocognitive disorder (MiND) (n = 27) who were admitted to a geriatric psychiatry clinic and healthy controls (HC) (n = 29) were compared. Age and level of education were taken as covariates, and an analysis of covariance (ANCOVA) was performed since the MND-AD group was older and less educated. The MND-AD group had lower performance in EM and SM scores of the M-DAT. M-DAT failed to differentiate between MiND and HE. Both subscale scores of the M-DAT were associated with other neuropsychological test performances as well as the level of education. The results suggest that M-DAT is a valid and reliable tool that examines both EM and SM performances. M-DAT is an alternative for the assessment of SM evaluated by verbal fluency or naming tests. Evaluating EM and SM together is an important advantage; however, M-DAT is influenced by education, and the items require updating.

Maternal mental health, marital adjustment, and family support in the grieving process after a pregnancy loss

Pregnancy loss can have a profound impact on a woman’s psychological and emotional health often leading to a grieving process. Furthermore, the loss of a child is a risk factor for Prolonged Grief Disorder (PGD) according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-Text Revision (DSM-5-TR). This cross-sectional study investigated the associations between mental health, marital adjustment, family support, gestational age, and prolonged grief. We recruited 93 women who had lost a pregnancy and had a living child born after the loss. Maternal mental health and gestational age at the time of loss were the variables most correlated with prolonged grief symptoms. A network model further confirmed the results and highlighted the importance of adopting a systemic and interactive approach to these and the other variables of interest related to pregnancy loss. Raising awareness regarding mental healthcare and support networks for mothers after pregnancy loss is essential.

A tradeoff between safety and freedom: Adults’ lived experiences of ARFID

BackgroundAvoidant restrictive food intake disorder (ARFID) is characterized as a pattern of restrictive eating leading to significant medical and/or psychosocial impairment (American Psychiatric Association in Diagnostic and statistical manual of mental disorders, American Psychiatric Association, Washington, D.C., 2013). Most existing research on ARFID utilizes quantitative methodologies to study children and adolescents. As a result, the experiences of adults with ARFID have been underrepresented in research. To fill this gap, the current study examines the lived experiences of adults with a DSM-5 diagnosis of ARFID.MethodParticipants (n = 9) included adult women aged 20–42 (M = 27, SD = 6.2) recruited from social media advertising. Open-ended, semi-structured interviews were conducted. Data were analyzed using interpretative phenomenological analysis (IPA).ResultsOne of three overarching themes identified by IPA will be discussed in this study: “A tradeoff between safety and freedom,” which consists of two subthemes: (a) Ensuring safety from food unknowns and (c) Longing for Freedom. This overarching theme explores the influence of ARFID on an individual’s sense of safety and freedom.DiscussionThis study is one of few to qualitatively examine ARFID, and the only to do so using IPA. Findings offer novel insights relevant to researchers and clinicians who treat adults with ARFID and who wish to increase consideration and understanding of patient lived experience in their work.

Clinical Utility of Impact of Event Scale-Revised for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition Posttraumatic Stress Disorder.

The Impact of Event Scale-Revised (IES-R) is a widely used self-report for assessing posttraumatic stress disorder (PTSD), originally aligned with Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV diagnostic criteria. This study aimed to evaluate the applicability of the IES-R under the DSM-5 guidelines and establish a cutoff point for DSM-5 PTSD diagnosis. A total of 238 participants recruited from multiple psychiatric centers, including 67 patients with PTSD, 72 patients with psychiatric controls, and 99 healthy controls, were included in the study. All participants completed the Korean version of the Structured Clinical Interview for the DSM-5 research version to confirm the presence of PTSD, the Korean version of PTSD Checklist for DSM-5 (PCL-5), the Beck Depression Inventory-II, the Beck Anxiety Inventory, and the Spielberger State Trait Anxiety Inventory. The IES-R demonstrated good internal consistency and a high correlation with the PCL-5. Through factor analysis, 5 distinct dimensions emerged within the IES-R: sleep disturbance, intrusion, hyperarousal, avoidance, and numbness-dissociation. A proposed cutoff score of 25 on the IES-R was suggested for identifying patients with PTSD. These findings underscore the scale's concurrent validity with the DSM-5 PTSD criteria and its effectiveness as a screening tool. Implementing a cutoff score of 25 on the IES-R can enhance its utility in identifying DSM-5 PTSD cases.

Lung function in relation to brain aging and cognitive transitions in older adults: A population-based cohort study.

We investigated the association of peak expiratory flow (PEF) with dementia; cognitive impairment, no dementia (CIND); and transition from CIND to dementia, and possible underlying neuropathological mechanisms. A population-based cohort of adults aged 60+ was followed over 15 years to detect dementia (Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria), CIND (assessed through a cognitive battery), and progression from CIND to dementia, in relation to baseline PEF observations. A subsample (n=462) had 6-year follow-up data on brain magnetic resonance imaging markers of neurodegeneration and small vessel disease. In fully adjusted models, poor PEF performance (< 10th vs. ≥ 80th percentile) was associated with increased hazards for dementia (hazard ratio [HR]=1.89; 95% confidence interval [CI]=1.23-2.92) and CIND (HR=1.55; 95% CI=1.01-2.38) and CIND progression to dementia, although not statistically significantly (HR=2.44; 95% CI=0.78-6.88). People with poor PEF also experienced the fastest ventricular enlargement (β coefficient=0.67mL/year; 95% CI=0.13-1.21) and had the highest likelihood of developing lacunes (odds ratio=5.05; 95%CI=1.01-25.23). Poor lung function contributes to cognitive deterioration possibly through accelerated brain atrophy and microvascular damage. Poor lung function increased the risk of dementia and mild cognitive impairment (MCI). Poor lung function accelerated the progression from MCI to dementia. Poor lung function was linked to brain microvascular damage and global brain atrophy.

Gastrointestinal Symptoms in Autism Spectrum Disorder: A Case-Control Study.

Background and objectives This study aimed to explore the frequency of gastrointestinal (GI) symptoms and associated risk factors among children with autism spectrum disorder (ASD). Methods This was a retrospective case-control study including children aged 2-14 years diagnosed with ASD by the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria and the assessment card in the ASD center at King Salman Armed Forces Hospital. Data were obtained using a self-developed questionnaire that included demographic features, nutritional and behavioral characteristics, and GI symptoms in the previous six months. The control group consisted of typically developing (TD) children matched to the ASD group for age and gender. Syndromic autism with defined somatic abnormalities and recognized genetic causes (e.g., fragile X syndrome, tuberous sclerosis) were excluded Results A total of 146 ASD children and 114 normal children were included. No significant demographic differences were found between the groups. The ASD group had a higher frequency of low income and a significantly lower rate of exclusive breastfeeding in the first six months. GI symptoms, specifically constipation, abdominal gases and distension, diarrhea, undigested food particles in stool, and mouth ulcers, were significantly more frequent in the ASD group. Weight abnormalities (both increase and decrease) were also more common. Family history of ASD was significantly more in ASD children with GI symptoms while low maternal education was more in those without. Conclusion This study reveals a high prevalence of GI symptoms in ASD children. Family history of ASD and maternal education may influence the GI symptoms reported in ASD children.

Suvorexant for Reduction of Delirium in Older Adults After Hospitalization

Delirium is common among older hospitalized adults. In addition to presenting immediate management issues, delirium can increase the long-term risk of dementia, institutionalization, and mortality. Delirium is associated with disrupted sleep, and prior studies suggest that some specific sleep-promoting agents may reduce delirium. To evaluate the orexin receptor antagonist suvorexant for reducing delirium in older adults at high risk for delirium after hospitalization. This double-blind, placebo-controlled, phase 3 randomized clinical trial was conducted at 50 hospitals in Japan between October 22, 2020, and December 23, 2022. The study population included Japanese adults aged 65 to 90 years who were at high risk for delirium (mild cognitive impairment or mild dementia, history of delirium at prior hospitalization, or both) and had been hospitalized for acute disease or elective surgery. Data analysis was performed between January 23 and March 13, 2023. Participants were randomized 1:1 to suvorexant (15 mg) or placebo taken at bedtime for up to 7 days while in the hospital. Delirium, the primary end point, was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria while participants were hospitalized. The treatment difference in the proportion of participants with delirium was analyzed. This study included 203 participants: 101 were treated with suvorexant (mean [SD] age, 81.5 [4.5]; years; 52 men [51.5%] and 49 women [48.5%]) and 102 received placebo (mean [SD] age, 82.0 [4.9] years; 45 men [44.1%] and 57 women [55.9%]). There were 17 participants with delirium (16.8%) in the suvorexant group compared with 27 (26.5%) in the placebo group (difference, -8.7% [95% CI, -20.1% to 2.6%]; P = .13). Adverse events were similar between the 2 groups. In this randomized clinical trial of suvorexant in older adults at high risk for delirium after hospitalization, fewer participants taking suvorexant had delirium compared with placebo, but the difference was not statistically significant. Further studies are needed to determine whether suvorexant may be useful for reducing delirium, particularly delirium with a hyperactive component, in this population. ClinicalTrials.gov Identifier: NCT04571944.

Psychiatric Diagnosis: A Clinical Guide to Navigating Diagnostic Pluralism.

The controversies surrounding the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases have generated significant debate across the psy-sciences. This debate has been further fueled by the launch of the Research Domain Criteria as a framework to facilitate advances in neuroscientific research, a renewed emphasis on dimensional models of psychopathology, currently exemplified by the Hierarchical Taxonomy of Psychopathology, and development of the Psychodynamic Diagnostic Manual by the psychodynamic community. In this article, we provide a clinical overview of recent debates surrounding categorical and dimensional approaches to psychiatric diagnosis, offer a critical assessment of proposed alternatives, and discuss how clinicians can navigate a plurality of diagnostic frameworks. Our discussion emphasizes that diagnostic frameworks need to be contextualized within the process of a comprehensive clinical evaluation, and their advantages and disadvantages should be understood in relationship to the theoretical orientations and practical needs of clinicians.

Prevalence and Associated Risk Factors of Insomnia Among Adults in Riyadh, Saudi Arabia.

Background Insomnia is a common sleep disorder with significant effects on physical and mental health. This study aimed to document the prevalence of insomnia and its associated risk factors among adults in Riyadh, Saudi Arabia. Materials and methods A cross-sectional study was conducted in Riyadh using the Sleep Condition Indicator Questionnaire (SCIQ). Data were collected from 548 participants. The inclusion criteria encompassed adults aged 18 and above living in Riyadh, Saudi Arabia. Information on sociodemographic characteristics, medical history, and sleep patterns was gathered through a translated eight-itemSCIQ (score ≤16=insomnia). Statistical analysis involved descriptive and inferential statistics using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States). Results The findings revealed a significant prevalence of insomnia, affecting 219 individuals (40%). Insomnia was significantly associated with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, including difficulty initiating or maintaining sleep, frequency of sleep disturbances, significant distress, and duration of sleep disturbances (p<0.001 for each). The highest prevalence of insomnia was observed in the 40-60-year age group (n=91, 45.7%, p=0.014), among smokers (n=27, 60%, p=0.0063), and among obese individuals (n=20, 54.1%, p=0.035). Additionally, insomnia was strongly associated with anxiety (n=49, 66.2%, p<0.001), depression (n=27, 54%, p=0.033), and hypertension (n=24, 58.5%, p=0.011). Conclusion This study highlighted the high prevalence of insomnia among adults in Riyadh, particularly among older adults, smokers, and those with chronic health conditions. These findings underscore the need for targeted interventions to address insomnia and its associated risk factors. Future research should focus on longitudinal studies to establish causal relationships and explore the impacts of lifestyle and genetic factors on insomnia.

Negative affect variability as a potential mechanism of behavior change in alcohol use disorder treatment.

Negative affect and affect variability figure prominently in models of addictive behaviors but are not without controversy. Negative affect variability may better capture a mechanism of behavior change in alcohol use disorder (AUD) treatment because it contains information about affect regulation, a common clinical target. The aims of this study are to examine the change in: (a) trajectory of negative affect variability, (b) association of negative affect variability and abstinence, and (c) association of negative affect variability and heavy drinking during AUD treatment. This article is a secondary analysis of data drawn from a randomized clinical trial. N = 181 participants diagnosed with Diagnostic and Statistical Manual of Mental Disorders, fifth edition AUD (Mage = 50.8, SDage = 10.6; 51.4% female) received 12 sessions of Cognitive Behavioral Coping Skills Therapy for AUD. Participants completed one daily diary prompt per day for 84 consecutive days. Each day, participants reported on negative affect and number of alcoholic drinks consumed the previous day. Time-varying effect models examined changes in negative affect variability and its associations with abstinence and heavy drinking. Negative affect variability decreased throughout treatment. The positive association between negative affect variability and heavy drinking became nonsignificant (decoupled) midway through treatment. The inverse association between negative affect variability and daily abstinence became nonsignificant (decoupled) at approximately day 75 of 84. When mean levels of NA were added as a covariate, the effects were in the same direction but no longer statistically significant. Reductions in negative affect variability may capture an important change mechanism of behavioral treatments for AUD because it contains information about affect regulation as compared with mean levels of negative affect. Negative affect variability warrants further consideration as a mechanism of behavior change. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Characterization of Bipolar Disorder I and II: Clinical Features, Comorbidities, and Pharmacological Pattern.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition provides precise diagnostic criteria to differentiate between bipolar disorder (BD) type I and II; nevertheless, it can be challenging to come up with the right diagnosis. The aim of this study is to evaluate the sociodemographic differences, clinical features, comorbidities, and pharmacological pattern between patients with BD type I and II. A total of 680 patients with BD type I and II were consecutively recruited to our psychiatry department. A semi-structured interview was used to collect several information. Patients with BD type I were mostly males, single, with a lower current age, and unemployed compared to patients with BD type II. Furthermore, patients with BD type I showed an earlier age at onset and a significant higher prevalence of psychotic and residual symptoms, a higher number of hospitalizations, and involuntary admissions. On the other hand, patients with BD type II were associated with a significant higher prevalence of lifetime suicide attempts, psychiatric comorbidities, and use of alcohol. Finally, antidepressant drugs were prescribed more often to patients with BD type II, while antipsychotics and mood stabilizers were mostly prescribed in patients with BD type I. the differentiation of the 2 nosologic bipolar diagnosis is in line with the current scientific interest, confirming the existence of a markedly different profile between BD type I and II. This differentiation could reduce the heterogeneity of bipolar presentation in research, optimize clinical assessment, and increase the interest in developing more precise and individualized therapeutic strategies, also implementing psychosocial therapies.