Understanding Of Mental Disorders Research Articles

Models in Psychiatry: The Science and Mythology of understanding Mental disorder

Models in Psychiatry: The Science and Mythology of understanding Mental disorder

'They accused me of strangling her': epilepsy and violence debate in Croatia at the end of the nineteenth and the beginning of the twentieth centuries.

Nineteenth-century psychiatry shifted its focus to the brain as the seat of mental disorders. With a new understanding of mental disorders arose the need to consult forensic psychiatrists in cases of criminal acts committed by persons with mental illness. This article focuses on three murders committed by 'epileptics' at the end of the nineteenth and the beginning of the twentieth centuries in Croatia. An analysis of these cases will help to situate forensic psychiatry at the turn of the century within the Austro-Hungarian Empire, and reveal the authority that forensic experts wielded in the courts. We will argue that Cesare Lombroso's biological theory of crime, as well as the influence of eugenicists and pharmaceutical companies, shaped the long-standing relationship between epilepsy and violent behaviour.

Application of network methods for understanding mental disorders: pitfalls and promise.

Galvanized with the availability of sophisticated statistical techniques and large datasets, network medicine has emerged as an active area of investigation. Following this trend, network methods have been utilized to understand the interplay between symptoms of mental disorders. This realistic approach that may provide an improved framework into understanding mental conditions and underlying mechanisms is certainly to be welcomed. However, we have noticed that symptom network studies tend to lose sight of the fundamentals, overlook major limitations embedded in study designs, and make inferences that are difficult to justify with current findings. There is concern that disregarding these flaws may halt the progress of the network approach in psychiatry. Therefore, in this paper, we first attempt to identify the pitfalls: (1) a reductionist understanding of medicine and psychiatry, thereby inadvertently reintroducing the dichotomy of medicine (lung cancer) and psychiatry (depression), (2) a shortsighted view of signs and symptoms, (3) overlooking the limitations of available datasets based on scales with embedded latent class structures, (4) overestimating the importance of the current findings beyond what is supported by the study design. By addressing current issues, the hope is to navigate this rapidly growing field to a more methodologically sound and reproducible path that will contribute to our understanding of mental disorders and its underlying mechanisms.

The Construction of Socio-Cultural Stigmatization of Mental Disorders: A Study on the Forms and Factors of Stigma


 
 
 
 The construction of socio-cultural stigmatization on the understanding of mental disorders is particularly interesting to study in the people with mental disorders who received treatment at the Mental Hospital. Mental disorder is a disease caused by the chaos of thoughts, perceptions and behavior in which the individualaare not able to adjust to themselves, other people, society and the environment. By applying the cultural studies viewpoint that is siding with the oppressed, the study aims to determine the forms and factors causing the stigma of people with mental disorders. The research method used is observation, in-depth interviews and life history data collection. The collected data were then analyzed using qualitative descriptive and interpretative. The results showed that the forms of stigma with mental disorders are divided into two, namely the public stigma (stigma derived from the community) and self-stigma (stigma comes from the patient and his own family). The forms of the public stigma include rejection, exclusion, and violence. The self-stigma takes the forms, among others, prejudice, guilt, fear and anger. Factors behind the stigma of mental disorders are external and internal factors. External factors include, among others, the madness is a disgrace, the myth of mental illness, and people's belief regarding the role of dukun. While the internal factors are family knowledge of the etiology of mental disorders, lack of family support and feelings of shame.
 
 
 

A symptom network structure of the psychosis spectrum

Current diagnostic systems mainly focus on symptoms needed to classify patients with a specific mental disorder and do not take into account the variation in co-occurring symptoms and the interaction between the symptoms themselves. The innovative network approach aims to further our understanding of mental disorders by focusing on meaningful connections between individual symptoms of a disorder and has thus far proven valuable insights to psychopathology. The aims of current study were to I) construct a symptom network and investigate interactions between a wide array of psychotic symptoms; II) identify the most important symptoms within this network and III) perform an explorative shortest pathway analysis between depressive and delusional symptoms.We analyzed interview data from n=408 male patients with non-affective psychosis using the Comprehensive Assessment of Symptoms and History (CASH). A network structure of 79 symptoms was computed to explore partial correlations between positive, negative, catatonia and affective symptoms.The resulting network showed strong connectivity between individual symptoms of the CASH, both within- and between-domains. Most central symptoms included ‘loss of interest’, ‘chaotic speech’, ‘inability to enjoy recreational interest in activities’, ‘inability to form or maintain relationships with friends’ and ‘poverty of content of speech’. The shortest pathway analysis between depressive and delusional symptoms displayed an important role for ‘persecutory delusions’.In conclusion, this study showed that individual psychotic symptoms are meaningfully related to each other not only within their own cluster, but also between different clusters and that important information may be acquired by investigating interactions at a symptom level.

A Deletion Variant of the α2b-Adrenoceptor Modulates the Stress-Induced Shift from "Cognitive" to "Habit" Memory.

Stress induces a shift from hippocampus-based "cognitive" toward dorsal striatum-based "habitual" learning and memory. This shift is thought to have important implications for stress-related psychopathologies, including post-traumatic stress disorder (PTSD). However, there is large individual variability in the stress-induced bias toward habit memory, and the factors underlying this variability are completely unknown. Here we hypothesized that a functional deletion variant of the gene encoding the α2b-adrenoceptor (ADRA2B), which has been linked to emotional memory processes and increased PTSD risk, modulates the stress-induced shift from cognitive toward habit memory. In two independent experimental studies, healthy humans were genotyped for the ADRA2B deletion variant. After a stress or control manipulation, participants completed a dual-solution learning task while electroencephalographic (Study I) or fMRI measurements (Study II) were taken. Carriers compared with noncarriers of the ADRA2B deletion variant exhibited a significantly reduced bias toward habit memory after stress. fMRI results indicated that, whereas noncarriers of the ADRA2B deletion variant showed increased functional connectivity between amygdala and putamen after stress, this increase in connectivity was absent in carriers of the deletion variant, who instead showed overall enhanced connectivity between amygdala and entorhinal cortex. Our results indicate that a common genetic variation of the noradrenergic system modulates the impact of stress on the balance between cognitive and habitual memory systems, most likely via altered amygdala orchestration of these systems.SIGNIFICANCE STATEMENT Stressful events have a powerful effect on human learning and memory. Specifically, accumulating evidence suggests that stress favors more rigid dorsal striatum-dependent habit memory, at the expense of flexible hippocampus-dependent cognitive memory. Although this shift may have important implications for understanding mental disorders, such as post-traumatic stress disorder, little is known about the source of individual differences in the sensitivity for the stress-induced bias toward habit memory. We report here that a common genetic variation of the noradrenergic system, a known risk factor for post-traumatic stress disorder, modulates the stress-induced shift from cognitive to habit memory, most likely through altered crosstalk between the hippocampus and dorsal striatum with the amygdala, a key structure in emotional memory.

THE THEORETICAL INTEGRATIVE MODEL FOR THE LATVIAN CLINICAL PERSONALITY INVENTORY

The purpose of this article is to present a theoretical integrative model, which reflects contemporary tendencies in the understanding of mental disorders and functional impairment, and which is used as a theoretical frame for the development of the Latvian Clinical Personality Inventory (LCPI). This article, based on the latest research findings in the field, supports the necessity of a combined analysis of mental disorders and functional impairment. Due to scientific findings and deeper understanding of the interrelation between mental disorders and functioning impairment, it has become possible to develop psychological instruments for valid assessment of the disturbances in an individual's cognition, emotion regulation, and behaviour combining with analysis of most essential and relevant aspects of their functioning. An integrative theoretical model of LCPI, developed on the selected criteria from Diagnostic and Statistical Manual of Mental Disorders (DSM – 5; APA, 2013) and WHO International Classification of Functioning, Disability and Health (ICF; WHO, 2001/2015) is presented in the article. Conducted literature analysis permits to conclude, that in a context of clinical personality assessment, a combined analysis of symptoms of mental disorders and relevant functioning criteria is very promising and will be useful in many assessment contexts. Based on such an integrative approach the Latvian Clinical Personality Inventory is currently being developed. This project is a part of the National Research Programme (No. 5.8.2.).

Editorial: Endophenotypes for Schizophrenia and Mood Disorders: Implications from Genetic, Biochemical, Cognitive, Behavioral, and Neuroimaging Studies.

Editorial: Endophenotypes for Schizophrenia and Mood Disorders: Implications from Genetic, Biochemical, Cognitive, Behavioral, and Neuroimaging Studies.

Affective responses across psychiatric disorders—A dimensional approach

Studying psychiatric disorders across nosological boundaries aims at a better understanding of mental disorders by identifying comprehensive signatures of core symptoms. Here, we studied neurobiological correlates of emotion processing in several major psychiatric disorders. We assessed differences between diagnostic groups, and investigated whether there is a psychopathological correlate of emotion processing that transcends disorder categories. 135 patient with psychiatric disorders (alcohol dependence, n=29; schizophrenia, n=37; major depressive disorder (MDD), n=25; acute manic episode of bipolar disorder, n=12; panic disorder, n=12, attention deficit/hyperactivity disorder (ADHD), n=20) and healthy controls (n=40) underwent an functional magnetic resonance imaging (fMRI) experiment with affectively positive, aversive and neutral pictures from the International Affective Picture System (IAPS). Between-group differences were assessed with full-factorial ANOVAs, with age, gender and smoking habits as covariates. Self-ratings of depressed mood and anxiety were correlated with activation clusters showing significant stimulus-evoked fMRI activation. Furthermore, we examined functional connectivity with the amygdala as seed region during the processing of aversive pictures. During the presentation of pleasant stimuli, we observed across all subjects significant activation of the ventromedial prefrontal cortex (vmPFC), bilateral middle temporal gyrus and right precuneus, while a significant activation of the left amygdala and the bilateral middle temporal gyrus was found during the presentation of aversive stimuli. We did neither find any significant interaction with diagnostic group, nor any correlation with depression and anxiety scores at the activated clusters or with amygdala connectivity. Positive and aversive IAPS-stimuli were consistently processed in limbic and prefrontal brain areas, irrespective of diagnostic category. A dimensional correlate of these neural activation patterns was not found.

A Reconciliation for the Future of Psychiatry: Both Folk Psychology and Cognitive Science

Philosophy of psychiatry faces a tough choice between two competing ways of understanding mental disorders. The folk psychology (FP) view puts our everyday normative conceptual scheme in the driver’s seat – on the assumption that it, and it only, tells us what mental disorders are (1). Opposing this, the scientific image (SI) view (2, 3) holds that our understanding of mental disorders must come, wholly and solely, from the sciences of the mind, unfettered by FP. This paper argues that the FP view is problematic because it is too limited: there is more to the mind than FP allows; hence, we must look beyond FP for properly deep and illuminating explanations of mental disorders. SI promises just this. But when cast in its standard cognitivist formulations, SI is unnecessarily and unjustifiably neurocentric. After rejecting both the FP view, in its pure form, and SI view, in its popular cognitivist renderings, this paper concludes that a more liberal version of SI can accommodate what is best in both views – once SI is so formulated and the FP view properly edited and significantly revised, the two views can be reconciled and combined to provide a sound philosophical basis for a future psychiatry.

Entrenched reductionisms: The bête noire of psychiatry.

Like Hannah Decker, I too deplore the destructive battle of psychosocial and biological reductionisms that has bedeviled psychiatry. When I started my psychiatric training almost 50 years ago, the prevailing model for understanding mental disorders was broadly bio/psycho/social in the grand tradition of Pinel and Freud, brought to and adapted in America by Adolph Meyer. When psychiatry is practiced well, it integrates insights from all the different ways of understanding human nature. Unfortunately, the mental health field has since degenerated into a civil war between the biomedical and psychosocial models with little room for compromise or finding middle ground. The inflexible biological reductionists assume that genes are destiny and that there is a pill for every problem: they take a "mindless" position. The inflexible psychosocial reductionists assume that mental health problems all arise from unpleasant experience: They take a "brainless" position. I have spent a good deal of frustrating time trying to open the minds of extremists at both ends, though rarely making much headway. In my view, however, and where I differ from Decker, the reductionisms do not sort so neatly into alternating historical periods.

Neural Binding, Consciousness, and Mental Disorders: Complexity as a Common Element

Abstract Concepts from complex systems have been widely used in model building and experiments in neuroscience. This article presents a short overview of synchronization and chaos theory in studies of perception, and consciousness. In addition, these findings seem to have serious implications for the understanding of mental disorders. Finally some consequences for the future of psychiatry are discussed.

Finding a solution to psychosis: the emergence of a new path.

SummaryThe transition from a dichotomous diagnostic classification system to the more holistic approach to understanding mental disorders engendered by the so-called biopsychosocial model has definite advantages, but it runs the risk of sacrificing methodological rigor to achieve all-inclusiveness. The Special Article by Bebbington on understanding psychosis in this issue attempts to show that high-quality psychosocial epidemiological research on the development of psychosis can, at least partially, overcome these limitations. Bebbington’s emphasis on the importance of non-psychotic symptoms such as disturbance in sleep and mood in the development of psychosis provides a new perspective on the conceptualization of psychosis, but I remain unconvinced about the usefulness of such symptoms in the differentiation of valid sub-categories of schizophrenia or other psychoses.

The global crisis of depression: the low of the 21st century?

Truly inspiring leadership for health is rare, and until November 2014, such leadership for mental health within public health seemed to have disappeared. Thanks to The Economist, I observed an inspiring address by Kofi Annan, opening a conference in London on 'The Global Crisis of Depression'. His supporting cast included politicians from the United Kingdom (Norman Lamb), Denmark (Nick Haekkerup) and Sweden (Elisabeth Svantesson); international leaders of business, economic planning and education; and political strategist Alastair Campbell's personal narrative of depression. Readers of Perspectives might value the prominent voluntary and community sector contribution (e.g. Time to Change or MQ: Transforming Mental Health). But the real leadership came from Annan, drawing on experience as Secretary-General of the United Nations (UN) and continuing advocacy for human rights, conflict resolution and the Millennium Development Goals.At the most conservative estimate, 350 million lives are overshadowed by depression.1 Depression is already the leading cause of disability in our world, with a global economic cost (2010 estimate) of US$800 billion and rising.2 Annan emphasised that lack of treatment and social support denies those who suffer their human rights (especially in critical circumstances like conflict or natural disasters). This lack of universal care is not just due to a lack of trained providers but is embedded within widespread social stigma and poor community understanding of mental disorders in general. Many wider ambitions for our world (including the Millennium Development Goals) will not be achieved without addressing depression as a global priority. Diminished work productivity may be the first problem to address. In a substantial question and answer session, Annan was at his most impressive: well-informed, evidence-based and constructive. For example, lessons learned about AIDS and employment in Brazil could be applied to the new World Health Organization (WHO) Mental Health Action Plan. Health gain was not restricted to treatment by clinicians, but non-clinical resources like teachers would play a vital part. His vision of schools and communities working together to prevent depression in young people echoed our recent asset-based review.3 Women were twice as likely to suffer from depression as men. As poor maternal mental health casts its shadow from one generation to the next, we need a new understanding of gender and depression. …

Transdiagnostic factors of psychopathology and substance use disorders: a review.

Research on the structure of mental disorders and comorbidity indicates that many forms of psychopathology and substance use disorders are manifestations of relatively few transdiagnostic latent factors. These factors have important consequences for mental disorder research and applied practice. We provide an overview of the transdiagnostic factor literature, with particular focus on recent advances. Internalizing and externalizing transdiagnostic factors have been well characterized in terms of their structures, links with disorders, stability, and statistical properties (e.g., invariance and distributions). Research on additional transdiagnostic factors, such as thought disorder, is quickly advancing latent structural models, as are integrations of transdiagnostic constructs with personality traits. Genetically informed analyses continue to clarify the origins of transdiagnostic factor levels, and links between these factors and important environmental exposures provide promising new avenues of inquiry. Transdiagnostic factors account for the development and continuity of disorders and comorbidity over time, function as the primary links between disorders and important outcomes such as suicide, mediate associations between environmental exposures and disorders, provide an empirically supported classification system, and serve as foci for efficient, broadband intervention approaches. Overall, transdiagnostic factor research indicates the paramount importance of understanding these constructs and, thereby, broadening our understanding of mental disorder in general.

The ADHD Explosion: Myths, Medication, Money, and Today's Push for Performance

Contents Foreword by David Mechanic Acknowledgments Introduction Chapter 1: The TNT Fueling the Explosion: Origins and Costs of ADHD Chapter 2: The Nature and Causes of ADHD: Where Biology Meets Culture Chapter 3: Diagnosing and Treating ADHD: Do It Right or Pay the Price Chapter 4: Upward Spiral of ADHD Medications: Enhanced Performance or Potential for Abuse? Chapter 5: What a Difference a State Makes: How Educational Policy Determines Diagnosis and Treatment Chapter 6: The Cost of ADHD: It's the Economy, Stupid Chapter 7: ADHD and the Media: What's Being Said and What's Being Sold? Chapter 8: ADHD Around the World Chapter 9: Beyond White, Middle-Class Boys-Plus the Stigma of ADHD Chapter 10: The Future of ADHD: Predictions, Confusions, and Conclusions Notes References Index

‘Mildred Said she’d do it’: A Quaker Child Psychiatrist and Autism Pioneer *

The life of Dr Mildred Creak spanned almost the whole of the twentieth century (1898–1993) and enormous changes in the understanding of mental disorders and of how children’s wellbeing might be ensured. She made her mark as a psychiatrist despite prevailing prejudices against her sex and she was significant both in establishing the discipline of child psychiatry and for the early history of autism diagnosis. Her life and work intersected with great contemporaries in the field of psychiatry, including notable Quaker psychiatrists who, like her, enlisted during the Second World War. The contribution of Quakers to army psychiatry is relatively undocumented, especially by Quakers themselves. Mildred Creak’s professional life and Quaker commitments intersected too. She was among the group of Quakers that visited Russia in 1951, to much publicity. The author regards her as an unsung twentieth-century Quaker of significance.

What kind of science for psychiatry?

Psychiatry has invested its hopes in neuroscience as a path to understanding mental disorders and developing more effective treatments and ultimately cures. Recently, the U.S. NIMH has elaborated this vision through a new framework for mental health research, the Research Domain Criteria (RDoC). This framework aims to orient mental health research toward the discovery of underlying neurobiological and biobehavioral mechanisms of mental disorders that will eventually lead to definitive treatments. In this article we consider the rationale of the RDoC and what it reveals about implicit models of mental disorders. As an overall framework for understanding mental disorders, RDoC is impoverished and conceptually flawed. These limitations are not accidental but stem from disciplinary commitments and interests that are at odds with the larger concerns of psychiatry. A multilevel, ecosocial approach to biobehavioral systems is needed both to guide relevant neuroscience research and insure the inclusion of social processes that may be fundamental contributors to psychopathology and recovery.

Social neuroscience in psychiatry: of obvious relevance.

Cacioppo et al 1 make the important point that the study of normal and abnormal social behavior is essential in the understanding of mental disorders. Indeed, it is hard to imagine a mental disorder that does not involve, or lead to, abnormalities in social interaction. One could even say that one of the hallmarks of mental illness is that social interactions are affected. Obviously, and as argued by many, the human species is a social species and therefore its brain is developed to support social activities. The paper provides three examples of psychiatric disorders where abnormalities in social functioning are involved: major depressive disorder, antisocial personality and hypoactive sexual desire disorder. However, the relationship between abnormal social activities and these three disorders may be quite dissimilar. One could argue that in major depression the abnormalities in social interactions are secondary to the disease and may therefore be important in treatment and rehabilitation but not as important in understanding the etiology of the illness 2. In contrast, antisocial personality disorder is characterized at its core by abnormal social interaction, where the abnormality may be lifelong and of a developmental nature. Finally, hypoactive sexual desire disorder may lead to social interaction abnormalities, but these may not be the cause of the illness. The authors mention, but do not address in detail, two other mental disorders where abnormal social interaction, specifically impaired social cognition, may be a root cause of the illness: autism 3 and schizophrenia 4. Emotional and cognitive dysfunctions are the core clinical features of schizophrenia 5. Moreover, it has been argued that impairments in emotion recognition and theory of mind (ToM) may even trump the value of general cognition and symptoms in explaining outcome in schizophrenia 6. In healthy individuals, social cognition has been extensively studied using functional and structural imaging, and a network of brain regions subserving it has been identified 7. In short, the processing of facial expressions depends critically on the amygdala and the orbitofrontal cortex, whereas in mentalizing tasks, such as ToM, the medial and orbitofrontal cortex is critical 8. In schizophrenia, functional neuroimaging studies have consistently demonstrated reduced activity of the amygdala during processing of facial emotions compared to healthy controls 9, and reduced activation of the prefrontal cortex (PFC) has been related to impaired performance on ToM tasks. Indeed, a recent meta-analysis of functional imaging studies, comprising 450 schizophrenia patients and 422 healthy controls, has shown reduced amygdala and PFC activity in social cognition in schizophrenia 10. In contrast to the numerous functional neuroimaging studies in schizophrenia, only few structural imaging studies have investigated the relationship between abnormalities of the amygdala and PFC and social cognitive deficits seen in patients. So far, samples have been small (between 16 and 38 patients), and the influence of IQ and symptomatology has often been disregarded. We recently completed a study where we investigated whether social cognitive deficits in patients with schizophrenia are related to gray matter volume abnormalities of the amygdala and PFC. We assessed facial emotion recognition and ToM in 166 patients with schizophrenia and 134 healthy controls, and magnetic resonance imaging brain scans were acquired. Preliminary results suggest that reduced PFC, but not amygdala, gray matter volume is associated with social cognitive deficits in schizophrenia 11. Thus, anatomical abnormalities in schizophrenia may in part be related to social cognitive dysfunction. Whether this is specific to schizophrenia or these anatomical changes are also observed in other disorders characterized by social deficits remains to be studied. All in all, Cacioppo et al's paper makes a very important and compelling case that social neuroscience should be integrated into psychiatry and may make important contributions in understanding the etiology and sequelae of mental disorders. However, there is a lot of pioneering work that needs to be done to start understanding the role of this important human aspect in the etiology and course of psychiatric illness.

Commentary on “The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)”: Army STARRS: A Framingham-Like Study of Psychological Health Risk Factors in Soldiers

Although historically the Army suicide rate has been significantly lower than the civilian rate, in 2004, the suicide and accidental death rates began trending upward. By 2008, the Army suicide rate had risen above the national average (20.2 per 100,000). In 2009, 160 active duty Soldiers took their lives, making suicide the third leading cause of death among the Army population. If accidental death, frequently the result of high-risk behavior, is included, then more Soldiers died by their own actions than in combat in 2009. The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) was thus created in 2009 to begin to address these problems. The Army STARRS project is a large consortium of seven different studies to develop data-driven methods for mitigating or preventing suicide behaviors and improving the overall mental health and behavioral functioning of Army Soldiers during and after their Army service. The first research articles from the Army STARRS project were published in late 2013 and early 2014. This work has already begun to outline important facets of risk in the military, and it is helping to drive an empirically derived approach to improvements in understanding mental disorders and risk behavior and to improve prevention and support of mental health and resilience. The Framingham Heart Study, started in the 1940s, marked a watershed event in utilizing large cross-sectional and prospective longitudinal collaborative research to identify and understand risk factors for cardiovascular disease. The Army STARRS project, through its collaborative, prospective, and robust innovative design and implementation, may provide the beginning of a similar scientific cohort in mental disorders. The work of this project will help understand biological and psychological aspects of military service, including those leading to suicide. When coupled with timely feedback to Army leadership, it permits near real-time steps to diagnose, mitigate, and manage emerging mental health issues and the root causes of risk and resilience in Army Soldiers, with potential impact extending across many traumatized populations—not unlike a parallel process that has markedly improved survival and recovery from physical combat wounds.