DSM5

  • 文章类型: Journal Article
    在这次审查中,作者提供了关于神经性厌食症(AN)在整个生命周期中的最新认识。专注于过去5年的重要文学作品,这篇综述总结了AN领域内DSM-5的最新更新,包括新的AN诊断:非典型厌食症。本综述涵盖的其他部分包括对整个发育范围内AN的流行病学理解的改进,已被确立为黄金标准的治疗方法以及最近在治疗中探索的新方向,以及AN的生物心理社会基础的最新进展。总之,尽管这篇综述捕捉到了该领域对AN的整体概念化的几个进步,治疗和诊断能力的几个关键领域仍然需要额外的关注和研究。
    In this review, the authors provide an update on the understanding of anorexia nervosa (AN) across the lifespan. Focusing on key pieces of literature from the past 5 years, this review summarizes recent updates to DSM-5 within the domain of AN, including the addition of a new AN diagnosis: atypical anorexia. Additional sections covered in this review include improvements in the epidemiological understanding of AN across the developmental spectrum, treatment approaches that have been established as gold standard as well as new directions recently explored in treatment, and recent advancements in the biopsychosocial underpinnings of AN. Altogether, although this review captures several advancements in the field\'s overall conceptualization of AN, several key areas of treatment and diagnostic capacity continue to require additional focus and research.
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  • 文章类型: Letter
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  • 文章类型: Journal Article
    There is considerable controversy around psychiatric diagnosis generally and personality disorders specifically. Since its conception, borderline personality disorder has been controversial because of the stigma associated with the diagnosis and the therapeutic nihilism held by practitioners who encounter people with this high prevalence problem in acute settings. This paper reviews the history of the diagnosis of BPD and summarizes some of the controversy surrounding the categorical nature of diagnosis. Both the DSM 5 and ICD-11 will be discussed; however, for the purposes of this paper, the DSM 5 will take the primary focus due to greater cultural significance. Recent developments in the treatment of borderline personality disorder suggest that it is a highly treatable condition and that full clinical recovery is possible. This paper formulates an argument that despite problems with psychiatric diagnosis that are unlikely to be resolved soon, a diagnosis should be made with an accompanying formulation to enable people to receive timely and effective treatment to enable personal and clinical recovery.
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  • 文章类型: Journal Article
    BACKGROUND: Systemic lupus erythematosus (SLE) patients have high risk for depression which is a potentially life-threatening disorder.
    OBJECTIVE: To evaluate the prevalence and severity of depression in a sample of Iraqi patients with SLE if present.
    METHODS: This cross-sectional study involved 60 patients with SLE diagnosed according to revised American College of Rheumatology (ACR) classification criteria. Demographics and clinical data were collected. All patients were screened for depression by using the diagnostic and statistical manual of mental disorders-5 (DSM5) diagnostic criteria of depression. Severity of their depression was determined by using the Beck Depression Inventory criteria.
    RESULTS: The prevalence of depression was 31.7%. A severe form of depression was observed in 13.3% of SLE cases, moderate depression in 10%, and a mild degree of depression was 8.3% of the cases. Patients with high SLE disease activity index (SLEDAI score >12) had an obviously higher rate of depression (40%) compared to 20% among those with mild or moderate disease. There was no important or statistically significant difference in median SLEDAI score between depression severity categories (p > 0.05).
    CONCLUSIONS: Prevalence of depression in SLE patients was relatively high. SLE disease activity increase depression rate.
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  • 文章类型: Journal Article
    BACKGROUND: A scale aimed at measuring ambivalence among people with pachinko/pachi-slot playing disorder, the Pachinko/Pachi-Slot Playing Ambivalence Scale (PPAS), was developed and its reliability and validity ascertained.
    METHODS: A total of 522 participants (average year: 48.0) who were residing in Tokyo Metropolitan Area, and had played pachinko within the previous year completed questions relating to demographics, four gambling-related scales (including South Oaks Gambling Screen) and two general ambivalence scales (including Ambivalence over Emotional Expressiveness Questionnaire).
    RESULTS: Internal consistency (α = 0.87) and test-retest reliability (r = 0.66) were confirmed. The PPAS\'s score was associated with each related scale\'s score (r = 0.37-0.62).
    CONCLUSIONS: The PPAS was shown to be consistent with previous scales and useful in clinical settings.
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  • 文章类型: Journal Article
    In 2008, the National Institute of Mental Health (NIMH) announced that in the next few decades, it will be essential to study the various biological, psychological and social \"signatures\" of mental disorders. Along with this new \"signature\" approach to mental health disorders, modifications of DSM were introduced. One major modification consisted of incorporating a dimensional approach to mental disorders, which involved analyzing, using a transnosological approach, various factors that are commonly observed across different types of mental disorders. Although this new methodology led to interesting discussions of the DSM5 working groups, it has not been incorporated in the last version of the DSM5. Consequently, the NIMH launched the \"Research Domain Criteria\" (RDoC) framework in order to provide new ways of classifying mental illnesses based on dimensions of observable behavioral and neurobiological measures. The NIMH emphasizes that it is important to consider the benefits of dimensional measures from the perspective of psychopathology and environmental influences, and it is also important to build these dimensions on neurobiological data. The goal of this paper is to present the perspectives of DSM5 and RDoC to the science of mental health disorders and the impact of this debate on the future of human stress research. The second goal is to present the \"Signature Bank\" developed by the Institut Universitaire en Santé Mentale de Montréal (IUSMM) that has been developed in line with a dimensional and transnosological approach to mental illness.
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  • 文章类型: Journal Article
    目的:本研究旨在根据四种诊断方法评估卡顿紧张的评估者间可靠性和患病率:布什弗朗西斯卡顿紧张评定量表(BFCRS)筛查和完整量表,Braunig的Catatonia评定量表(CRS),ICD10和DSM5。
    方法:对于评估者间的可靠性,不同的评估者使用四个量表提供的定义对患者进行评估:BFCRS屏幕和总计,CRS,ICD10和DSM5。Kippendorff\'α用于计算评分者间的可靠性。使用spearman相关性评估不同系统之间的一致性。在三级护理医院的精神病区连续成人入院的临床样本中,使用四个定义研究了卡顿多症的患病率。
    结果:发现BFCRSTotal(α=0.779)的评分者间可靠性良好,DSM5和BFCRS筛选为中等(分别为α=0.575和α=0.514),CRS和ICD10为低(分别为α=0.111和α=0.018)。BFCRSTotal和DSM5定义的卡通症具有最高的一致性(rs=0.892p<0.001)。在连续住院的患病率样本中,在BFCRSScreen和ICD10的定义下,患病率最高(10.3%,置信区间[CI]3.9%至16.7%),其次是BFCRS总计和DSM5定义6.9%,CI1.6%至12.2%),而CRS的患病率最低(3.4%,CI0%至7.2%)。
    结论:用于确定临床样本中的紧张症的不同方法会产生不同的患病率。
    OBJECTIVE: The present study aimed to assess inter-rater reliability and prevalence of catatonia according to four diagnostic methods: Bush Francis Catatonia Rating Scale (BFCRS) both screening and complete scale, Braunig\'s Catatonia Rating Scale (CRS), ICD 10 and DSM5.
    METHODS: For inter-rater reliability, different raters evaluated patients using the definitions provides by the four scales: BFCRS Screen and Total, CRS, ICD10 and DSM5. Kippendorff\'α was used to compute the inter-rater reliability. Concordance between different systems was assessed using spearman correlation. Prevalence of catatonia was studied using the four definitions in a clinical sample of consecutive adult admissions in a psychiatry ward of a tertiary care hospital.
    RESULTS: The inter-rater reliability was found to be good for BFCRS Total (α=0.779), moderate for DSM5 and BFCRS screen (α=0.575 and α=0.514 respectively) and low for CRS and ICD10 (α=0.111 and α=0.018 respectively). BFCRS Total and DSM5 definitions of catatonia had highest concordance (rs=0.892 p<0.001). In the prevalence sample of consecutive hospital admissions, the prevalence was found to be highest with the definitions of BFCRS Screen and ICD 10 (10.3%, confidence intervals [CI] 3.9% to 16.7%), followed by BFCRS Total and DSM5 definitions 6.9%, CI 1.6% to 12.2%) and while CRS yielded the lowest prevalence rate (3.4%, CI 0% to 7.2%).
    CONCLUSIONS: Different methods used to determine catatonia in the clinical sample yield different prevalence of this condition.
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  • 文章类型: Journal Article
    The field of psychiatry is approaching a major inflection point. The basic science behind cognition, emotion, behavior, and social processes has been advancing rapidly in the past 20 years. However, clinical research supporting the classification system in psychiatry has not kept up with these scientific advances. To begin organizing the basic science of psychiatry in a comprehensive manner, we begin by selecting fragile X syndrome, a neurogenetic disease with cognitive-behavioral manifestations, to illustrate key concepts in an integrative, multidimensional model. Specifically, we describe key genetic and molecular mechanisms (e.g., gamma-aminobutyric acidergic dysfunction and metabotropic glutamate receptor 5-associated long-term depression) relevant to the pathophysiology of fragile X syndrome as well as neural correlates of cognitive-behavioral symptoms. We then describe what we have learned from fragile X syndrome that may be applicable to other psychiatric disorders. We conclude this review by discussing current and future opportunities in diagnosing and treating psychiatric diseases.
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  • 文章类型: Journal Article
    Persons with schizophrenia are at a high risk, almost 4.6 times more likely, of having drug abuse problems than persons without psychiatric illness. Among the influential proposals to explain such a high comorbidity rate, the \'self-medication hypothesis\' proposed that persons with schizophrenia take to drugs in an effort to cope with the illness and medication side effects. In support of the self-medication hypothesis, data from our earlier clinical study confirmed the strong association between neuroleptic dysphoria and negative subjective responses and comorbid drug abuse. Though dopamine has been consistently suspected as one of the major culprits for the development of neuroleptic dysphoria, it is only recently our neuroimaging studies correlated the emergence of neuroleptic dysphoria to the low level of striatal dopamine functioning. Similarly, more evidence has recently emerged linking low striatal dopamine with the development of vulnerability for drug addictive states in schizophrenia. The convergence of evidence from both the dysphoria and comorbidity research, implicating the role of low striatal dopamine in both conditions, has led us to propose that the person with schizophrenia who develops dysphoria and comorbid addictive disorder is likely to be one and the same.
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  • 文章类型: Journal Article
    Psychiatric and psychosocial disorders among cancer patients have been reported as a major consequence of the disease and treatment. The problems in applying a pure psychiatric approach have determined the need for structuring more defined methods, including screening for distress and emotional symptoms and a more specific psychosocial assessment, to warrant proper care to cancer patients with psychosocial problems. This review examines some of the most significant issues related to these two steps, screening and assessment of psychosocial morbidity in cancer and palliative care. With regard to this, the many different variables, such as the factors affecting individual vulnerability (e.g., life events, chronic stress and allostatic load, well-being, and health attitudes) and the psychosocial correlates of medical disease (e.g., psychiatric disturbances, psychological symptoms, illness behavior, and quality of life) which are possibly implicated not only in \"classical\" psychiatric disorders but more broadly in psychosocial suffering. Multidimensional tools [e.g., and specific psychosocially oriented interview (e.g., the Diagnostic Criteria for Psychosomatic Research)] represent a way to screen for and assess emotional distress, anxiety and depression, maladaptive coping, dysfunctional attachment, as well as other significant psychosocial dimensions secondary to cancer, such as demoralization and health anxiety. Cross-cultural issues, such as language, ethnicity, race, and religion, are also discussed as possible factors influencing the patients and families perception of illness, coping mechanisms, psychological response to a cancer diagnosis.
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