Search

Although the use of computerized testing in psychopathology assessment has increased in recent years, limited research has examined the impact of this format in terms of potential differences in test validity rates. The current study explores potential differences in the rates of valid and invalid Minnesota Multiphasic Personality Inventory—2 (MMPI-2) protocols between computerized and paper-and-pencil administrations. Participants were 387 undergraduate students (157 men and 230 women) from a Midwestern university who completed either a computerized version or a paper-and-pencil version of the MMPI-2. Chi-square analyses revealed some important differences between administration modalities by gender. Overall, results indicated that although no differences existed in the computerized version, men were more likely to invalidate the paper-and-pencil version. Furthermore, although less likely overall to produce invalid MMPI-2 results, women were more likely to invalidate the paper-and-pencil version via random responding compared with the computerized version. Limitations and future directions are discussed. [ABSTRACT FROM PUBLISHER]

The article offers information related to the impact of Intimate Partner Violence (IPV) on the children. It mentions that IPV impacts families at disturbing rates, with a considerable number of children subject to severe, chronic, and multifaceted violence. It also mentions that children exposed to IPV are at elevated risk for emergent psychopathology, including depression, posttraumatic stress disorder, and disruptive behavior disorders.

Objective: The aim of this article was to examine the concept of mental health and the policies that have been advanced to improve the wellbeing of the population. Conclusions: In the last century there have been many changes in the phenomena of psychiatric disorder, the management of those disorders and the outcomes. All of the changes have largely been due to the efforts of those working pragmatically at the coalface. There is little to suggest that the plans and programs advanced in the last half century have achieved more than enhancing the status of those who advance them. Conclusion: It is difficult to define mental health and equally difficult to develop a comprehensive program that will benefit the whole field. [ABSTRACT FROM AUTHOR]

Affect, behavior, and severity of psychopathological symptoms do not remain static throughout the life of an individual, but rather they change over time. Since the rise of the smartphone, longitudinal data can be obtained at higher frequencies than ever before, providing new opportunities for investigating these person-specific changes in real-time. Since 2019, researchers have started using the exponentially weighted moving average (EWMA) procedure, as a statistically sound method to reach this goal. Real-time, person-specific change detection could allow (a) researchers to adapt assessment intensity and strategy when a change occurs to obtain the most useful data at the most useful time and (b) clinicians to provide care to patients during periods in which this is most needed. The current paper provides a tutorial on how to use the EWMA procedure in psychology, as well as demonstrates its added value in a range of potential applications. [ABSTRACT FROM AUTHOR]

Background: A number of studies have identified significant associations between trauma-related shame and psychopathology including posttraumatic stress disorder (PTSD), dissociation, and depression. The aim of this paper was to assess the extent to which trauma-related shame is associated with psychological distress across populations (e.g., veterans, college students, women, clinical samples) and offer via meta-analyses a preliminary conclusion about the importance of assessing trauma-related shame. Methods: Records in Academic Search Complete, MedLine, MedLine Complete, PILOTS, PsycINFO, PsychTests, and PubMed were reviewed. Authors identified 25 studies that met the following inclusion criteria: (1) reported findings of an empirical study with quantitative results; (2) included any measurement of a trauma-related shame; and (3) included any measure of psychological distress or psychological symptoms. Data were extracted using a structured protocol, and random effects meta-analyses were calculated. Findings: There were moderate weighted mean correlations between trauma-related shame and symptoms of psychopathology (r = 0.44), trauma-related distress (r = 0.49), and depression (r = 0.35). There was significant heterogeneity among studies. Neither study quality nor sample characteristics were significant moderators. Conclusion: This meta-analysis demonstrated robust associations between trauma-related shame and symptoms of psychopathology broadly as well as trauma-related distress and depression. The findings underscore the importance of explicitly assessing trauma-related shame as part of standard care for trauma survivors who present for treatment. Several treatments explicitly address the role of shame and have demonstrated efficacy for reducing symptoms of trauma-related distress. [ABSTRACT FROM AUTHOR]

Low self-worth pervades discussions of psychopathology, is a central feature of many psychiatric disorders, and appears in conceptions of psychological distress in a range of cultural contexts. Explication of this aspect of self-evaluation offers clinical utility especially when adequate attention is paid to social and cultural aspects of the self. In this paper, we propose that refining the conceptualization of self-worth as felt perceptions of one's mattering and deservingness of equity and psychological, social, and material resources offers a unique clinical utility. We present an argument for this definition of self-worth, building on existing literature, as a relativistic construct informed and reinforced by dynamic feedback from intrapersonal, interpersonal, sociocultural, and structural socioecological levels. To highlight that self-worth has been an implied but under-examined concept, we follow with a selective review of psychological and sociological perspectives of self-esteem and related constructs. We conclude with a discussion of our conceptualization's implications for measurement and treatment, including the potential transdiagnostic utility of self-worth. [ABSTRACT FROM AUTHOR]

Many fields of medicine have benefitted from the formation of clinical trials networks, whereby researchers come together on a large scale to identify high-priority questions and implement coordinated clinical trials. Clinical trials networks in the field of mental health, however, have been rare and largely absent from the Australian context. Here, we present an overview of the newly formed Growing Minds Australia Clinical Trials Network, which represents the first comprehensive clinical trials network in child and youth mental health in Australia. The 60 principal members of the Growing Minds Australia Clinical Trials Network represent teams across 19 diverse areas related to specific forms of psychopathology (e.g. internalising, externalising, neurodevelopmental disorders, early psychosis, substance use), specific research methods and processes (e.g. health economics, eHealth, implementation science) and specialised areas of practice (e.g. school-based systems, parenting interventions, Indigenous mental health, refugee families). Core functions of the Growing Minds Australia Clinical Trials Network include collaborative trial protocol development; peer review, prioritisation and endorsement of proposed trials; training; development of clinical guidelines; and consumer representation. The research by the clinical trials network will encompass the populations typically accessing youth mental health services, while placing a key emphasis on the early periods of life, and the role of parents and caregivers as critical partners in the co-design of research and the delivery of intervention and prevention strategies. The structures and processes built into the network are designed to coordinate collaboration between diverse stakeholders and ensure that provisions for translation are integrated into research from the outset. In this paper, we examine the potential for a dedicated clinical trials network to initiate fundamental improvement in child and youth mental health systems, and discuss the unique and complex challenges associated with establishing such an initiative. [ABSTRACT FROM AUTHOR]

The study of survivors of a serious suicide attempt (SSA)––an attempt that would have been fatal had it not been for the provision of rapid and effective emergency treatment––can help researchers understand the suicidal mind. Serious suicide attempters are epidemiologically very similar to those who died by suicide, and thus can serve as valid proxies for studying suicides. In this paper, our objective was to briefly review the main risk factors that may facilitate more dangerous suicide behavior with high levels of intent. Our review highlights several dimensions of risk factors for SSAs, including psychopathology, mental pain, communication difficulties, decision-making impulsivity, and aggression. Several studies have indicated that the interaction between some of these dimensions, especially between mental pain and interpersonal difficulties, may serve as major catalysts for SSAs. Suicidal risk assessment should incorporate a designated evaluation of these risk factors as part of suicide prevention models. [ABSTRACT FROM AUTHOR]

The author comments on the article "The Broad Spectrum of Bipolar Disorder: Implications for Research and Practice," published within the issue of the journal. He agrees with the thesis suggested by the article's authors regarding the importance of bipolar disorder and the diagnostic concerns hindering its early recognition and treatment. However, he disagrees the observation of the author regarding the treatment of bipolar disorders with antidepressants.

In early modern Scotland, several visionaries experienced vivid relationships with spirits. This paper analyses their experiences historically, with the aid of modern scholarship in medicine, psychology and social science. Most of the visionaries were women. Most of their spirit-guides were fairies or ghosts. There could be traumas in forming or maintaining the relationship, and visionaries often experienced spirit-guides as powerful, capricious and demanding. It is argued that some visionaries experienced psychotic conditions, including psychosomatic injuries, sleepwalking, mutism and catatonia. Further conditions related to visionary experience were not necessarily pathological, notably fantasy-proneness and hallucinations. Imaginary companions and parasocial relationships are discussed, as are normality, abnormality and coping strategies. There are concluding reflections on links between culture and biology. [ABSTRACT FROM AUTHOR]

Objective: The current international trend is to create large datasets with existing data and/or deposit newly collected data into repositories accessible to the scientific community. These practices lead to more efficient data sharing, better detection of small effects, modelling of confounders, establishment of sample generalizability and identification of differences between any given disorders. In Australia, to facilitate such data-sharing and collaborative opportunities, the Neurobiology in Youth Mental Health Partnership was created. This initiative brings together specialised researchers from around Australia to work towards a better understanding of the cross-diagnostic neurobiology of youth mental health and the translation of this knowledge into clinical practice. One of the mandates of the partnership was to develop a protocol for harmonised prospective collection of data across research centres in the field of youth mental health in order to create large datasets. Methods: Four key research modalities were identified: clinical assessments, brain imaging, neurocognitive assessment and collection of blood samples. This paper presents the consensus set of assessments/data collection that has been selected by experts in each domain. Conclusion: The use of this core set of data will facilitate the pooling of psychopathological and neurobiological data into large datasets allowing researchers to tackle important questions requiring very large numbers. The aspiration of this transdiagnostic approach is a better understanding of the mechanisms underlying mental illnesses. [ABSTRACT FROM AUTHOR]

This paper explores key concepts in the writings of Weber in the years preceding the publication of the first edition of Karl Jaspers' Allgemeine Psychopathologie, focusing on the concept of understanding (Verstehen). This is a key hermeneutic concept and is discussed within the larger context of the epistemological and methodological reflections of both authors. They similarly tried to import the understanding within the humanistic disciplines as a rigorous but anti-reductionist scientific method. However, while Weber tried to mix explanation and understanding according to a legal metaphor, Jaspers retained Dilthey's sharper distinction between explanation in natural sciences and understanding in humanistic sciences. Finally, Jaspers' understanding is relatively more empathic, while Weber's understanding is more rationalistic. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to describe systematically recent studies that show the importance of cholesterol in psychopathology. Methods: This study was a review. The following databases were searched for relevant published articles on human studies: MEDLINE, Web of Science, EBSCOhost Academic Search Complete, and Psychology and Behavioral Sciences Collection (papers from January 2012 to March 2016). Results: Eighteen recent papers were selected, and thematic dimensions showing correlations between cholesterol and behavioral and psychopathological variables were depression, suicide, personality, and aggression. Conclusion: This paper demonstrates that recent research corroborates the idea that cholesterol plays an important role in governing behavior and psychopathology in humans. Deepening the studies in this field could be a promising avenue for future research, with implications for treating people with behavior or mental health problems. [ABSTRACT FROM AUTHOR]

This paper is an intervention within feminist and queer debates that have re-posed so-called negative states of being as offering productive possibilities for political practice and social transformation. What is sometimes called the politics of negative affect or analyses of political feeling has sought to de-pathologise shame, melancholy, failure, depression, anxieties and other forms of 'feeling bad', to open up new ways of thinking about agency, change and transformation. Ann Cvetkovich's recent memoir explores depression as a public feeling and argues that 'feeling bad might, in fact, be the ground for transformation'. As she suggests, the question, 'how do I feel' could usefully be reframed as 'how does capitalism feel'? This performative staging of political forms of psychosocial reflexivity opens up new strategies for survival, new visions of the future, and importantly de-medicalises feeling beyond an individual expression of psychopathology. The grounds for affective politics might be found within new feminist futures that are attentive to the relations between emotion, affect, feelings and politics. This paper will be situated within these debates and the challenge of thinking about the productive possibilities of negative states of being. However, rather than focus on depression, I will turn my attention to experiences such as psychosis and temporal dissociation, based on my long-standing research with the Hearing Voices Network. In the context of discussions of disability and capability I will discuss the value of concepts such as debility, and 'living in prognosis', and respond to the call to think through what such states might offer for feminist and queer practice. [ABSTRACT FROM AUTHOR]

This paper traces the significance of the diagnosis of ‘moral insanity’ (and the related diagnoses of ‘monomania’ and ‘manie sans délire’) to the development of psychiatry as a profession in the nineteenth century. The pioneers of psychiatric thought were motivated to explore such diagnoses because they promised public recognition in the high status surroundings of the criminal court. Some success was achieved in presenting a form of expertise that centred on the ability of the experts to detect quite subtle, ‘psychological’ forms of dangerous madness within the minds of offenders in France and more extensively in England. Significant backlash in the press against these new ideas pushed the profession away from such psychological exploration and back towards its medical roots that located criminal insanity simply within the organic constitution of its sufferers. [ABSTRACT FROM AUTHOR]

Background: Cannabis-induced psychotic disorder (CIPD) is a psychiatric disorder induced by cannabis consumption. The psychological and psychophysiological features of this disorder are still unknown. We aimed to examine the psychological, personality and psychophysiological features of patients with CIPD. This study is an analytical extension of our previously published data, which previously found prepulse inhibition (PPI) deficits in the CIPD group used in this current paper.Methods: We used a sample of 45 patients with CIPD. After 9 months of follow up, these patients were assessed with a Symptom Checklist-90-R (SCL-90-R) questionnaire of psychopathology, with the Eysenck Personality Questionnaire, and with a psychophysiological paradigm of inhibition of the startle reflex (PPI). These results were compared with a group of patients with schizophrenia and cannabis abuse (SCHZ) ( n = 54); patients with cannabis dependence (CD) ( n = 21); and healthy controls ( n = 50).Results: CIPD patients obtained significant higher scores in the SCL-90-R subscale of neuroticism. These patients showed PPI percentages similar to SCHZ patients within early attentional levels (30 ms). The variables with greater correlation, and that appeared in the CIPD group were interpersonal sensitivity, depression and phobia.Conclusions: Neurotic symptomatology and difficulties in inhibition of the startle reflex might be risk factors for developing CIPD. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to analyse in a philosophically informed way the recent National Institute of Mental Health proposal for the Research Domain Criteria (RDoC) framework.Conclusion: Current classification systems have helped unify psychiatry and the conditions that it is most concerned with. However, by relying too much on syndromes and symptoms, they too often do not define stable constructs. As a result, inclusions and removals from the manuals are not always backed by sound reasons. The RDoC framework is an important move towards ameliorating matters. This paper argues that it improves the current situation by re-referencing constructs to physical properties (biomarkers for disorders, for example), by allowing theoretical levels within the framework, and by treating psychiatry as a special case of the cognitive sciences. [ABSTRACT FROM AUTHOR]

The present paper investigates the methodology involved in Jaspers’ psychopathology and compares it with Husserl’s phenomenology and with Dilthey’s cultural science. Allgemeine Psychopathologie and other methodological works by Jaspers, the works of Husserl and Dilthey that Jaspers cited, and previous research papers on Jaspers are reviewed. Jaspers had conflicting views on understanding, which were comprised of both empathic understanding and rational, ideal-typical understanding. Such a standpoint on understanding is considerably different from Dilthey’s. Additionally, the present paper reconfirms that Jaspers’ ‘phenomenology’ as a form of descriptive psychology for the understanding of empirical psychic states is different from Husserl’s phenomenology. Thus, this paper casts doubt on the common opinion that Jaspers was under the profound influence of Husserl or Dilthey. [ABSTRACT FROM PUBLISHER]

Nondieting psychological interventions for overweight/obesity emerged from poor maintenance of change in weight reduction interventions, psychological difficulties experienced by this group, and the position that focusing on weight loss can reinforce psychological struggles. The nondieting paradigm aims to improve wellness without weight loss. This paper reviews the efficacy of nondieting interventions for overweight/obesity. Thirteen randomized controlled trials were reviewed, which compared nondieting interventions to wait list, weight loss, and psychosocial comparison groups. In the short-term and in follow-up, nondieting interventions resulted in improvement of body dissatisfaction, restrained eating, and eating disorder psychopathology, but not other psychological or physiological variables. Despite not focusing on weight reduction, there were no weight differences compared to weight loss treatments at 12-18 month follow-up. These findings suggest that elements of the nondieting paradigm may be beneficial to psychological wellbeing in individuals with overweight/obesity, and that integrating such interventions into clinical practice may be helpful. [ABSTRACT FROM AUTHOR]

Border zone disorders involve neurological disorders with psychiatric symptoms and signs as well as psychiatric disorders with soft neurological features. This becomes a cause for great diagnostic and therapeutic concerns. We, in this paper, analyzed some of the imitators such as epilepsy, dementia, some forms of encephalitis, and pure psychiatric diseases which produce problems in decision making due to soft neurological features and the utility of electroencephalography (EEG) as a simple diagnostic tool in differentiating some of these conditions from each other as well as the therapeutic role of EEG in some of these disorders. We retrospectively took index cases which produced problems for us in decision making in the last 5 years and correlated with the final diagnosis, EEG parameters as well as literature available by PubMed search using specific key words based on the conditions identified. EEG can be normal in organic diseases and abnormal in psychiatric diseases. Typical EEG findings in neuropsychiatric syndromes point to specific diagnosis. Soft EEG changes are common in psychiatric disorders and do not indicate organicity. EEG can be used to assess efficacy and toxicity of therapeutic agents in psychiatry. Biofeedback-based training to keep the brain in particular rhythm is of use in psychiatric disorders as a pharmaco-sparing agent. [ABSTRACT FROM AUTHOR]

Experimental psychopathology is the application of experimental methods to the study of psychopathology and its underlying processes. The study of individual differences in the development, maintenance and/or relapse of psychopathology is currently at the forefront of research. Stressful events are known to exert a substantial impact on our lives. Why however, do some people react in an extremely adaptive way, while others develop pathology in the aftermath of a trauma? One particularly interesting individual differences factor is genetic makeup and the aim of this paper is to review the current state of the art of genetics in experimental psychopathology which is illustrated by using fear conditioning as an exemplary model in the study of mechanisms underlying anxiety. We identify and discuss current challenges of the field and provide recommendations on how these can be met. In addition, criteria for experimental models of psychopathology as well as future directions are discussed. [ABSTRACT FROM AUTHOR]

This paper outlines a putative pathway for experimental psychopathology research developing psychological models of clinical disorders. The pathway uses established external validity criteria to define the pathway and clarifies the important role that research conducted on healthy participants can play in our understanding of clinical disorders. Defining a research pathway for experimental psychopathology in this way has a number of benefits It would (1) make explicit the need to address the external validity of developed models, (2) provide a clear set of criteria that would be required to extend research on healthy individuals to diagnostic populations, and (3) recommend using general psychological knowledge when developing models of psychopathology. [ABSTRACT FROM AUTHOR]

Internalizing psychopathology (i.e., depression and anxiety) is a leading cause of disability worldwide. The recognition that both genetic factors (nature) and environmental factors (nurture) contribute to the aetiology of internalizing disorders has led to a rapid growth in research of gene-environment interactions (G×E) and of epigenetic mechanisms underlying G×E. The purpose of this paper was to critically review evidence on the contributions of genes, environments and G×E to the risk of internalizing psychopathology across the life course. The existing G×E studies have primarily focused on a limited number of candidate genes. Overall, albeit with some conflicting findings, these studies have supported G×E effects on the risk for depressive and anxiety outcomes. Future G×E studies would benefit from more systematic assessment of both negative and positive environmental influences, utilization of a developmentally sensitive life-course approach, and thorough investigations of epigenetic mechanisms that can underlie the complex gene-environment co-action. [ABSTRACT FROM AUTHOR]

Objective: This clinical update review focuses on the classification and description of common neuropsychiatric manifestations in Parkinson's disease (PD).Method: We conducted a systematic search of the literature using Pubmed and selected the most recent and relevant papers for this review.Results: Neuropsychiatric manifestations in PD are are very frequent and may arise from an abnormal psychopathological response to the disease, neurobiological changes related to the disease itself, complications of treatments or a combination of all of these.Conclusions: Neuropsychiatric symptoms may precede the motor clinical presentation of PD. Early recognition is essential. [ABSTRACT FROM AUTHOR]

Rationale: In recent decades, the use of ayahuasca (AYA) - a β-carboline- and dimethyltryptamine-rich hallucinogenic botanical preparation traditionally used by Northwestern Amazonian tribes for ritual and therapeutic purposes - has spread from South America to Europe and the USA, raising concerns about its possible toxicity and hopes of its therapeutic potential. Thus, it is important to analyze the acute, subacute, and long-term effects of AYA to assess its safety and toxicity.Objectives: The purpose of this study was to conduct a systematic review of human studies assessing AYA effects on psychiatric symptoms, neuropsychological functioning, and neuroimaging.Methods: Papers published until 16 December 2015 were included from PubMed, LILACS and SciELO databases following a comprehensive search strategy and pre-determined set of criteria for article selection.Results: The review included 28 full-text articles. Acute AYA administration was well tolerated, increased introspection and positive mood, altered visual perceptions, activated frontal and paralimbic regions and decreased default mode network activity. It also improved planning and inhibitory control and impaired working memory, and showed antidepressive and antiaddictive potentials. Long-term AYA use was associated with increased cortical thickness of the anterior cingulate cortex and cortical thinning of the posterior cingulate cortex, which was inversely correlated to age of onset, intensity of prior AYA use, and spirituality. Subacute and long-term AYA use was not associated with increased psychopathology or cognitive deficits, being associated with enhanced mood and cognition, increased spirituality, and reduced impulsivity.Conclusions: Acute, subacute, and long-term AYA use seems to have low toxicity. Preliminary studies about potential therapeutic effects of AYA need replication due to their methodological limitations. [ABSTRACT FROM AUTHOR]

Suicide is a common occurrence in psychiatric disorders and is a cause of increased healthcare utilization worldwide. Schizophrenia is one of the most common psychiatric disorders worldwide and posited to be seen in 1% of the population worldwide. Suicide is a common occurrence in schizophrenia with 25%-30% patients with schizophrenia attempting suicide and 8%-10% completing it. There is a need for valid biological markers to help clinicians identify patients with schizophrenia that may be at a risk of suicide and thus help in them receiving better care and interventions at the earliest even before a suicide attempt occurring. There are clear neurobiological changes at a genetic, neuroimaging, and neurochemical level that occurs in patients with schizophrenia that attempt suicide. There is a new theory that postulates neuronal plasticity and neuroprotection to have a role in the biological changes that ensue when suicidal thoughts and feelings occur in patients with schizophrenia. Neurotrophic growth factors like brain-derived neurotrophic factor (BDNF) have been documented to play a role in the protection of neurons and in the prevention of neurobiological changes that may lead to suicide both in schizophrenia and depression. The present paper presents a commentary that looks at the role of BDNF as a protective factor and neurobiological marker for suicide in schizophrenia. [ABSTRACT FROM AUTHOR]

Objectives: This paper aims to briefly overview the processes of neuro-reciprocity relevant to vicarious traumatization of psychiatrists through their clinical roles.Conclusions: High rates of trauma in mental health service users, understanding of the effects of trauma on the brain and mechanisms of neuro-reciprocity in empathic attunement suggest that psychiatrists are at high risk of vicarious trauma. Preventing vicarious trauma at an organizational level through trauma-informed approaches is of paramount importance. [ABSTRACT FROM AUTHOR]

There is consensus that an integrated approach which addresses the clinical needs of individuals who have histories of substance abuse and psychological trauma concurrently is an acceptable and preferred approach to treatment. Several integrated models have emerged in recent years. In this paper we first define the concepts of substance abuse and psychological trauma, investigate the relationship between both and proceed to discuss why an integrated approach is most compelling. Finally, we review and critically examine the different integrated models that have been developed in terms of efficacy, effectiveness and empirical evidence. The paper concludes with suggestions on how the field can be improved. [ABSTRACT FROM AUTHOR]

The article discusses and analyses a paper from the year 1852 on neologisms and other language disorders of people who were insane by 19th century German Ludwig Snell, who was considered a non-academic alienist or someone who treats mental diseases. Snell's paper illustrates the impact on descriptive psychopathology caused by the early 19th century view that language shaped thought and culture, which is referred to as the "Humboldt-Sapir-Whorf hypothesis," and dictated how language disorders were studied in psychiatry through the middle 20th century. The cognitive revolution that occurred after World War II in which psychiatrists believed that thought was more important than language. This led to the idea that a "thought disorder" was the primary ailment in schizophrenia.

Objective: Up to 15% of depression patients eventually present with treatment-resistant or refractory depression (TRD), a condition that causes significant social and economic burdens. Our paper aims to summarize the current medical literature on the conceptual and methodologic issues involved in the definition, assessment, and staging of TRD.Method: We reviewed the recently published medical literature to identify papers that specifically discuss TRD. For this, we searched MEDLINE, EMBASE, and PsycINFO for potentially relevant English-language articles published between January 1996 and June 2006.Results: Recent methodologic and conceptual advances have contributed to the achievement of an acceptable level of theoretical consensus on the general meaning of TRD. Accordingly, depression is usually considered resistant or refractory when at least 2 trials with antidepressants from different pharmacologic classes (adequate in terms of dosage, duration, and compliance) fail to produce a significant clinical improvement. Regarding diagnostic assessments, an accurate and systematic evaluation should be made to elicit the potential role of several contributing factors, such as medical and psychiatric comorbidity.Conclusion: Recently, 3 staging methods for TRD have been described, but they currently require extensive empirical support. Future research on TRD should include prospective studies addressing the validity of the proposed criteria, the impact of depression comorbid with other psychiatric disorders and (or) physical conditions, and the possible predictors o treatment outcome. There is an important and clear need for studies that empirically test current definitions, assessment strategies, and staging methods of TRD. [ABSTRACT FROM AUTHOR]

Objective: To provide some direction for those interested in obtaining funding with the purpose of highlighting opportunities for beginner researchers in the health-care field. Method: Features of a good grant application are described and an audit of seven mental health professional journals was undertaken, the latter to determine, inter alia, whether the paper reported research findings and whether the authors received formal research funding. Result: The audit revealed that many types of papers that are published do not receive formal research funding and describe, for example, services, training issues, clinical practice and education programmes. Conclusion: Innovative and enterprising efforts are required to secure clinical research funding. Submissions must be detailed, comprehensive and relevant, but the onus is also on the researcher to ensure a feasible study, where funding obligations can be fulfilled and findings readily disseminated. Many research studies are conducted without achieving competitive funding, and getting published – and getting started in writing – does not hinge on conducting formal research or receiving research funding. [ABSTRACT FROM AUTHOR]

Objective: The physical health and well-being of mental health patients have been a concern to health professionals for many years. However, very few positive gains have been made to address this problem. This paper outlines the efforts of the Inner North Brisbane Mental Health Service, Royal Brisbane and Women’s Hospital, to design and implement a structured educational programme, aimed at addressing and encouraging healthy lifestyle behaviours in its community mental health service recipients. Methods: Three programme modules were designed, addressing the topics of Nutrition and Healthy Eating, Physical Health, and Community Based Activities and Interests. Referral of patients to the programme was by their case manager or doctor. At the conclusion of each module, participants were asked to complete a satisfaction survey evaluating the programmes. The survey also gathered feedback regarding any suggestions and/or recommendations to improve content suitability and relevance. Results: Since commencing the Healthy Living Program, each module has been conducted at least twice, the topic of Healthy Eating receiving the most referrals and therefore conducted most frequently. To date, 35 satisfaction surveys have been evaluated. The overwhelming majority of respondents offered very positive feedback about the programme, most being able to identify some healthy lifestyle changes they planned to make in response to programme attendance. Conclusions: This paper highlights the importance of incorporating healthy lifestyle programmes into mental health service delivery. The majority of patients who have attended the Healthy Living Program have indicated satisfaction with the content, but as yet information pertaining to long-term lifestyle change has not been collated. The next phase aims to examine whether the programme attendance has more long-term outcomes in improving health and well-being and promoting healthy behaviour change of mental health service recipients. [ABSTRACT FROM AUTHOR]

Objective: To study the symbolism of community as understood and practised within a mental health Crisis and Assessment Service in an Australian city. Theoretical approaches: The paper draws on anthropological theories of symbolism, boundary work and social networks. Method: Ethnographic fieldwork techniques were employed for data collection. Ethnographic analysis was then applied to these data. Results: In mental health practice, rules of professional behaviour established a boundary that prohibited mental health professionals from social engagement with members of the community they served. Ethical imperatives prevented them from forming interpersonal bonds with their clients. Rules of privacy and confidentiality meant that they could not relate to the client's social network as a whole. Conclusions: The companion to this paper identified a summarizing symbol, which we designated community, and it specified the social values it represented when appropriated to the task of drawing a boundary between hospital and community. This paper specifies additional social values represented by community when it is appropriated to the task of drawing a boundary between community mental health professionals and the community. [ABSTRACT FROM AUTHOR]

Objective: Recognizing the prodrome of a first psychotic episode prospectively creates the opportunity of intervention, which could delay, ameliorate or even prevent onset. Valid criteria and a reliable methodology for identifying possible prodromes are needed. This paper describes an instrument, the Comprehensive Assessment of At-Risk Mental States (CAARMS), which has been designed for such a purpose. It has two functions: (i) to assess psychopathology thought to indicate imminent development of a first-episode psychotic disorder; and (ii) to determine if an individual meets criteria for being at ultra high risk (UHR) for onset of first psychotic disorder. This paper describes the pilot evaluation of the CAARMS. Method: Several methodologies were used to test the CAARMS. First, CAARMS scores in a group of UHR young people and the association between CAARMS scores and the risk of transition to psychotic disorder, were analysed. Second, CAARMS scores in a UHR group were compared to a control group. To assess concurrent validity, CAARMS-defined UHR criteria were compared to the existing criteria for identifying the UHR cohort. To assess predictive validity, the CAARMS-defined UHR criteria were applied to a sample of 150 non-psychotic help-seekers and rates of onset of psychotic disorder at 6-month follow-up determined for the CAARMS-positive (i.e. met UHR criteria) group and the CAARMS-negative (i.e. did not meet UHR criteria) group. The inter-rater reliability of the CAARMS was assessed by using pairs of raters. Results: High CAARMS score in the UHR group was significantly associated with onset of psychotic disorder. The control group had significantly lower CAARMS scores than the UHR group. The UHR criteria assessed by the CAARMS identified a similar group to the criteria measured by existing methodology. In the sample of non-psychotic help-seekers those who were CAARMS-positive were at significantly increased risk of onset of psychotic disorder compared to those who were CAARMS-negative (relative risk of 12.44 (95% CI = 1.5–103.41, p = 0.0025)). The CAARMS had good to excellent reliability. Conclusions: In these preliminary investigations, the CAARMS displayed good to excellent concurrent, discriminant and predictive validity and excellent inter-rater reliability. The CAARMS instrument provides a useful platform for monitoring subthreshold psychotic symptoms for worsening into full-threshold psychotic disorder. [ABSTRACT FROM AUTHOR]

Objective: A substantial proportion of patients found in primary care complain of physical symptoms not attributable to any known conventionally defined disorder, that is, medically unexplained or functional somatic symptoms. The objective of this paper is to outline the problems with the current classification and propose a classification more suitable for primary health care. Method: We refer to and discuss relevant literature including papers on our own research on the topic in the light of our experiences from major projects on somatizing patients in primary health care. Results: Functional somatic symptoms may impose severe suffering on the patient and are costly for society because of high health-care utilization, lost working years and social expenses. At present, studies on functional somatic symptoms and disorders and their treatment are hampered by lack of a valid and reliable diagnostic classification. The diagnostic categories of somatoform disorders are overlapping. Thus, the present situation is that patients with identical symptoms and clinical pictures may receive different diagnostic labels depending on the focus of interests of the assessing physician. A particular problem in primary care is that the somatoform diagnostic categories only include persistent cases and do not offer the opportunity for classification of the patients with short-symptom duration found in this setting. We present a framework for a new descriptive classification of functional somatic symptoms and unfounded illness worrying, and outline a new classification that covers the whole spectrum of severity seen in clinical practice. Conclusion: A precondition for an appropriate management of patients with functional somatic symptoms is a valid taxonomy common for all medical specialties facilitating cooperative care. Classification systems as outlined in this paper may be a candidate for such a system, but it should be subject to further evaluation in research. [ABSTRACT FROM AUTHOR]

General adult psychiatrists are required to assess risk of violence as frequently as forensic psychiatrists. Yet most of the literature on risk assessment has originated from forensic settings, has been written by forensic psychiatrists, is applicable to forensic patients but may not apply to general psychiatric settings. Because the patient population and the nature of risk assessed may differ between the two settings, there is a need to consider the relevance of systems of assessment of risk of violence specific to the context of general adult psychiatry.We searched the literature on the way risk has been conceptualized in different disciplines using Medline database from 1993 to 2003. Keywords used were violence and risk management and risk assessment. Additional papers were identified from cross-references and personal knowledge of authors.Seven hundred and nine key papers were identified. We identified three common key concepts that define risk:Uncertainty, weighing up the likelihood of different outcomes arisingand, thepossibility of benefits as well as harm due to risk assessment. The impact of safety culture − the collection of beliefs, norms, attitudes, roles and practices while making daily activities and management decisions− on psychiatric thinking is examined. We review the two main methods of risk assessment from forensic psychiatric literature (actuarial and clinical) with a view to examine their utility in general adult psychiatric context.In order to develop a system of risk assessment relevant to general adult psychiatry, we note the benefits of shifting from risk prediction to assessment, management and reduction of risk, the need to merge actuarial and clinical approaches, communication of risk and finally the need to involve patients in the process of risk assessment. [ABSTRACT FROM AUTHOR]

This paper identifies rates of common mental disorders among Māori and non-Māori consulting a general practitioner (GP), and explores the association between ethnicity and social and material deprivation.Survey of GPs and their patients. Participants were randomly selected GPs (n = 70), and their patients (n = 3414, of whom a subset of 786 form the basis of this paper). The main comparison is between self-identified ethnicity, mental disorder assessed by the Composite International Diagnostic Interview, and social and material deprivation measured by NZDep2001 (an area based measure), and an individualized index of deprivation.Rates of mental disorder among Māori general practice attenders were higher than among non-Māori. Overall, Māori women attenders were twice as likely as non-Māori women attenders to have a diagnosable mental disorder. The rates of anxiety, depressive and substance use disorders were all higher for Māori than for others attending GPs. Treatment for psychological problems was offered by the GP at similar rates to both Māori and non-Māori. Although there were differences between Māori and non-Māori in terms of social and material deprivation, higher rates of mental disorder among Māori attending GPs compared to non-Māori cannot be accounted for by these differences alone.These findings support the view that whilst social and material deprivation may play a role in the high rates of mental disorders among Māori general practice attenders, there are additional ethnicity-specific factors involved. Interventions to address Māori mental health (whether by reducing risk factors for mental disorder, by promoting disclosure, early recognition and intervention, or by ensuring access to acceptable and effective treatments) may need to explicitly take those factors into account. [ABSTRACT FROM AUTHOR]

The article presents abstracts of various papers related to health promotion, published in the May 2005 issue of the "American Journal of Health Promotion." The paper "Mortality and Suicide Among Danish Women With Cosmetic Breast Implants," examines mortality among Danish women who underwent cosmetic breast implant surgery and evaluates the baseline prevalence of psychopathological disorders as measured by admission to a psychiatric hospital among women seeking cosmetic surgery. The paper "Meat Consumption and Risk of Colorectal Cancer." examine the relationship between recent and long-term meat consumption and the risk of incident colon and rectal cancer.

The article presents a bibliography of papers related to psychology. To help readers of the journal "Teaching of Psychology" locate relevant papers, the papers are arranged into a small number of subject categories. Generally, if fewer than three items fell into a specific subject category, they were relegated to a category labeled miscellaneous. Some of the papers are "Simulated Clinical Training in an Advanced Undergraduate Seminar," by E. Akillas, M.K. Middlecamp, "Uncover the Disorder: A Review Activity for Abnormal Psychology Courses," by M.K. Middlecamp.

This commentary speaks to several issues that arise from the papers in this special issue. Two articles--Kessler (2002) and Mirowsky and Ross (2002)--focus on a major measurement issue: dimensional versus diagnostic-type assessments. One topic requires greater attention: the correspondence of these measures with the underlying states they supposedly measure--constructs in the psychometric tradition and empirically defined illnesses in the medical or psychiatric tradition. Conclusions about the nature of these unobserved states remain tentative at this time. Three articles--Keyes (2002), Schwartz (2002), and Umberson, Williams, and Anderson (2002)--address the expansion of mental health outcomes. The existing reliance on emotional distress is problematic for sociological research because a single disorder is not a good proxy for estimates of the overall mental health consequences of social arrangements. Although these papers present diverse and sometimes conflicting perspectives, collectively they demonstrate that no one approach to outcomes is best for all research questions. [ABSTRACT FROM AUTHOR]

Objective: Psychoanalytic theories of the mind emerged in the immediate post-Darwinian era of the 1880s and 1890s. Since that time much has changed in both psychoanalytic and evolutionary theorizing. This paper explores recent evolutionary thinking on psychopathology. Method: Relevant literature was reviewed. Results: This paper outlines some of the common behavioural defence mechanisms and then explores ways in which they are represented in various disorders, with a focus on depression. This paper suggests that ‘symptoms’ can be related to the activation of evolved defence mechanisms to respond to losses and threats. Such will involve, for example, anxious arousal and heightened vigilance and attention to the threat, with the type of defence (e.g. fight, flight, submit, help seeking) being mirrored in particular symptom presentations. Conclusion: Defences can become pathological when they are too easily aroused or prolonged, are arrested (aroused but not expressed) and/or ineffective. [ABSTRACT FROM AUTHOR]

While the contribution of patients’ perspectives regarding their psychotherapeutic experiences has been widely recognized, some have received less attention from research, as is the case of people with schizophrenia. This paper focuses on the subjective experience of psychotherapy in order to go more in-depth into aspects related to the therapeutic success. A study of multiple cases was carried out which included four patients who participated in semi-structured interviews. Data analysis was performed based on the Grounded Theory. Results show that the process of psychotherapeutic change in people with schizophrenia can be understood as a progressive reintegration of the self into the biographical continuity and they contribute to understanding the meaning that psychotherapy can have for people suffering from schizophrenia. [ABSTRACT FROM AUTHOR]

Objective: There is a need for a simple and brief tool that can be used in routine clinical practice for the quantitative measurement of mental state across all diagnostic groups. The main utilities of such a tool would be to provide a global metric for the mental state examination, and to monitor the progression over time using this metric.Method: We developed the mental state examination scale (MSES), and used it in an acute inpatient setting in routine clinical work to test its initial feasibility.Results: Using a clinical case, the utility of MSES is demonstrated in this paper. When managing the patient described, the MSES assisted the clinician to assess the initial mental state, track the progress of the recovery, and make timely treatment decisions by quantifying the components of the mental state examination.Conclusion: MSES may enhance the quality of clinical practice for clinicians, and potentially serve as an index of universal mental healthcare outcome that can be used in clinical practice, service evaluation, and healthcare economics. [ABSTRACT FROM AUTHOR]

The Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project represents an integration of research methodology into a community-based outpatient practice affiliated with an academic medical centre. The MIDAS project is the largest clinical epidemiological study using semi-structured interviews to assess a wide range of psychiatric disorders in a general clinical outpatient practice. In an early report from the MIDAS project, we found that across diagnostic categories clinicians using unstandardized, unstructured clinical interviews underrecognized diagnostic comorbidity, compared with the results of semi-structured interviews. Moreover, we found that the patients often wanted treatment for symptoms of disorders that were diagnosed as comorbid, rather than principal, conditions. This highlighted the importance, from the patient's perspective, of conducting thorough diagnostic interviews to diagnose disorders that are not related to the patient's chief complaint because patients often desire treatment for these additional diagnoses. While several of the initial papers from the MIDAS project identified problems with the detection of comorbid disorders in clinical practice, regarding the diagnosis of bipolar disorder we observed the emergence of an opposite phenomenon-clinician overdiagnosis. The results from the MIDAS project, along with other studies of diagnosis in routine clinical practice, have brought to the forefront the problem with diagnosis in routine clinical practice. An important question is what do these findings suggest about the community standard of care in making psychiatric diagnoses, and whether and how the standard of care should be changed? The implications are discussed. [ABSTRACT FROM AUTHOR]

Objective: This paper considers the meaning of the terms hoarding, collecting and accumulation, with a focus on what is abnormal and what is not. Conclusions: Hoarding is an adaptive behaviour. When hoarding is excessive and interferes with people’s lives, it is a disorder. A central feature of hoarding disorder is accumulation of items due to unwillingness to discard them. This must be distinguished from abnormal accumulation of material caused by poor motivation or unawareness concerning the need to discard. [ABSTRACT FROM AUTHOR]

Under the assumption that the treatment of substance abuse begins well before substance abusers actually enroll in treatment, this paper conceptualizes the process of recruitment into treatment, and investigates attrition of treatment seeking clients during the treatment recruitment stage. The paper identifies two stages prior to treatment enrollment, treatment exploration and treatment recruitment, and presents the results of a study of 1,924 homeless, mentally ill chemical abusing men who looked for community-based treatment in New York City between 1991 and 1996. Only 326 of these men actually entered treatment. The rest were lost either prior to or during the recruitment stage. The paper focuses on the 823 men who reached the treatment recruitment stage, and attempts to correlate their sociodemographic, psychological and substance abuse characteristics with the different types of attrition during treatment recruitment. The results show that certain client characteristics predict rejection and certain other characteristics predict acceptance by the treatment programs. [ABSTRACT FROM AUTHOR]

Kurt Schneider’s insight nearly 80 years ago that schizophrenia could be demarcated from other psychoses by a small set of particular delusions and hallucinations powerfully influenced diagnostic practice. The theoretical status of such ‘first rank symptoms’ as a whole, however, has rarely been addressed. But if they are sensitive and specific to the condition, it is about time that their essential nature and potential origin be considered. This is the purpose of the present paper. I argue that these psychopathological phenomena are indeed relatively sensitive and specific to the condition, that their nature can be formulated within a Schelerian model of what constitutes a human being, and that their origin fits anthropological and neuropsychological notions of the make-up of contemporary human beings. [ABSTRACT FROM PUBLISHER]

Objective: This paper provides an overview of mentalization-based therapy (MBT). Multiple strands of research evidence converge to suggest that affect dysregulation, impulsivity and unstable interpersonal relationships are core features of borderline personality disorder (BPD). The MBT approach to BPD attempts to provide a theoretically consistent way of conceptualising the inter-relationship of these features. Methods: MBT makes mentalizing a core focus of therapy and was initially developed for the treatment of BPD in routine clinical services, delivered in group and individual modalities. This article provides a brief overview of mentalizing and its relevance to BPD, provides an overview of MBT and notes a number of current trends in MBT. Results: MBT provides clinicians with an empirically supported approach to BPD and its treatment. Conclusions: Whilst mentalizing is viewed as an integrative framework for therapy, more knowledge is needed as to which of the therapies are of most benefit for individual patients. [ABSTRACT FROM AUTHOR]

The aim of this article is to contribute to the analysis of the origins of psychiatric semiology, which by emphasizing subjectivity in clinical practice, gave birth to psychopathology as the scientific and intellectual enterprise of alienism. In other words, beyond simple anatomical and clinical observation, there was an effort to ‘listen to’ and ‘read’ the patient’s delirium. In essence, the basic thesis which this short paper seeks to defend is that, despite a growing anatomical and clinical mind-set and a clear interest in physically locating mental illness within the body, during the Romantic period, psychiatry was able to construct a semiology largely based on the experience of the ego, on the inner world of the individual. This makes it possible to establish, from a clinical perspective, that the birth of alienism – of psychiatry – must be situated within the framework of a modernity in which the culture of subjectivity was one of its most characteristic features. [ABSTRACT FROM PUBLISHER]

Objectives: It has been proposed that legislation for same-sex marriage has a positive mental health benefit. The purpose of this paper is to review and evaluate the empirical and conceptual links between same-sex marriage and mental health.Conclusions: There are substantive methodological issues in the four surveys and comparisons undertaken. Difficulties with the validity of the evidence are discussed. Conceptual difficulties in the arguments relating to victimisation as well as the psychology of marriage are highlighted. It was concluded that it is premature to make claims of causality vis-a-vis same-sex marriage legislation and mental health. [ABSTRACT FROM AUTHOR]