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Background Catatonia is a presenting sign for many primary psychiatric disorders but it can also herald medical and neurological conditions. Increasing research has highlighted co-occurrence catatonia and delirium and how this combination warrants a thorough medical workup. Case presentation We present a case of a middle-aged woman with catatonia and delirium secondary to neurosarcoidosis only involving the brain; we document her 30-day hospitalization and intensive medical work-up that eventually revealed isolated neurosarcoidosis. This is the first reported case to our knowledge in the literature of catatonia occurring due to isolated neurosarcoidosis. Conclusion For this patient, albeit with a history of schizophrenia, the presence of delirium pushed the medical team to pursue a comprehensive work up instead of relying on a psychiatric diagnosis as the explanation for her puzzling clinical presentation. This case report supports a paradigm shift for physicians to think of catatonia similar to delirium: A syndrome that results from an underlying condition that must be treated in order to resolve the catatonia.

Many children with a range of psychiatric diagnoses manifest impaired levels of emotion dysregulation (ED). Over the past decade, there has been increasing examination of psychosocial interventions for ED. We found preliminary evidence of positive effects for a wide range of psychosocial treatments that were associated with improvements in emotion recognition, emotional reactivity, and emotion regulation. More studies are needed because results are limited by the small number of controlled trials, heavy reliance on parent ratings, and heterogeneity of the samples.

Psychiatric diagnoses (PD) present a significant burden on elective surgery patients and may have potentially dramatic impacts on outcomes. As ailments of the spine can be particularly debilitating, the effect of PD on outcomes was compared between elective spine surgery patients and other common elective orthopedic surgery procedures. This study included 412,777 elective orthopedic patients who were concurrently diagnosed with PD within the years 2005 to 2016. 30.2% of PD patients experienced a post-operative complication, compared to 25.1% for non-PD patients (p 0.001). Mood Disorders (bipolar or depressive disorders) were the most commonly diagnosed PD for all elective Orthopedic procedures, followed by anxiety, then dementia (p 0.001). Logistic regression analysis found PD to be a significant predictor of higher cost to charge ratio (CCR), length of stay (LOS), and death (all p 0.001). Between, hand, elbow, and shoulder specialties, spine patients had the highest odds of increased CCR and unfavorable discharge, and the second highest odds of death (all p 0.001).

Cognitive impairment and varied psychiatric manifestations are common in thyroid disorders. But autoimmune thyroid disorders masquerading as dementia or psychotic disorders without other overt systemic features of dysthyroidism are rare. Here we are presenting a detailed analysis of four heterogeneous cases of thyroid related cognitive impairments mimicking and fulfilling criteria of known psychiatric diagnosis for a brief period of time, requiring multiple psychotropic medications without any significant improvement. Cognitive impairment and behavioral abnormalities with a known psychiatric diagnosis, with unknown temporal profiling of anti-thyroid peroxidase (TPO) positivity, without encephalopathy and subsequent complete or partial responsiveness with levothyroxin, point towards a possible new entity not well explored so far.

This study evaluated the contribution of psychological pain to self-harming behaviours, controlling for several co-variables. A convenience sample of 207 U.S. residents provided socio-demographic and clinical information and responded to the Psychache Scale. Logistic regression analysis demonstrated that when controlling for the significant co-variables of drug use and having a psychiatric diagnosis, psychological pain provided a significant contribution in predicting self-harming behaviours. Psychological pain also correlated with the frequency of self-harming behaviours, controlling for significant co-variables. We conclude that, when clinicians collect life history and assess relevant risk factors for self-harming behaviours, it is also important to assess psychological pain.

Objective To analyze the risk of megestrol, a glucocorticoid and progesterone receptor agonist used to enhance appetite, on the development of a new psychiatric diagnosis. Design and Participants Deidentified data of megestrol (n = 706) and propensity score-matched comparison (age, gender, and body mass index) patients (n = 2,118) from January 1, 2001 to June 30, 2018 were obtained from the UT Southwestern patient database. Data were analyzed using a series of conditional binary logistic regressions controlling for comorbidities, pre-existing psychiatric disorders, and number of patient encounters. Setting A large academic medical center database of megestrol-treated patients and matched comparison patients was used. Measurements and Results The regression model showed that megestrol was significantly associated with developing a new psychiatric diagnosis (B = 1.28, Wald χ21 = 83.12, odds ratio [OR] = 3.60, p Conclusions Patients taking megestrol were significantly more likely to develop a new psychiatric diagnosis than comparison patients. Highest risks were associated with the development of cognitive diagnoses. The findings suggest that megestrol, like other glucocorticoid agonists, is associated with an increased risk of developing a psychiatric disorder. This risk should be considered when determining the risk-to-benefit ratio of megestrol use in patients.

Most research on autism spectrum disorder (ASD) has focused on younger individuals, but there is increasing awareness that more must be known about the clinical needs and outcomes of older adults with ASD. This article reviews what is known about barriers to recognition in the elderly, the prevalence of ASD over the lifespan, outcomes in adulthood in comparison to the general population, co-occurring psychiatric diagnoses, and healthcare needs in this population.

The introduction of behavioral addictions is a relatively new concept in psychiatry. It was not until 2010 that the term behavioral addictions was added to the official classification of psychiatric diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Gambling, typically thought to be an adult behavior, has become commonplace among adolescents. Although technological advances have made accessing information and communication easier, excessive use of the Internet and smartphones can result in multiple mental and physical health issues. Gambling disorders, gaming disorders, Internet use disorder, and excessive smartphone use often begin during childhood and adolescence.

Accurate psychiatric diagnosis is critical for both sound clinical interventions and valid research methodology. Over the years, attempts to improve diagnostic reliability and accuracy led to the development of more explicit operationalized diagnostic criteria, starting with DSM-III, and subsequently fully structured and semistructured diagnostic interviews.1 As diagnostic assessment changed and with advances in technology, the use of computers soon developed in parallel to improve the reliability and validity of psychiatric diagnosis. As far back as 1968, computers were used to help clinicians formulate psychiatric diagnoses, by helping them process clinical information according to diagnostic algorithms.2 Since that time, there has been an exponential rise in the use of technology in clinical research and practice. Indeed, computers have been used both to transition diagnostic interviews from paper-and-pencil format to instruments that are clinician-administered via an electronic platform and to create self-report versions of clinician-administered diagnostic interviews. We will discuss each of these in turn.

Purpose Disorders of mother-infant bonding have been described since early 20th Century. Previous studies have looked at the prevalence of bonding disorders among mothers with postpartum psychiatric disorders. However, its frequency among healthy postpartum mothers is less studied. Methods Two hundred and fifty mother-infant dyads were studied using the Mini International Neuropsychiatric Interview (MINI), the Stafford Interview, Bangalore Maternal Behaviour Scale (BMBS) and Tamil versions of the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Bonding Questionnaire (PBQ). The mothers were interviewed between 4 weeks to six months postpartum. In addition, thirty one mothers with a lifetime history of psychiatric disorders were interviewed using the above scales. Results The frequency of bonding disorders was found to be 24% among healthy postpartum mothers as against 45.2% in mothers with psychiatric disorder. However, the frequency of mild disorders of bonding was relatively lower at 5.6% among healthy mothers and 6.5% among mothers with psychiatric disorders. We found that mothers in India had a clinging / over-involved subtype of anxiety that prevented them from leaving their baby under care of another competent adult. While infant-related anxiety was seen in 10% of healthy mothers, about 20% of mothers with psychiatric diagnoses had anxiety. The presence of bonding disorders was not correlated with any maternal or infant related factors except difficulty in breastfeeding. Conclusions Disorders of mother infant bonding are seen in healthy postpartum mothers. The frequency of mild disorders of bonding appears to be similar across countries and this condition warrants further attention.

International audience; The purpose of this article is to describe complex psychiatric disorders, to recall “minimal classical” explorations in psychiatry, to describe the concept of “complex psychiatric disorders” and to propose a systematized method of exploration.Some organic diseases are well known for their links with psychiatric disorders (manic syndrome and hyperthyroidism, depressive syndrome and corticotropic insufficiency, anxiety disorder and heart disease, etc.).Many other neurological, autoimmune, metabolic, paraneoplastic or endocrine pathologies can have essentially psycho-behavioral manifestations before being neurological or systemic.A large number of factors (nutritional, toxic, immunological, etc.), often ignored, influence the links between organicity and psychiatric pathologies.It is necessary to optimize the medical management of these patients in whom the psychiatric diagnosis masks a curable organo-psychiatric cause.; Cet article a pour objectifs de décrire des troubles psychiatriques complexes, de rappeler les explorations « classiques minimales » en psychiatrie, de décrire le concept de « troubles psychiatriques complexes » et de proposer une méthode d’exploration systématisée.Certaines pathologies organiques sont bien connues pour leurs liens avec les troubles psychiatriques (syndrome maniaque et hyperthyroïdie, syndrome dépressif et insuffisance corticotrope, trouble anxieux et maladie cardiaque, etc.).De nombreuses autres pathologies neurologiques, auto-immunes, métaboliques, paranéoplasiques ou endocriniennes peuvent avoir des manifestations essentiellement psycho-comportementales avant d’être neurologiques ou systémiques.Un grand nombre de facteurs (nutritionnels, toxiques, immunologiques, etc.), souvent ignorés, exercent une influence sur les liens existants entre organicité et pathologies psychiatriques.Il est nécessaire d’optimiser la prise en charge médicale de ces patients chez qui le diagnostic psychiatrique masque une cause organo-psychiatrique curable.

Recently, research focusing on the implications of brain injuries for deleterious outcomes spanning a wide range of developmental domains has flourished. Findings from this literature suggest that brain injury is a potent source of risk for negative outcomes including neurodegenerative diseases, cognitive impairment, behavioral problems, and psychiatric diagnoses. Despite this evidence, few studies have examined the extent to which these findings represent a causal relationship. This review outlines the expansive literature in this developing area and provides a discussion of potential threats to internal validity. Finally, suggestions for future research are provided with a particular emphasis on leveraging existing findings to better understand the role of brain injury in the development of deleterious outcomes.

Background Suicidal behavior has been associated with maladaptive strategies for emotion regulation; however, limited research has explored this association after controlling for diagnosis. This study aims to explore this connection across diagnoses. We hypothesized that patients who reported greater difficulty with emotion regulation would be more likely to have made suicide attempts. Method Participants included 1046 psychiatric outpatients. Diagnoses and information about suicide history were determined using semi-structured interviews. Patients also completed the Difficulties in Emotion Regulation Scale (DERS). Analyses were conducted to determine the relationships between emotion regulation difficulties and lifetime suicide attempts. Results Emotion regulation difficulties did not independently predict suicidal behavior. After controlling for the contribution of emotion dysregulation on lifetime suicide attempts, diagnoses of borderline personality disorder and posttraumatic stress disorder were the only disorders independently associated with a history of suicidal behavior. Limitations The generalizability of our findings may be limited based on the sample's demographic characteristics and low base rate of suicide attempts. This study was cross-sectional in nature; therefore, the predictive capacity of either DERS scores or psychiatric diagnoses in terms of future suicidal behavior could not be determined. Conclusions The independent effect of emotion dysregulation on suicidal behavior was negated after controlling for psychiatric diagnosis. Individuals with certain disorders tend to make suicide attempts for reasons that are distinct from emotion dysregulation, whereas emotion dysregulation may be at the core of suicidality for individuals with other clinical presentations.

A reduced P1 visual-evoked potential amplitude has been reported across several psychiatric disorders, including schizophrenia-spectrum, bipolar, and depressive disorders. In addition, a difference in P1 amplitude change to a red background compared to its opponent color, green, has been found in schizophrenia-spectrum samples. The current study examined whether specific psychiatric symptoms that related to these P1 abnormalities in earlier studies would be replicated when using a broad transdiagnostic sample. The final sample consisted of 135 participants: 26 with bipolar disorders, 25 with schizophrenia-spectrum disorders, 19 with unipolar depression, 62 with no current psychiatric disorder, and 3 with disorders in other categories. Low (8%) and high (64%) contrast check arrays were presented on gray, green, and red background conditions during electroencephalogram, while an eye tracker monitored visual fixation on the stimuli. Linear regressions across the entire sample (N = 135) found that greater severity of both clinician-rated and self-reported delusions/magical thinking correlated with a reduced P1 amplitude on the low contrast gray (neutral) background condition. In addition, across the entire sample, higher self-reported constricted affect was associated with a larger decrease in P1 amplitude (averaged across contrast conditions) to the red, compared to green, background. All relationships remained statistically significant after covarying for diagnostic class, suggesting that they are relatively transdiagnostic in nature. These findings indicate that early visual processing abnormalities may be more directly related to specific transdiagnostic symptoms such as delusions and constricted affect rather than specific psychiatric diagnoses or broad symptom factor scales.

The aim of this study was to assess social- perceptual Theory of Mind in bipolar disorder (BD). 112 euthymic participants with BD I or BD II (65 with BD I and 47 with BD II) were compared to a group of 112 persons with no psychiatric diagnosis and 43 with unipolar depression (UD). They completed the task of the "Reading the Mind in the Eyes" (RMET). The results show that participants with BD, I and II, as well as the group with UD performed significantly more poorly than the control group. As for the wrong answers, BDs mostly chose positive valence stimuli, while the UD group chose negative valence items. The main limitation of this research is related to the characteristics of the cross-sectional study. It cannot detect at what time of the disorder these differences in emotion processing will appear with more intensity. As for future research, we suggest interventions to improve the deficits in ToM in bipolar persons. The use of the RMET in the first stages of BD II could help to facilitate a correct diagnosis.

This article presents rule induction algorithms for identify and evaluate variables related to social vulnerability risk factors of the individual that influence the diagnosis of psychotic disorders. 213 variables were analyzed: sociodemographic, psychic experiences in the community, traumas in childhood, bullying, and use of marijuana, tobacco, and alcohol. Four subsets were constructed and with them, we reach an attribute reduction of 80%. In development, an accuracy of approximately 80% was maintained. About the number of rules there was a reduction of 90% of possibilities generated, simplifying the representation of the model. Thus, the results proved promising for the use of this approach as a basis in the construction of decision support systems in the area and in the deepening of studies for the incorporation of new variables in psychiatric diagnosis, increasing the reliability and validity of the diagnostic process.

Background:\ud Data on psychiatric disorders in survivors born very preterm (VP; 2499 g and/or gestational age ≥37 weeks), and 3) structured measure of psychiatric diagnoses using DSM or ICD criteria. Diagnoses of interest were Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), Anxiety Disorder, Mood Disorder, Disruptive Behaviour Disorder (DBD), Eating Disorder, and Psychotic Disorder. A systematic search for eligible studies was conducted (PROSPERO Registration Number 47555).\ud \ud Findings:\ud Data were obtained from 10 studies (1385 VP/VLBW participants, 1780 controls), using a range of instruments and approaches to assigning diagnoses. Those born VP/VLBW had ten times higher odds of meeting criteria for ASD (odds ratio [OR] 10·6, 95% confidence interval [CI] 2·50, 44·7), five times higher odds of meeting criteria for ADHD (OR 5·42, 95% CI 3·10, 9·46), twice the odds of meeting criteria for Anxiety Disorder (OR 1·91, 95% CI 1·36, 2·69), and 1·5 times the odds of meeting criteria for Mood Disorder (OR 1·51, 95% CI 1·08, 2·12) than controls. This pattern of findings was consistent within age (

Psychiatric inpatients in the Fukushima prefecture were immediately evacuated from hospitals following the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident in 2011. Whereas the psychiatric status and physical condition of these patients have been considered as factors related to triage during hospital evacuation, few studies show how this background affects the evacuation destination. Thus, the study objective was to reveal associations between hospital evacuation destinations among psychiatric inpatients and their characteristics. This retrospective study enrolled psychiatric inpatients who had been evacuated by the Fukushima prefectural government following the FDNPP accident (N = 783). Patients were classified into two groups based on their evacuation destination (within/outside the Fukushima prefecture). Univariable and multivariable analyses were conducted to investigate the associations between evacuation destination and patients’ traits, including psychiatric/physical backgrounds. Three-quarters of inpatients were evacuated to hospitals outside the prefecture. Multivariable analysis showed that patients diagnosed with mental retardation (ICD-10 F70–79) and psychiatric patients with respiratory diseases (J00–99), genitourinary diseases (N00–99) as comorbidities tended to have been evacuated to hospitals within the prefecture. By contrast, patients with nervous system diseases (G00–99) as comorbidity tended to have been evacuated to hospitals outside the prefecture. In psychiatric patients, specific psychiatric diagnoses and several types of physical comorbidities were associated with the evacuation destination. Prospective follow-up studies are necessary to reveal how the presumed triage strategy has improved the outcomes in evacuated psychiatric patients.

Background: Schizophrenia (SZ) and bipolar disorder (BD) patients share deficits in motor functions in the form of neurological (NSS) and cerebellar soft signs (CSS), and implicit motor learning disturbances. Here, we use cluster analysis method to assess (1) the relationship between those abnormalities in SZ and BD and (2) the differences between those groups. Methods: 33 SZ patients, 33 BD patients as well as 31 healthy controls (HC) took part in the study. We assessed CSS with the International Cooperative Ataxia Rating Scale (ICARS) and NSS with the Neurological Evaluation Scale (NES). Implicit motor learning was evaluated with the Serial Reaction Time Task (SRTT). Participants were divided into clusters (Ward's method) based on the mean response time and mean error rate in SRTT. The difference in ICARS and NES scores, and SRTT variables between clusters were evaluated. We have measured associations between SRTT parameters and both ICARS and NES total scores and subscores. Results: Cluster analysis based on the SRTT parameters allowed to extract three clusters. Those were characterized by the increasing disruption of motor functioning (psychomotor retardation, the severity of NSS and CSS) regardless of the diagnosis. Cluster 1 covered almost all of HC and was characterized by faster reaction times and small number of errors. BD and SZ patients represented in cluster 1, although fully functional in performing the SRTT, showed higher rates of NSS and CSS. Patients with BD and SZ were set apart in clusters 2 and 3 in a similar proportion. Cluster 2 presented significantly slower reaction times but with the comparable number of errors to cluster 1. Cluster 3 consisted of participants with normal or decreased reaction time and significantly increased number of errors. None of the clusters were predominantly composed of the patients representing one psychiatric diagnosis. Conclusions: To our best knowledge, we are presenting the first data indicating the relationship between implicit motor learning and NSS and CSS in SZ and BD patients' groups. Lack of clusters predominantly represented by patients with the diagnosis of SZ or BD may refer to the model of schizophrenia-bipolar disorder boundary, pointing out the similarities between those two disorders.

BACKGROUND: Surgical patients receiving psychopharmacologic treatment have been associated with adverse outcomes in total hip and knee arthroplasty (THA and TKA). The purpose of this study was to investigate whether a specific high-risk group of patients receiving psychopharmacologic treatment could be identified based upon a nationwide psychiatric diagnosis register.METHODS: From 7 different orthopedic centers, 8288 THA and TKA patients were included from January 2010 to November 2012 of which 943 (11.4%) received psychopharmacologic treatment. Patients receiving preoperative psychopharmacologic treatment were divided into 2 groups based on the presence or absence of a psychiatric diagnosis in a nationwide administrative database and analyzed with respect to length of hospital stay (LOS >4 days) and 30- and 90-day readmissions using multivariable logistic regression models.RESULTS: A total of 191 patients receiving psychopharmacologic treatment were registered with a psychiatric diagnosis while 752 patients received psychopharmacologic treatment without a registered psychiatric diagnosis. No significantly increased risk was found in patients with a preoperative registered psychiatric diagnosis compared to patients without, with regard to LOS >4 days (odds ratio [OR], 1.19; P = .51), 30-day readmission (OR, 0.56; P = .086), or 90-day readmission (OR, 0.81; P = .446), respectively. However, both groups had an increased risk of LOS >4 days and readmissions compared to a control population without psychopharmacologic treatment or any registered psychiatric diagnoses.CONCLUSION: No further risk was found for psychopharmacologically treated THA/TKA patients with an additional hospital-related psychiatric diagnosis compared to patients without, suggesting that the psychopharmacologic treatment per se is an outcome risk factor independent of severity of the psychiatric disorder.

Mental illness has reached crisis proportions, yet we still have no clear links between psychiatric diagnoses and what's going on in the brain--and no effective new classes of drugs. There's one group of compounds that shows promise. They seem to be capable of alleviating symptoms for long periods, in some cases with just a single dose. The catch is that these substances, known as psychedelics, have been outlawed for decades. Wong investigates how psychedelic drugs are transforming the way we think about mental illness.

Introduction and objectives Higher rates of psychiatric disorders are reported among cirrhotic patients. This study examines the demographic and clinical outcomes post-liver transplant (LT) among cirrhotic patients with a major psychiatric diagnosis (cases) compared to those without psychiatric diagnosis (controls). Materials and methods Retrospective case control design was used among 189 cirrhotic patients who had undergone LT at Methodist University Hospital Transplant Institute, Memphis, TN between January 2006 and December 2014. Multivariable regression and Cox proportional hazard regression were conducted to compare allograft loss and all-cause mortality. Results The study sample consisted of a matched cohort of 95 cases and 94 controls with LT. Females and those with Hepatic Encephalopathy (HE) were more likely to have psychiatric diagnosis. Patients with hepatocellular carcinoma (HCC) were twice as likely to have allograft loss. Psychiatric patients with HCC had two and a half times (HR 2.54; 95% CI: 1.20–5.37; p = 0.015) likelihood of all-cause mortality. Data censored at 1-year post-LT revealed that patients with psychiatric diagnosis have a three to four times higher hazard for allograft loss and all-cause mortality compared to controls after adjusting for covariates, whereas when the data is censored at 5 year, allograft loss and all-cause mortality have two times higher hazard ratio. Conclusions The Cox proportional hazard regression analysis of censored data at 1 and 5 year indicate higher allograft loss and all-cause mortality among LT patients with psychiatric diagnosis. Patients with well-controlled psychiatric disorders who undergo LT need close monitoring and medication adherence.

Background\ud \ud This Commission addresses several priority areas for psychiatry over the next decade, and into the 21st century. These represent challenges and opportunities for the profession to sustain and develop itself to secure the best possible future for the millions of people worldwide who will face life with mental illness.\ud \ud \ud Part 1: The patient and treatment\ud \ud Who will psychiatrists help? The patient population of the future will reflect general demographic shifts towards older, more urban, and migrant populations. While technical advances such as the development of biomarkers will potentially alter diagnosis and treatment, and digital technology will facilitate assessment of remote populations, the human elements of practice such as cultural sensitivity and the ability to form a strong therapeutic alliance with the patient will remain central.\ud \ud \ud Part 2: Psychiatry and health-care systems\ud \ud Delivering mental health services to those who need them will require reform of the traditional structure of services. Few existing models have evidence of clinical effectiveness and acceptability to service users. Services of the future should consider stepped care, increased use of multidisciplinary teamwork, more of a public health approach, and the integration of mental and physical health care. These services will need to fit into the cultural and economic framework of a diverse range of settings in high-income, low-income, and middle-income countries.\ud \ud \ud Part 3: Psychiatry and society\ud \ud Increased emphasis on social interventions and engagement with societal expectations might be an important area for psychiatry's development. This could encompass advocacy for the rights of individuals living with mental illnesses, political involvement concerning the social risk factors for mental illness, and, on a smaller scale, work with families and local social networks and communities. Psychiatrists should therefore possess communication skills and knowledge of the social sciences as well as the basic biological sciences.\ud \ud \ud Part 4: The future of mental health law\ud \ud Mental health law worldwide tends to be based on concerns about risk rather than the protection of the rights of individuals experiencing mental illness. The United Nations Convention on the Rights of Persons with Disabilities, which states that compulsion based in whole or in part on mental disability is discriminatory, is a landmark document that should inform the future formulation and reform of mental health laws. An evidence-based approach needs to be taken: mental health legislation should mandate mental health training for all health professionals; ensure access to good-quality care; and cover wider societal issues, particularly access to housing, resources, and employment. All governments should include a mental health impact assessment when drafting relevant legislation.\ud \ud \ud Part 5: Digital psychiatry—enhancing the future of mental health\ud \ud Digital technology might offer psychiatry the potential for radical change in terms of service delivery and the development of new treatments. However, it also carries the risk of commercialised, unproven treatments entering the medical marketplace with detrimental effect. Novel research methods, transparency standards, clinical evidence, and care delivery models must be created in collaboration with a wide range of stakeholders. Psychiatrists need to remain up to date and educated in the evolving digital world.\ud \ud \ud Part 6: Training the psychiatrist of the future\ud \ud Rapid scientific advance and evolving models of health-care delivery have broad implications for future psychiatry training. The psychiatrist of the future must not only be armed with the latest medical knowledge and clinical skills but also be prepared to adapt to a changing landscape. Training programmes in an age in which knowledge of facts is less important than how new knowledge is accessed and deployed must refocus from the simple delivery of information towards acquisition of skills in lifelong learning and quality improvement.\ud \ud \ud Conclusion\ud \ud Psychiatry faces major challenges. The therapeutic relationship remains paramount, and psychiatrists will need to acquire the necessary communication skills and cultural awareness to work optimally as patient demographics change. Psychiatrists must work with key stakeholders, including policy makers and patients, to help to plan and deliver the best services possible. The contract between psychiatry and society needs to be reviewed and renegotiated on a regular basis. Mental health law should be reformed on the basis of evidence and the rights of the individual. Psychiatry should embrace the possibilities offered by digital technology, and take an active role in ensuring research and care delivery in this area is ethically sound and evidence based. Psychiatry training must reflect these multiple pressures and demands by focusing on lifelong learning rather than simply knowledge delivery.

Suicidality is a general term that describes the continuum of suicidal ideation, intent, self-injurious behavior, attempts, and completed suicide. Suicidality across the entire spectrum is a public health concern with significant impact, including billions in work loss and medical costs. There are many challenges to managing suicidality in an intensive care unit setting, which will be reviewed here. Additionally, this article will review the prevalence of suicide attempts in different psychiatric diagnoses, conducting a suicide assessment, role of involuntary psychiatric holds, and most common challenges encountered in the ICU setting.

Current treatment strategies for psychiatric disorders remain inadequate. Impeding development of novel therapeutics is our incomplete knowledge of the molecular pathophysiology underlying these disorders. Changes to miRNA function and expression are increasingly being associated with pathological behavioral states. Furthermore, the prospect of using of miRNA expression profiles (the miRNome) as objective psychiatric diagnosis tools is gaining traction. In this review, we focus on recent findings surrounding the link between miRNA function and psychiatric disorders, and outline some of the key challenges that will need to be overcome if the therapeutic potential of these molecular effectors is to be fully realized.

Current bariatric literature on postoperative interventions that prevent or remediate suboptimal weight loss outcomes is limited. In response, Early Adherence Targeted Therapy (EATT), an efficient early postoperative intervention to target patients at high risk for suboptimal postoperative weight loss outcomes was developed. The rationale for and a detailed description of EATT is provided, including sample session transcripts. Preliminary findings from a pilot designed to explore EATT’s feasibility and acceptability are reported. EATT is a principle driven, skills-based intervention that addresses psychological skill deficits that underlie poor dietary adherence and maladaptive eating behaviors associated with suboptimal weight loss outcomes. Of 22 postoperative patients who consented to participate, 13 screened positive for poor dietary adherence and thus received EATT (77% female, 69% White, 23% Hispanic; mean age = 42.9 years; mean BMI = 45.4 ± 12.8 kg/m2). The majority had undergone gastric bypass surgery (54%) and 76.9% had a psychiatric diagnosis, with 61% on psychotropic medications. Patient retention was high, with 11/13 (85%) completing treatment. Treatment was delivered efficiently, with an average of only 4.5 sessions (out of a possible 12) required to significantly increase dietary adherence (p

The term postpartum depression is used generically to denote occurrence of a depressive episode after childbirth. Emerging research suggests that bipolar disorder is common among women with postpartum depression. Due to the lack of awareness of its existence, bipolar postpartum depression is often misdiagnosed as major depressive disorder, causing long delays for women to receive appropriate treatment. We hypothesize that screening all women with postpartum depression for bipolar disorder would help correctly identify subgroups of women based on the underlying psychiatric diagnosis. This suggested approach could improve the outcome of postpartum depression and facilitate timely disorder-specific treatment interventions.

Background Despite a high prevalence of psychiatric conditions in autistic adults, research examining the diagnostic stability of psychiatric conditions diagnosed prior to autism is limited. Method The present study examined the occurrence of (1) psychiatric diagnoses obtained before autism was diagnosed, (2) psychiatric conditions co-occurring with autism following its diagnosis, and (3) psychiatric conditions that were diagnosed before autism but no longer co-occurred with autism following its diagnosis. Participants (N = 1019, 51.5% female) provided information on psychiatric conditions predating their diagnosis of autism and psychiatric conditions co-occurring with autism. This information was combined to identify prior diagnoses that were no longer present post-autism diagnosis. Results Results showed that 50.2% of participants (62.7% of females and 37% of males) had at least one prior diagnosis. Mood and personality disorders were the most frequent prior diagnoses. Moreover, 59.3% (67% of females and 51% of males) reported having at least one diagnosis co-occurring with autism. Mood and anxiety disorders were the most frequent co-occurring diagnoses. Finally, 37.7% (47% of females and 27.3% of males) reported at least one previously diagnosed psychiatric condition that was no longer listed as a condition co-occurring with autism following its diagnosis. Personality disorders were most frequently no longer reported as diagnoses co-occurring with autism, despite being listed as prior diagnoses. Conclusions This study provides quantitative estimates of the temporal stability of specific psychiatric conditions before and after a diagnosis of autism in adults.

This study examined sociocultural correlates of exercise dependence symptoms (EDSX) in young Asian/Asian American men. We hypothesized that greater adherence to Asian cultural values would be positively associated with EDSX and that the internalization of muscularity and thinness appearance ideals would exacerbate this link. Participants included 266 Asian/Asian American men (18–30y, Mage = 24.4 ± 3.6y; MBMI = 24.2 ± 5 kg/m2) enrolled in a larger study examining disordered eating and body image concerns in ethnically/racially diverse young men. Participants completed an online survey that assessed demographics, adherence to Asian values, internalization of muscularity and thinness appearance ideals, and EDSX. After adjusting for BMI, income, education, and presence of a psychiatric diagnosis, a linear regression model indicated that adherence to Asian values was significantly and positively associated with EDSX (B = 12.13, p = .036). Neither internalization of muscularity (p = .812) nor thinness (p = .967) appearance ideals moderated this association. However, independently, both internalization of muscularity (B = 10.93, p

Resume La depression mixte correspond a un syndrome depressif avec des elements d’activation psychomotrice, de la lignee hypomaniaque. Les patients avec une depression mixte sont particulierement a risque de conduites suicidaires, d’abus de substances, et surtout de resistance therapeutique. Cependant, cette situation pathologique reste peu identifiee, et peu etudiee malgre sa frequence elevee. Sa faible reconnaissance a ete probablement liee a l’absence de ce concept dans les classifications internationales. Le DSM-5, recemment publie dans sa version definitive, a propose une refonte de la definition des etats mixtes, depassant une conception particulierement restrictive dans le DSM-IV. Des « caracteristiques mixtes » peuvent servir de specificateur pour un episode de trouble de l’humeur, depressif ou maniaque. La depression avec caracteristique mixte est definie par la presence de trois symptomes de la lignee maniaque associee a la depression, hors agitation, distractibilite ou irritabilite. Nous discutons dans cet article de la pertinence clinique de ce concept. Nous montrons que les criteres diagnostiques du DSM-5 manquent de coherence clinique, sont difficilement applicables, et ne permettent pas d’identifier la majorite des depressions mixtes. Cela risque de freiner l’avancee de la recherche sur la depression mixte, dont les strategies therapeutiques restent encore peu etudiees systematiquement, et dont l’epidemiologie et les facteurs de risque ne sont encore que partiellement connus. L’approche du DSM-5, d’allure innovante, a finalement conduit a une avancee modeste, dont le fondement scientifique reste discute.

Background/Purpose The aim of this study was to examine the correlations between the severity of alprazolam dependence and socio-demographic characteristics, the characteristics of alprazolam use, psychiatric comorbidity, and beliefs toward alprazolam use among long-term alprazolam users in Taiwan. Methods A total of 148 long-term alprazolam users participated in this study. The Chinese version of the Severity of Dependence Scale was used to assess participants' severity of alprazolam dependence in the preceding month. Their socio-demographic characteristics, family function characteristics, dosage of prescribed alprazolam, duration of alprazolam use, alcohol use pattern, pain reliever and cigarette use pattern, severity of depressive symptoms, psychiatric diagnosis, and belief toward alprazolam use were investigated. Results The results of multiple regression analysis indicated that a longer duration of alprazolam use, severe depressive symptoms, a high level of belief in the necessity of alprazolam treatment, and a high level of concern about the potential adverse consequences of alprazolam use were significantly associated with more severe alprazolam dependence. Conclusion Doctors should closely monitor the severity of alprazolam dependence among long-term users, especially patients' levels of depression, beliefs in the necessity of alprazolam treatment, and their concerns over the adverse consequences of continued treatment with alprazolam.

Patients undergoing elective lumbar spine fusion experience symptoms of PTSD relating to their surgeries in substantial numbers. While pre-operative symptoms of psychiatric distress or psychiatric diagnoses are risk factors for such symptoms, many patients without such “red flags” also report these effects. In addition, the ultimate clinical benefit reported by patients experiencing post-operative symptoms of PTSD is reduced when compared to patients without such symptoms. Recognition and management of such concerns peri-operatively may offer an avenue to enhance clinical outcomes and improve patient experience following elective lumbar fusion.

Background Deletion of the recurrent ~600 kb BP4-BP5 chromosomal region 16p11.2 has been associated with a wide range of neurodevelopmental outcomes. Methods To clarify the phenotype of 16p11.2 deletion, we examined the psychiatric and developmental presentation of predominantly clinically referred individuals, with a particular emphasis on broader autism phenotype characteristics in individuals with recurrent ~600 kb chromosome 16p11.2 deletions. Using an extensive standardized assessment battery across three clinical sites, 85 individuals with the 16p11.2 deletion and 153 familial control subjects were evaluated for symptom presentation and clinical diagnosis. Results Individuals with the 16p11.2 deletion presented with a high frequency of psychiatric and developmental disorders (>90%). The most commonly diagnosed conditions were developmental coordination disorder, phonologic processing disorder, expressive and receptive language disorders (71% of individuals >3 years old with a speech and language–related disorder), and autism spectrum disorder. Individuals with the 16p11.2 deletion not meeting diagnostic criteria for autism spectrum disorder had a significantly higher prevalence of autism-related characteristics compared with the familial noncarrier control group. Individuals with the 16p11.2 deletion had a range of intellectual ability, but IQ scores were 26 points lower than noncarrier family members on average. Conclusions Clinically referred individuals with the 16p11.2 deletion have high rates of psychiatric and developmental disorders and provide a genetically well-defined group to study the emergence of developmental difficulties, particularly associated with the broader autism phenotype.

Relationships of coping styles to maturation, sex, and psychiatric diagnoses are not well defined. Accordingly, we examined their development from late-adolescence into adulthood, and their associations with psychiatric disorders. We assessed coping styles in 970 subjects prospectively, at mean ages 17, 24, 29, and 33, using the Coping Inventory for Stressful Situations. Selected DSM-IV-TR lifetime psychiatric disorders were assessed at age 24. We found that reliance on adaptive task-oriented coping (TOC) increased sharply from ages 17 to 24, (effect size [ES] = 0.94), and stabilized thereafter; less adaptive emotion-oriented coping (EOC) declined continuously over time. Men and women had similar TOC scores from ages 17 to 33, but women had moderately higher EOC scores at age 17 (ES=0.53). Greater reliance on EOC at age 24 was associated with more major depressive or anxiety disorders, adjusted for stressors and sex. Greater use of TOC at age 17 was associated with less risk for drug or alcohol abuse/dependence by age 24 after adjusting for sex and stressors. In conclusion, coping styles generally became more adaptive with maturation, though women used EOC more than men. Additionally, greater reliance on TOC in late-adolescence may reduce risks for substance use disorders.

This study aimed to examine the degree to which posttraumatic stress disorder (PTSD) affects the relationship between social support and psychological distress for U.S. Afghanistan/Iraq era veterans with and without co-occurring psychiatric disorders. Veterans (N=1825) were administered self-report questionnaires and a structured diagnostic interview as part of a multi-site study of post-deployment mental health through the Department of Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC). Main and interaction effects models assessed the association between psychological distress and social support for three comparisons conditions (Controls vs. PTSD-only, non-PTSD, and PTSD plus co-morbid diagnoses). Having PTSD was a critical factor in attenuating the strength of this association, more so than other diagnoses. Furthermore, those with PTSD plus co-morbid diagnoses did not demonstrate significantly larger attenuation in that association compared to the PTSD-only group, indicating that psychiatric comorbidity may be less important in considering the role of social support in PTSD. By understanding this relationship, new avenues for engaging and enhancing treatment outcomes related to social support for veterans of this cohort may be identified. Additional longitudinal research could help evaluate the effect of PTSD symptom clusters, social support type, and trauma exposure type on these relationships.

The Computer System for the Structured Mandala (CSSM) has been developed to quantitatively and automatically evaluate color-related elements in a structured mandala, find the statistically significant elements that differentiate the four groups of non-patients, anxious patients, depressed patients, and schizophrenic patients, and identify which of the four groups drew the mandala. A total of 495 samples of structured mandalas were obtained from the four groups. The system applied the statistical methods of factor analysis and regression analysis. The system found 67 statistically significant elements and successfully identified the group based on only a structured mandala without further information. The CSSM contributes to the automation and standardization of the structured mandala as an art therapy assessment with high reliability, validity, and usefulness. The system can be used as an assessment for other art therapy dealing with various psychological disorders.

Somatic co-morbidities of the psychiatric diagnosis represent an important issue, due to the lowering of the diagnostic threshold through a complex screening and through treatment implications. Modern Psychotropic treatments come with side effects and adjacent somatic disorders raise suspicions on the most relevant antidepressant or antipsychotic. For doctors specialized in somatic diagnoses, the existence of the “psi” symptoms induce a hesitation in pointing to certain investigations. The patient himself explains his symptoms in a different manner. There is a gap in what concerns the late detection of secondary somatic diagnoses in patients already diagnosed with a mental disorder.

Even though individuals with psychiatric conditions have a prevalence of smoking approximately 2-4 times greater than the general population, surprisingly little evidence exists to inform an assessment of the full range of tobacco-related mortality in such populations. The current study aims to provide mortality estimates for conditions causally related to tobacco use among individuals hospitalized with a primary psychiatric diagnosis in California from 1990 to 2005. Restricting cases to those of individuals aged 35 or older at the mid-point of their follow-up period, we assembled cohorts of individuals with ICD-9 diagnoses of schizophrenia and related disorders ("schizophrenia"; n = 174,277), depressive disorders (n = 338,250), or bipolar disorder (n = 78,739). Inpatient records were linked to death-certificate data. We generated age-, sex-, and race-adjusted standardized mortality ratios (SMRs) for the 19 diseases identified by the Centers for Disease Control and Prevention as being causally linked to tobacco use. The SMRs for all tobacco-linked diseases combined were: schizophrenia, 2.45 (95% CI = 2.41-2.48); bipolar, 1.57 (95% CI = 1.53-1.62); and depression, 1.95 (95% CI = 1.93-1.98). Tobacco-related conditions comprised approximately 53% (23,620/44,469) of total deaths in the schizophrenia, 48% (6004/12,564) in the bipolar, and 50% (35,729/71,058) in the depression cohorts. Addressing tobacco use in psychiatric populations is a critical clinical and public-health concern, especially in light of the currently limited clinical attention devoted to tobacco use in these groups.