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Turk Psikiyatri Dergisi = Turkish... 2021Dear Editor, The 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11), including the chapter on mental, behavioural and...
Dear Editor, The 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11), including the chapter on mental, behavioural and neurodevelopmental disorders, has been adopted unanimously by the 72nd World Health Assembly in Geneva on May 25, 2019. The endorsement of the new classification will not come into effect until January 1, 2022. Until that date, the Member States of the World Health Organization (WHO) will keep on using the ICD-10 for reporting data. The most significant innovations in the ICD-11 chapter, and the most important differences from the DSM-5, have been detailed elsewhere (Reed et al. 2019). Several issues debated in the process of development of the chapter - including the role of a dimensional component within a system that remains mainly based on categories, and the need for a further clinical characterization of the individual patient, in addition to the diagnosis, in order to guide the formulation of the prognosis and the management plan, have been also covered in the recent literature (Clark et al. 2017, Rebello et al. 2019, Fuss et al. 2019, Gureje et al. 2019, van Os et al. 2019, Fusar-Poli et al. 2019, Forbes et al. 2019, Gaebel et al. 2019, Patel 2019, Kotov et al. 2020, Maj et al. 2020, Sanislow et al. 2020). The training of professionals in the use of the ICD-11 chapter is now ongoing worldwide, under the coordination of a WHO International Advisory Group led by G.M. Reed. Educational courses have been conducted at the 18th and 19th World Congresses of Psychiatry (Mexico City, Mexico, September 27-30, 2018; and Lisbon, Portugal, August 21-24, 2019) (Giallonardo 2019, Pocai 2019, Perris 2020). A more comprehensive online 20-hr training course has been organized by the Naples WHO Collaborating Centre on Research and Training in Mental Health and the European Psychiatric Association from 9 to 30 April, 2021. The course has been coordinated by G.M. Reed and M. Maj, and has covered all the main sections of the ICD-11 chapter on mental disorders. W. Gaebel, M. Cloitre, M. Maj, C.S. Kogan, P. Monteleone, M. Swales, J.B. Saunders and N.A. Fineberg composed the Faculty. The live course has been attended by 120 psychiatrists, selected from almost 500 applicants, representing 78 different countries. A further group of 250 psychiatrists have had access to the course on demand. Two ICD-11 training sessions have been organized by the Psychiatric Association of Turkey within its 24th Clinical Education Symposium, held from 2 to 6 June 2021. One covered psychotic disorders and mood disorders, with the participation of W. Gaebel and M. Maj and the chairmanship of S. Vahip and C. Atbasoglu. The other dealt with trauma-related, fear-related and obsessive-compulsive disorders, with the participation of M. Cloitre and D.J. Stein and the chairmanship of R. Tukel and C. Kilic. Each session had more than 150 participants. An ICD-11 training event has been also organized by the UK Royal College of Psychiatrists from 25 to 26 May 2021. One further educational event is now going to be held by the World Psychiatric Association from 8 to 29 November 2021 (www.wpanet.org). A training course with exclusive access to the members of the WHO Global Clinical Practice Network (https://gcp.network) has been recently set up by the WHO Collaborating Centre on Mental Health at the Columbia University, in collaboration with the WHO Department of Mental Health and Substance Use. The course consists of 15 online training units, each focusing on a different disorder grouping and EDUCATIONAL ACTIVITIES RELATED TO THE ICD-11 CHAPTER ON MENTAL DISORDERS 292 Received: 13.09.2021, Accepted: 15.09.2021, Available Online Date: 30.11.2021 MD., University of Campania L. Vanvitelli, WHO Collaborating Centre for Research and Training in Mental Health, Naples, Italy. Dr. Vincenzo Giallonardo, e-mail: [email protected] https://doi.org/10.5080/u26898 taking from one to one and a half hours. Each unit provides a description of the relevant diagnostic grouping and the main innovations with respect to the ICD-10. Knowledge check questions are included to test the outcome of training. Participants have the opportunity to practice by applying diagnostic guidelines to clinical case examples. This training course is going to be available also in Spanish, and additional translations are planned. The WHO Global Clinical Practice Network now includes more than 16.000 clinicians from 159 countries (51% psychiatrists, 30% psychologists; 40% from Europe, 25% from Western Pacific, 24% from the Americas, 5% from Southeast Asia, 3% from Eastern Mediterranean, and 3% from Africa; 63% from high-income countries, 37% from middle- and low-income countries). The Network contributed significantly to the development of the ICD-11 chapter on mental disorders, in particular through its participation in the Internet field trials of the diagnostic system. It is now further serving as a catalyst for scientific and clinical research collaborations. All health professionals working in mental health or primary care are welcome to join the Network. Vincenzo GİALLONARDO REFERENCES Clark L, Cuthbert B, Lewis-Fernández R et al (2017). Three approaches to understanding and classifying mental disorder: ICD-11, DSM-5, and the National Institute of Mental Health's Research Domain Criteria (RDoC) Psychol Sci Public Interest 18:72-145. Forbes MK, Wright AGC, Markon KE et al (2019) The network approach to psychopathology: promise versus reality. World Psychiatry 18:272-3. Fusar-Poli P, Solmi M, Brondino N et al (2019) Transdiagnostic psychiatry: a systematic review. World Psychiatry 8:192-207. Fuss J, Lemay K, Stein DJ et al (2019) Public stakeholders' comments on ICD-11 chapters related to mental and sexual health. World Psychiatry 18:233-5. Giallonardo V (2019) ICD-11 sessions within the 18th World Congress of Psychiatry. World Psychiatry 18:115-6 Gaebel W, Reed GM, Jakob R (2019) Neurocognitive disorders in ICD-11: a new proposal and its outcome. World Psychiatry 18:232-3. Gureje O, Lewis-Fernandez R, Hall BJ et al (2019) Systematic inclusion of culture-related information in ICD-11. World Psychiatry 18:357-8. Kotov R, Jonas KG, Carpenter WT et al (2020) Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum. World Psychiatry 19:151-72. Maj M, Stein DJ, Parker G et al (2020) The clinical characterization of the adult patient with depression aimed at personalization of management. World Psychiatry 19:269-93. Patel V (2019) Reimagining outcomes requires reimagining mental health conditions. World Psychiatry 18:286-7. Perris F (2020) ICD-11 sessions at the 19th World Congress of Psychiatry. World Psychiatry 19:263-4. Pocai B (2019) The ICD-11 has been adopted by the World Health Assembly. World Psychiatry 18:371-2. Rebello TJ, Keeley JW, Kogan CS et al (2019) Anxiety and fear-related disorders in the ICD-11: results from a global case-controlled field study. Arch Med Res 50:490-501. Reed GM, First MB, Kogan CS et al (2019) Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry 18:3-19. Sanislow CA (2020) RDoC at 10: changing the discourse for psychopathology. World Psychiatry 19:311-2. van Os J, Guloksuz S, Vijn TW et al (2019) The evidence-based group-level symptom-reduction model as the organizing principle for mental health care: time for change? World Psychiatry 18:88-96.
Topics: Adult; Anxiety Disorders; Humans; International Classification of Diseases; Mental Disorders; Mental Health; Psychotic Disorders
PubMed: 34964105
DOI: 10.5080/u26898 -
The Primary Care Companion For CNS... Nov 2023To investigate the effectiveness of acute short-stay hospital admissions in psychiatric observation units for improving the flow of patients with mental health...
To investigate the effectiveness of acute short-stay hospital admissions in psychiatric observation units for improving the flow of patients with mental health presentations through the emergency department (ED). CINAHL, MEDLINE, OVID, PsycINFO, PubMed, Web of Science, and Google Scholar were systematically searched for English-language studies from 1990 onward. Descriptors used to describe psychiatric observation units were identified, and in databases with MESH term availability, the terms "mental disorder" and "emergency services, psychiatric" were also utilized to further enhance the search. A total of 6,571 studies were screened. The PICOS framework was used to determine the inclusion and exclusion criteria, and the process of study selection followed PRISMA guidelines. Articles were included if the unit studied had a length of stay (LOS) < 72 hours and if patients suffered from a mental health condition and were treated as hospital inpatients. Reviewers performed data extraction and quality assessment of the included studies following the review protocol. A total of 14 psychiatric observation unit studies were included in the review: 5 in North America and 9 in Australia. Most of these units were in large urban general hospitals. There appears to be some improvement in ED LOS for patients with mainly crisis mental health presentations. Seven of the 14 studies specifically discussed ED LOS, and 6 of these studies showed mild to moderate improvement in ED LOS, ranging from 17 minutes to > 11 hours. Psychiatric observation units were mainly located in North American and Australian settings. These units may reduce ED LOS based on limited, poor-quality evidence. Further research is required to determine whether psychiatric observation units have ongoing effects on ED LOS and alleviate access block. .
Topics: Humans; Clinical Observation Units; Australia; Hospitalization; Length of Stay; Emergency Service, Hospital; Retrospective Studies
PubMed: 37976230
DOI: 10.4088/PCC.22r03468 -
Sante Mentale Au Quebec 2023Context In the exercise of his practice, the psychiatrist is commonly called upon to assess the suicidal risk of a patient and may, under the circumstances, engage his...
Context In the exercise of his practice, the psychiatrist is commonly called upon to assess the suicidal risk of a patient and may, under the circumstances, engage his professional liability and become the subject of a civil suit in the event of the death of the patient. Despite the existence of guidelines and tools for the assessment and management of suicide risk, the practice often remains unstandardized. Few studies have focused on the assessment and management of this risk from a legal perspective. Some knowledge of case law could be useful to psychiatrists in making future decisions, both from a medico-legal point of view and to improve the care offered. Objectives This article aims to study the civil liability of the psychiatrist following the suicide of a patient by analyzing Canadian case law from a perspective of continuous improvement of practice with particular attention to the assessment and management of suicide risk. Method A systematic review of the judgments was carried out on CanLII.org, a virtual library of Canadian legal information allowing access to the judgments rendered by the courts of first instance, the Courts of Appeal as well as those of the Supreme Court of Canada. The search strategy consisted in using the key words "suicide," "psychiatrie," "faute" and "responsabilité" as well as their English translation to retain the recourses where a judgment was rendered by the court and where at least one psychiatrist acted as a defendant or co-defendant following the suicide of a patient. Results Nine judgments met our inclusion criteria. Since elements were of interest for our research question, it seemed wise to us to also include three decisions where the patient did not die of his suicidal attempt but kept significant sequelae. The analysis of the judgments made it possible to identify the alleged faults most often reproached to the psychiatrist by the plaintiff and to present the usual position of the courts, and the arguments which underlie them. The alleged faults can be grouped into three categories: an assessment of the suicide risk deemed faulty, a management of the suicide risk by supervisory measures deemed faulty and an omission to have used legal custody measures when they should have been applied. In nearly all cases, Canadian courts render a decision in favor of the psychiatrist, demonstrating sensitivity to the reality of psychiatrists' practice. The recommendations resulting from our analysis of Canadian case law support the guidelines of the American Psychiatric Association and the Ontario Hospital Association practice guidelines for suicide risk assessment and management, particularly in terms of the content of evaluation, specific moments of re-evaluation and documentation. Conclusion Knowledge of Canadian case law on civil liability for the suicide of a patient represents an additional asset for the practice of responsible and quality psychiatry.
Topics: Humans; United States; Psychiatrists; Suicide; Psychiatry; Liability, Legal; Ontario
PubMed: 38578190
DOI: No ID Found -
The British Journal of Psychiatry : the... Nov 2019Excessive use of the internet is increasingly recognised as a global public health concern. Individual studies have reported cognitive impairment in problematic internet... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Excessive use of the internet is increasingly recognised as a global public health concern. Individual studies have reported cognitive impairment in problematic internet use (PIU), but have suffered from various methodological limitations. Confirmation of cognitive deficits in PIU would support the neurobiological plausibility of this disorder.
AIMS
To conduct a rigorous meta-analysis of cognitive performance in PIU from case-control studies; and to assess the impact of study quality, the main type of online behaviour (for example gaming) and other parameters on the findings.
METHOD
A systematic literature review was conducted of peer-reviewed case-controlled studies comparing cognition in people with PIU (broadly defined) with that of healthy controls. Findings were extracted and subjected to a meta-analysis where at least four publications existed for a given cognitive domain of interest.
RESULTS
The meta-analysis comprised 2922 participants across 40 studies. Compared with controls, PIU was associated with significant impairment in inhibitory control (Stroop task Hedge's g = 0.53 (s.e. = 0.19-0.87), stop-signal task g = 0.42 (s.e. = 0.17-0.66), go/no-go task g = 0.51 (s.e. = 0.26-0.75)), decision-making (g = 0.49 (s.e. = 0.28-0.70)) and working memory (g = 0.40 (s.e. = 0.20-0.82)). Whether or not gaming was the predominant type of online behaviour did not significantly moderate the observed cognitive effects; nor did age, gender, geographical area of reporting or the presence of comorbidities.
CONCLUSIONS
PIU is associated with decrements across a range of neuropsychological domains, irrespective of geographical location, supporting its cross-cultural and biological validity. These findings also suggest a common neurobiological vulnerability across PIU behaviours, including gaming, rather than a dissimilar neurocognitive profile for internet gaming disorder.
DECLARATION OF INTEREST
S.R.C. consults for Cambridge Cognition and Shire. K.I.'s research activities were supported by Health Education East of England Higher Training Special interest sessions. A.E.G.'s research has been funded by Innovational grant (VIDI-scheme) from ZonMW: (91713354). N.A.F. has received research support from Lundbeck, Glaxo-SmithKline, European College of Neuropsychopharmacology (ECNP), Servier, Cephalon, Astra Zeneca, Medical Research Council (UK), National Institute for Health Research, Wellcome Foundation, University of Hertfordshire, EU (FP7) and Shire. N.A.F. has received honoraria for lectures at scientific meetings from Abbott, Otsuka, Lundbeck, Servier, Astra Zeneca, Jazz pharmaceuticals, Bristol Myers Squibb, UK College of Mental Health Pharmacists and British Association for Psychopharmacology (BAP). N.A.F. has received financial support to attend scientific meetings from RANZCP, Shire, Janssen, Lundbeck, Servier, Novartis, Bristol Myers Squibb, Cephalon, International College of Obsessive-Compulsive Spectrum Disorders, International Society for Behavioral Addiction, CINP, IFMAD, ECNP, BAP, the World Health Organization and the Royal College of Psychiatrists. N.A.F. has received financial royalties for publications from Oxford University Press and payment for editorial duties from Taylor and Francis. J.E.G. reports grants from the National Center for Responsible Gaming, Forest Pharmaceuticals, Takeda, Brainsway, and Roche and others from Oxford Press, Norton, McGraw-Hill and American Psychiatric Publishing outside of the submitted work.
Topics: Behavior, Addictive; Cognition; Cognition Disorders; Cognitive Dysfunction; England; Humans; Internet; Internet Use
PubMed: 30784392
DOI: 10.1192/bjp.2019.3 -
BioMed Research International 2021Vitiligo is a disfiguring skin disease with profound psychosocial impacts, such as anxiety, but the reported effect sizes of associations vary. We aimed to conduct a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Vitiligo is a disfiguring skin disease with profound psychosocial impacts, such as anxiety, but the reported effect sizes of associations vary. We aimed to conduct a meta-analysis to quantify the strength of association between anxiety and vitiligo and to estimate the prevalence of anxiety among individuals with vitiligo.
METHODS
A systematic literature search was performed in five online databases (MEDLINE, Embase, Web of Science, Cochrane Library, and PsycINFO) from inception until March 20, 2020. All of the eligible studies were comprehensively reviewed, and all of the available data were analyzed according to our predefined criteria.
RESULTS
Twenty-one studies involving 3259 patients in 11 countries were included in this meta-analysis. Compared with the healthy control group, patients with vitiligo often had concomitant anxiety (OR = 6.14 [95% CI: 3.35-11.24], = 30.1%). The pooled prevalence of anxiety in female patients was significantly higher than that in males (OR = 2.24 [95% CI: 1.31-3.84], = 0.0%). Subgroup analysis showed that the pooled prevalence of clinical anxiety disorder and anxiety symptoms was 12% (95% CI: 7%-16%, = 76.3%) and 34% (95% CI: 21%-46%, = 94.7%), respectively. No publication bias has been detected by Begg's funnel plot and Egger's test.
CONCLUSION
Patients with vitiligo have high anxiety comorbidity, with female predominance. Dermatologists and psychiatrists should be vigilant to the presence of anxiety, apply appropriate interventions to reduce the psychological impacts in a timely manner, and thus promote recovery in vitiligo patients. However, due to some objective limitations (poor information about the OR and diversity in assessment tools among included studies), findings should be interpreted with caution.
Topics: Anxiety; Anxiety Disorders; Comorbidity; Databases, Factual; Depression; Female; Humans; Male; Prevalence; Vitiligo
PubMed: 34055993
DOI: 10.1155/2021/6663646 -
Journal of Eating Disorders 2020Disordered Eating (DE) shows a strong association with athletics and can lead to several negative mental and physical health effects. Traditionally, sports have been... (Review)
Review
BACKGROUND
Disordered Eating (DE) shows a strong association with athletics and can lead to several negative mental and physical health effects. Traditionally, sports have been grouped based upon whether or not the sport emphasizes leanness as a competing factor. Due to sociocultural factors, risk for DE may also be associated with the sport type. The aim of this review is to critically analyze the available research and data in this field to consider the relationship between DE and sport type to see which factors influence prevalence among athletes.
METHOD
A systematic review was completed using keywords specific to DE and sport types. Articles were either excluded due to lack of specification of athlete type or failure to use a standardized screening tool or interview for data collection.
RESULTS
6 out of 7 studies found a significant increase in DE rates among lean sport types. When classifying by sport type reports were less consistent, but show non-lean sports also have increased rates of DE.
CONCLUSION
There are variations in prevalence of DE behaviors depending on athlete type. It is important to identify the risk for DE early in athletes so emphasis can be placed on treatment options to nullify progression to an eating disorder, lower negative impacts on an athlete's performance, and prevent other negative health effects. Using sport groups is important to clinical practice as well as research, as certain sports may have a higher risk for development of DE.
PubMed: 33005418
DOI: 10.1186/s40337-020-00323-2 -
Deutsches Arzteblatt International May 2023Depression is one of the most common mental disorders worldwide. The German National Disease Management Guideline on Unipolar Depression (NDGM), (Nationale...
BACKGROUND
Depression is one of the most common mental disorders worldwide. The German National Disease Management Guideline on Unipolar Depression (NDGM), (Nationale Versorgungsleitlinie, NVL), updated in 2022, contains recommendations on the diagnosis and treatment of acute and chronic depressive disorders.
METHODS
The update was based on the findings of a systematic review of the evidence (2013-2022) and was issued by a multidisciplinary panel after a formalized consensus process.
RESULTS
The structure of the guideline was fundamentally revised and is now based on the phases of depression and/or its treatment, as well as on the severity of the disease. There is newly added material with recommendations on Internet- and mobile-device based treatments, esketamine, repetitive magnetic stimulation, psychosocial therapies, rehabilitation, social participation, and complex forms of care. The guideline also emphasizes better coordination of all services in the care of patients with depression. This article covers the most important changes and additions among the 156 recommendations in the guideline. More information and accompanying materials are available at www.leitlinien.de/depression.
CONCLUSION
There are effective treatments for depression and a variety of supportive measures that can be applied with great benefit by primary care physicians, psychiatrists, psychotherapists, and complementary care providers. The updated guideline aims to further improve the early detection, definitive diagnosis, treatment, and interdisciplinary care of people with depression.
Topics: Humans; Depressive Disorder; Depression; Early Diagnosis
PubMed: 37070271
DOI: 10.3238/arztebl.m2023.0074 -
BJPsych Open Feb 2020Carers are key providers of care and support to mental health patients and mental health policies consistently mandate carer involvement. Understanding carers'...
BACKGROUND
Carers are key providers of care and support to mental health patients and mental health policies consistently mandate carer involvement. Understanding carers' experiences of and views about assessment for involuntary admission and subsequent detention is crucial to efforts to improve policy and practice.
AIMS
We aimed to synthesise qualitative evidence of carers' experiences of the assessment and detention of their family and friends under mental health legislation.
METHOD
We searched five bibliographic databases, reference lists and citations. Studies were included if they collected data using qualitative methods and the patients were aged 18 or older; reported on carer experiences of assessment or detention under mental health legislation anywhere in the world; and were published in peer-reviewed journals. We used meta-synthesis.
RESULTS
The review included 23 papers. Themes were consistent across time and setting and related to the emotional impact of detention; the availability of support for carers; the extent to which carers felt involved in decision-making; relationships with patients and staff during detention; and the quality of care provided to patients. Carers often described conflicting feelings of relief coupled with distress and anxiety about how the patient might cope and respond. Carers also spoke about the need for timely and accessible information, supportive and trusting relationships with mental health professionals, and of involvement as partners in care.
CONCLUSIONS
Research is needed to explore whether and how health service and other interventions can improve the involvement and support of carers prior to, during and after the detention of family members and friends.
PubMed: 32043435
DOI: 10.1192/bjo.2019.101 -
PloS One 2023Guidelines for the treatment and management of 'personality disorders' have been introduced to provide guidance on best practice based on evidence and views of key...
BACKGROUND
Guidelines for the treatment and management of 'personality disorders' have been introduced to provide guidance on best practice based on evidence and views of key stakeholders. However, guidance varies and there is yet to be an overall, internationally recognised consensus on the best mental health care for people with 'personality disorders'.
AIMS
We aimed to identify and synthesise recommendations made by different mental health organisations from across the world on community treatment for people with 'personality disorders'.
METHODS
This systematic review consisted of three stages: 1. systematic literature and guideline search, 2. quality appraisal, and 3. data synthesis. We combined a search strategy involving both systematic searching of bibliographic databases and supplementary search methods of grey literature. Key informants were also contacted to further identify relevant guidelines. Codebook thematic analysis was then conducted. The quality of all included guidelines was assessed and considered alongside results.
RESULTS
After synthesising 29 guidelines from 11 countries and 1 international organisation, we identified four main domains, with a total of 27 themes. Important key principles on which there was consensus included continuity of care, equity of access, accessibility of services, availability of specialist care, taking a whole systems approach, trauma informed approaches, and collaborative care planning and decision making.
CONCLUSIONS
Existing international guidelines shared consensus on a set of principles for the community treatment of 'personality disorders'. However, half of the guidelines were of lower methodological quality, with many recommendations not backed by evidence.
Topics: Humans; Consensus; Databases, Bibliographic; Mental Health; Personality Disorders; Personality
PubMed: 36913403
DOI: 10.1371/journal.pone.0264239 -
Scandinavian Journal of Public Health Mar 2024This systematic review aims to identify and describe how children of parents with mental illness, substance dependence, or severe physical illness/injury, experience... (Review)
Review
This systematic review aims to identify and describe how children of parents with mental illness, substance dependence, or severe physical illness/injury, experience and practise their everyday life. The review followed the four stepwise recommendations of Harden and colleagues when including quantitative and qualitative studies on peoples' experiences and views. In all, 23 studies with data from Norway (2010-2022) have been included. Brown and Clark's thematic analysis was applied. Three themes were constructed from the reviewed articles: (a) Children practice their relational agency by actively doing practical tasks, occasionally jobs to maintain family economy, and organising fun activities with the ill parent. (b) Emotional ambivalence when their own needs were set aside in favour of the parents. They loved their parents but also felt guilt, anger, disappointment, shame, fear of inheriting the illness and longed for a 'normal' everyday life. (c) Supportive contextual factors were, for example, at least one significant adult recognising them, participating in leisure activities, socialising with friends, and talking with other peers who shared similar experiences as next of kin. Obstructive factors were lack of information and recognition as well as silence and lack of dialogue within the family and/or health professional.
PubMed: 38506846
DOI: 10.1177/14034948241232040