The relationship between five-factor personality measurements and ICD-10 personality disorder dimensions: results from a sample of 229 subjects

This article examines the relationship between the five-factor model (FFM) and dimensional ICD-10 personality disorders. In a follow-up study of a child and adolescent psychiatric cohort, former patients and controls were assessed with NEO-FFI and the IPDE interview (CD-10 personality disorder). Full data were available for 229 subjects (149 former patients, 80 controls). Multiple regression analysis showed that the five factors of the FFM as independent variables explained between 5% (schizoid personality disorder) and 32% (anxious personality disorder) of the variance of ICD-10 dimensional personality disorder scores. For the two types of emotionally unstable personality disorder dimension (impulsive and borderline), for anxious (avoidant) personality disorder dimension and for the total score of any personality disorder dimension, FFM explained between 17% and 32% of the variance with almost identical results for the former patient group and the control group. High neuroticism was a feature of paranoid, emotionally unstable, histrionic, anankastic, anxious (avoidant), and dependent personality disorder dimensions, whereas low agreeableness was found in dissocial, emotionally unstable and histrionic personality disorder dimensions. Low extraversion was found in schizoid, anxious (avoidant) and dependent personality disorder dimensions, whereas histrionic PD dimension correlated with high extraversion. We find that the FFM is valuable for the further understanding not only of DSM-IV but also of ICD-10 personality disorder dimensions. The differences between ICD-10 and DSM-IV in this respect seem to be small.     

A Study of Pastoral Care,Referral, and Consultation Practices Among Clergy in Four Settings in the New York City Area

Clergy (N = 179) in the catchment areas of four hospitals in New York and Connecticut were surveyed about their pastoral care activities. Factor analysis revealed two separate sets of problems presented in pastoral counseling, with respect to clergys ratings of their competence to address them. The first factor included grief, death and dying, anxiety, and marital problems, in descending order of frequency. The second factor consisted of depression, alcohol/drugs, domestic violence, severe mental illness, HIV/AIDS, and suicide. Clergy were significantly less confident of their ability to deal with Factor 2 problems, yet clergy rarely consulted with mental-health professionals about either type of problem. Less than half of the clergy had training in Clinical Pastoral Education, but those who did tended to feel they were more competent to deal with both types of problems. On average, clergy devoted 3.7 hours per week to visiting patients and nearly 55% said they were definitely more likely to refer a patient to a hospital with a pastoral care department.     

Zur Prävalenz von Depersonalisation und Derealisation in der stationären Psychotherapie

Depersonalization (DP) and derealization (DR) remain poorly recognized in clinical routine. Active exploration through structured interviews is strongly recommended, because patients rarely describe spontaneously their experiences with DP/DR. 143 psychosomatic, first-admission inpatients were interviewed about the 1-month prevalence of DP/DR using the Structured Clinical Interview for DSM-IV dissociative disorders. Additionally, the German questionnaires of the Cambridge Depersonalization Scale, the Dissociative Experiences Scale, the SCL-90-R and the Inventory of Interpersonal Problems were used. In the sample we found a prevalence of 23.1% (N=33) for depersonalization-derealization syndrom (ICD-10 F48.1) and 7% (N=10) for secondary pathological DP/DR. A total percentage of 62.9% reported DP/DR to some degree or other. There was a noticeably high co-occurrence of anxiety disorders in patients with pathological DP/DR. Patients with pathological DP/DR were generally more impaired, suffered many more interpersonal problems and were particularly characterized by introversion. Considering the high prevalence of this phenomenon, more attention should be paid to DP/DR in routine diagnostic procedures, treatment and research.     

Cross-system concordance of personality disorder diagnoses of DSM-IV and diagnostic criteria for research of ICD-10

The aim in this study was to examine the cross-system concordance between the personality disorders (PDs) of DSM-IV and Diagnostic Criteria for Research of ICD-10 Classification of Mental and Behavioral Disorders, 10th rev. (ICD-10) PD diagnoses were made by a structured interview in a clinical psychiatric sample of 138 individuals. Both categorical and dimensional scores for each PD were established. The frequency of patients with a PD diagnosis on either classification who were also positive on the other varied from 26% for the schizoid PDs to 88% for the histrionic PDs. The chance-corrected agreement (Cohen's kappa) ranged from .37 to .94. The dimensional correlation (Pearson's r) between pairs of PD criteria sets was in the range of .79 to .98. In conclusion, when analyzed categorically, some of the PDs of DSM-IV and ICD-10-DCR were only moderately concordant. The reasons appear to be different criteria formulations and arbitrary thresholds for diagnoses. In contrast to categorical diagnoses, dimensional agreement was high, implicating similar trait-concept definitions. The least concordant pair of PD was antisocial (DSM-IV)-dissocial (ICD-10).     

The relationship between self-efficacy,readiness to change,and AUDIT risk levels in a sample of active duty emergency department patients

The purpose of this study was to test the relationship between self-efficacy, readiness to change, and Alcohol Use Disorders Identification Test (AUDIT) risk levels in a sample of active duty drinkers who were seeking care in a military emergency department. Civilian health educators screened participants for alcohol use with the AUDIT and collected sociodemographic, service, and drinking-related cognitions data from active duty patients admitted to an emergency department. A total of 787 active duty military personnel participated in the study. Almost half (48%) drank at least once a week and 32% reported consuming five or more alcoholic drinks during a typical drinking episode. One in five participants reported heavy episodic drinking weekly to almost daily. Results of a multinomial logistic regression model showed that active duty service members with a self-reported diagnosis of posttraumatic stress disorder since joining the military were more likely to be an at-risk or high/severe risk drinker relative to a low risk drinker. Higher controlled drinking self-efficacy was associated with a decrease in the odds of being either an at-risk or high/severe risk drinker. Increased readiness to reduce drinking was associated with an increase in the odds of being either an at risk or high/severe risk drinker. The results of this research suggest self-efficacy to control one’s heavy drinking as well as readiness to change may be important factors to consider when designing alcohol education programs within the military.     

Recent Suicidal Ideation Among Patients in an Inner City Emergency Department

The rates and associated features of suicidal ideation among 5,641 patients seeking routine, nonsuicide related care in an inner‐city emergency department were examined. Approximately 8% of patients seeking routine care in the emergency department reported some form of suicidal ideation within the past 2 weeks. Suicidal ideation was common in individuals who were single with poorer mental health, had higher depression, and had received some drug or alcohol treatment in the past 3 months or had used cocaine or marijuana in the past 30 days. Improved screening procedures could help to identify routine care patients who are at risk for suicide.     

Prevalence and correlates of ICD-11 adjustment disorder: Findings from the Zurich Adjustment Disorder Study

Background/Objective: The 11th revision of the International Classification of Diseases (ICD-11) will provide a new definition of adjustment disorder (AjD). The aim of the present study is to report on prevalence and correlates of ICD-11 AjD in a high-risk sample. Method: Three hundred thirty persons who had lost their job involuntarily were sampled by local job centres. The Munich Composite International Diagnostic Interview was administered with a new AjD module. Associations between AjD and correlates were investigated with logistic regression analyses. Results: 27.3% of the participants reported the AjD core symptom pattern. 13.8% men and 17.2% women met diagnostic guidelines of ICD-11 AjD. Prevalence increased with age and exposure to multiple stressors. The AjD core symptom pattern was associated with various sociodemographic correlates (e. g., lower financial household budget), whereas the full ICD-11 diagnosis including the exclusion algorithm was not. Regarding work-related factors, AjD occurred with a lower probability if the last job position had higher responsibilities and more general confidence for the future. Conclusions: ICD-11 AjD has a high prevalence among persons who lost their jobs involuntarily. Healthcare professionals should be aware of this problem. Research to investigate the ICD-11 AjD concept in the general populations and other subpopulations is needed.     

Evaluation of The Practitioner Online Referral and Treatment Service (PORTS): the first 18 months of a state-wide digital service for adults with anxiety,depression, or substance use problems

ABSTRACT

The Practitioner Online Referral and Treatment Service (PORTS) is a new digital mental health service (DMHS) providing assessment, treatment, and consultation across Western Australia, for adults with anxiety, depression, or substance use problems, and experiencing financial hardship or geographical disadvantage. From July 2017 to December 2018, a total of 2,527 individuals were referred to PORTS. Of these, 150 (6%) did not give consent for their results to be analysed. Of the remaining 2,377 patients, 615 (26%) could not be contacted to confirm the referral, 596 (25%) received assessment or information from PORTS, 427 (18%) were referred to another service, and 739 (31%) commenced treatment at PORTS. Almost half (47%) of patients were from areas with significant socio-economic disadvantage. Those referred by another mental health service were more likely to engage in treatment than those referred by a General Practitioner (GP). Overall outcomes were excellent, with large effect sizes (Cohen’s d: 1.1–1.4), from assessment to post-treatment and 3-month follow-up, reliable deterioration was low, and GP and patient satisfaction was high. These results indicate that the PORTS DMHS model is a promising method for engaging primary care patients with anxiety and depression, including those experiencing financial and geographical disadvantage.     

心内科处理心理障碍患者治疗方案的可行性分析

为了探讨在心内科治疗心理障碍患者的可行性,我们应用汉密尔顿量表评估400例到心内科就诊的患者,对诊断为焦虑或抑郁状态的患者分为两组（心内科干预组,心理科治疗组）,随访半年,观察焦虑或抑郁状态的缓解情况。结果显示,本研究共入选符合心理障碍诊断者71例,占就诊人数的17．75％。到心理科治疗患者30例,在心内科门诊治疗患者41例,半年随访评估,治疗有效率分别为16．7％和79．4％（16．7％vs79．4％,P〈0．05）。因此,在心内科门诊对就诊的心理障碍患者进行治疗,是一种可行的方案。     

Management of Writer’s Cramp

Writer's Cramp is a functional motor disorder classified as an occupational neurosis included under ICD-9 and under Other specified neurotic disorders of uncertain etiology in ICD-10. It is exhibited while writing in the form of spasms, in-coordination, pain, stiffness , and tension in muscles of fingers and hand of the writing arm; often spreading to lower and upper arm and subsequently to shoulder girdle. In India it has been reported to be 5.4 per thousand among office workers in urban settings. It has been treated differently by neurologists, psychiatrics and psychologists depending upon their views on its genesis. Psychological intervention tends to involve therapeutic packages ranging from 20 to 50 sessions with elements from relaxation, conditioning, reinforcement schedules and 'supinator' writing with abstinence from writing during the implementation of regime. The present paper discusses the successful treatment of writer's cramp with brief cognitive behavior management without any restrictions on writing     

Youth suicides unknown to psychiatric care providers.

Less than 50% of young suicides have consulted psychiatric care providers. Thus the population not found within the psychiatric care sector is described in this paper. Fifty-eight consecutive suicides among adolescents and young adults, studied by psychological autopsies, were classified according to presence or absence of previous psychiatric care. Fifteen of the sixteen subjects without previous care were males, six of these were diagnosed as having an adjustment disorder related to a recent event. Unemployment was less common (p < 0.01), the suicidal processes were shorter (p < 0.001), and previous parasuicide was less frequent (p < 0.001) among nonpatients. Evaluation in accordance with DSM-III-R criteria showed fewer substance abuse disorders (p < 0.01). Open suicidal communication prior to the suicide was less frequent but active methods were used by this population as often as by subjects known to care providers.     

A national survey of health care administrators' views on the importance of various chaplain roles

A random sample of hospital administrators throughout the United States was surveyed about their views on the importance of eleven chaplain roles and functions. The 494 respondents fell into three categories: (1) directors of pastoral care departments (N = 132); (2) administrators of hospitals that have a pastoral care department (N = 180); and (3) administrators of hospitals that do not have a pastoral care department (N = 182). All three groups considered all eleven roles to be relatively important, although administrators of hospitals that do not have a pastoral care department gave lower ratings, overall. Meeting the emotional needs of patients and relatives were seen as chaplains most important roles, whereas performing religious rituals and conducting religious services were seen as least important by all three groups. In all but a few instances, the level of importance that administrators assigned to the various roles were positively related to their ratings of their own religiousness and spirituality (r's = .11 to .26, p < .05).     

Ambulante psychotherapeutische Versorgung depressiver Patienten

Background

The effectiveness of psychotherapeutic interventions in treating depressive disorders has been shown in manifold ways. However, information is missing from the point of view of psychotherapists concerning diagnostic and therapeutic procedures, their experienced difficulties and barriers, their self-assessment of their competence in the handling of depressive patients and the satisfaction with the cooperation in routine care.

Method

A cross-sectional survey of cognitive-behavioral (n=61) and psychodynamic psychotherapists (n=78) was carried out.

Results

The concordance of clinical diagnoses with diagnoses using the formal ICD-10 criteria was very low. Both groups feel themselves specifically responsible for early detection and differential diagnosis. They neither differ with regard to the frequency of cooperation contacts to other service providers nor with regard to their satisfaction with them or the experienced barriers in the care for depressed patients.

Conclusion

A good psychotherapeutic care exists with options for improvement concerning diagnostic procedures and a stronger connection network.     

The effects of changes in the World Health Organization's International Classification of Diseases on suicide rates in 71 countries, 1950-1999

The World Health Organization (WHO) provides annual mortality statistics from 1950 onward based on the International Classification of Diseases (ICD). In this paper we evaluate the effects of ICD form revisions on suicide rates for 71 countries. The changes between ICD-6, ICD-7, ICD-8, and ICD-9 did not have an overall effect on reported suicide rates. The transitions to ICD-8 and ICD-9 were, however, associated with country-specific changes in the suicide rate in some countries. The change from ICD-9 to ICD-10 was associated with an overall change of -.73 suicides per 100,000 inhabitants. It is recommended that researchers using the WHO mortality data for longitudinal cross-national studies control for the ICD form used at different time points.     

A case-controlled field study evaluating ICD-11 proposals for relational problems and intimate partner violence

Background/Objective: Intimate partner relationship problems and intimate partner abuse and neglect — referred to in this paper as “relational problems and maltreatment” — have substantial and well-documented impact on both physical and mental health. However, classification guidelines, such as those found in the International Classification of Diseases (ICD-10), are vague and unlikely to support consistent application. Revised guidelines proposed for ICD-11 are much more operationalized. We used standardized clinical vignette conditions with an international panel of clinicians to test if ICD-11 changes resulted in improved classification accuracy. Method: English-speaking mental health professionals (N = 738) from 65 nations applied ICD-10 or ICD-11 (proposed) guidelines with experimentally manipulated case presentations of presence or absence of (a) individual mental health diagnoses and (b) relational problems or maltreatment. Results: ICD-11, compared with ICD-10, guidelines resulted in significantly better classification accuracy, although only in the presence of co-morbid mental health problems. Clinician factors (e. g., gender, language, world region) largely did not impact classification performance. Conclusions: Despite being considerably more explicated, raters’ performance with ICD-11 guidelines reveals training issues that should be addressed prior to the release of ICD-11 in 2018 (e. g., overriding the guidelines with pre-existing archetypes for relationship problems and physical and psychological abuse).     

A randomized controlled trial of community-oriented and hospital-oriented care for discharged psychiatric patients: influence of personality disorder on police contacts

An important forensic psychiatric measure, contacts with police, was compared in a randomized, controlled trial of 155 patients with severe mental illness with a previous admission within the past two years. The patients, who also had their personality status addressed formally before randomization, were allocated to community multidisciplinary teams or to hospital-based care programs after discharge from in-patient care and were followed up for one year. A total of 138 patients (89%) had at least one post-baseline assessment and of these patients, 16 (12%) had at least one police contact in the year of the study, most of which were emergency assessments. The data showed significantly greater numbers of police contacts in patients with increasing severity of personality disturbance. Patients with such disturbance were six times more likely to have police contacts than those with no personality disorder. There were significantly more contacts in patients with borderline and antisocial (dissocial) personality disorder allocated to community-oriented care compared with hospital-oriented care. These findings have important implications for risk assessment in severe mental illness.     

HAPPINESS IS A STOCHASTIC PHENOMENON

Abstract— Happiness, or subjective well-being, was measured on a birth-record-based sample of several thousand middle-aged twins using the Well-Being (WB) scale of the Multidimensional. Personality Questionnaire Neither socioeconomic status, educational attainment, family income, marital status, nor an indicant of religious commitment could account for more than about 3% of the variance in WB From 44% to 52% of the variance in WB, however, is associated with genetic variation. Based on the retell of smaller samples of twins after intervals of 4 5 and 10 years, we estimate that the heritability of the stable component of subjective well-being approaches 80%.