Symptom modelling can be influenced by psychiatric categories: choices for research domain criteria (RDoC)

Psychiatric researchers typically assume that the modelling of psychiatric symptoms is not influenced by psychiatric categories; symptoms are modelled and then grouped into a psychiatric category. I highlight this primarily through analysing research domain criteria (RDoC). RDoC’s importance makes it worth scrutinizing, and this assessment also serves as a case study with relevance for other areas of psychiatry. RDoC takes inadequacies of existing psychiatric categories as holding back causal investigation. Consequently, RDoC aims to circumnavigate existing psychiatric categories by directly investigating the causal basis of symptoms. The unique methodological approach of RDoC exploits the supposed lack of influence of psychiatric categories on symptom modelling, taking psychiatric symptoms as the same regardless of which psychiatric category is employed or if no psychiatric category is employed. But this supposition is not always true. I will show how psychiatric categories can influence symptom modelling, whereby identical behaviours can be considered as different symptoms based on an individual’s psychiatric diagnosis. If the modelling of symptoms is influenced by psychiatric categories, then psychiatric categories will still play a role, a situation which RDoC researchers explicitly aim to avoid. I discuss four ways RDoC could address this issue. This issue also has important implications for factor analysis, cluster analysis, modifying psychiatric categories, and symptom based approaches.     

Child,Adolescent and Adult Psychiatric Disorders in Africa: Implications for Psychological Interventions

The authors start by critically discussing some core features of Western psychiatric diagnosis, and present the cultural formulation as one approach to ensure that the cultural aspects of the diagnostic process are addressed, followed by a summary of what is known about the causes of psychiatric disorder. Five arguments are presented that provide support for the importance of psychiatric disorders in Africa: prevalence rates are high; psychiatric disorder is associated with a considerable burden from disability; in most cases, adults with psychiatric disorders experienced the onset of their disorder in childhood or youth; psychiatric disorders are strongly associated with medical conditions; and effective interventions exist for the majority of people suffering from psychiatric disorders. Against this background, current mental health services in Africa are reviewed. Finally, some suggestions are provided for how those providing psychological interventions can contribute to addressing the challenges posed by psychiatric disorders in Africa.     

A Longitudinal Analysis of Psychiatric Severity upon Outcomes Among Substance Abusers Residing in Self-Help Settings

A longitudinal analysis of psychiatric severity was conducted with a national sample of recovering substance abusers living in Oxford Houses, which are self-run, self-help settings. Outcomes related to residents' psychiatric severity were examined at three follow-up intervals over one year. Over time, Oxford House residents with high versus low baseline psychiatric severity reported significantly more days using psychiatric medication, decreased outpatient psychiatric treatment, yet no significant differences for number of days abstinent and time living in an Oxford House. These findings suggest that a high level of psychiatric severity is not an impediment to residing in self-run, self-help settings such as Oxford House among persons with psychiatric comorbid substance use disorders.     

Prevalence of traumatic brain injury in an inpatient psychiatric population

This study investigated the prevalence of traumatic brain injury (TBI) in an inpatient psychiatric population. We hypothesized increased prevalence of TBI relative to the general population due to a variety of risk factors observed in psychiatric patients. One hundred (mean age = 34) psychiatric inpatients completed the revised Head Injury Questionnaire. Chart review of 17 subjects reporting injuries established whether injuries were documented in medical records. Sixty-eight percent of this psychiatric population reported one or more injuries in which they were unconscious or dazed. This number is higher than the prevalence in the general population. Injuries were generally of mild to moderate severity; multiple injuries were common. Chart review of 17 subjects reporting TBI indicated that histories of TBI had not been noted in the medical record. Finally, 63% of TBI subjects reported that their injury predated the onset of their psychiatric symptoms. These results suggest a possible role of TBI in psychiatric symptomatology and have implications for psychiatric treatment in this population.     

Social Skills Training for Psychiatric Patients,II

In this second paper on social skills training for psychiatric patients the author critically reviews the controlled clinical outcome studies of social skills training in a number of psychiatric populations: mentally retarded persons, depressed patients, psychiatric outpatients, and psychiatric inpatients. He points out that more research is needed to determine the effectiveness of social skills training, especially for patients with debilitating chronic mental illness.     

Paternal Psychiatric Symptoms and Maladaptive Paternal Behavior in the Home During the Child Rearing Years

Data from the Children in the Community Study, a community-based longitudinal study were used to investigate associations between paternal psychiatric disorders and child-rearing behaviors. Paternal psychiatric symptoms and behavior in the home were assessed among 782 families during the childhood and adolescence of the offspring. Paternal anxiety, disruptive, mood, personality, and substance use disorders were independently associated with specific types of maladaptive paternal behavior in the home during the child-rearing years after paternal age, education, income, co-occurring paternal psychiatric symptoms, offspring age, sex, intelligence, temperament, and psychiatric symptoms were controlled statistically. Paternal psychiatric disorders that were present by mean offspring age 14 were associated with elevated risk for maladaptive paternal behavior in the home at mean age offspring 16, after prior maladaptive paternal behavior was controlled statistically. These findings suggest that paternal psychiatric disorder may be an important determinant of maladaptive paternal behavior in the home during the child-rearing years. Improved recognition and treatment of paternal psychiatric disorders may help to reduce the amount of maladaptive parenting behavior that many children and adolescents might otherwise be likely to experience.     

Die Sachverständigenexpertise im Spannungsfeld zwischen Justiz und Psychiatrie am Beispiel des Hangbegriffes des § 66 StGB (Sicherungsverwahrung)

Using the example of psychiatric expert opinions in trials leading to preventive detention, we analysed how far the corresponding orders by the courts were suited to guide the psychiatric experts and restrict them to their area of expertise. Furthermore we concentrated on the question, what reasons were given for preventive detention on both psychiatric and judicial side and how psychiatric arguments were adopted by the judges. Our results show clearly, that placing an order with the psychiatric expert as well as adopting the psychiatric arguments for preventive detention occur mainly in a stereotypic way. Psychiatric and judicial arguments for preventive detention refer both to previous delinquency. Aspects concerning the offenders personality appear to be secondary, although they play a major role in the decision for preventive detention. The article shows the controversy associated with forensic-psychiatric expertise in the courtroom and the need for communication and clarification between psychiatry and law.     

Genetic Counselling for Psychiatric Disorders: Accounts of Psychiatric Health Professionals in the United Kingdom

Genetic counselling is not routinely offered for psychiatric disorders in the United Kingdom through NHS regional clinical genetics departments. However, recent genomic advances, confirming a genetic contribution to mental illness, are anticipated to increase demand for psychiatric genetic counselling. This is the first study of its kind to employ qualitative methods of research to explore accounts of psychiatric health professionals regarding the prospects for genetic counselling services within clinical psychiatry in the UK. Data were collected from 32 questionnaire participants, and 9 subsequent interviewees. Data analysis revealed that although participants had not encountered patients explicitly demanding psychiatric genetic counselling, psychiatric health professionals believe that such a service would be useful and desirable. Genomic advances may have significant implications for genetic counselling in clinical psychiatry even if these discoveries do not lead to genetic testing. Psychiatric health professionals describe clinical genetics as a skilled profession capable of combining complex risk communication with much needed psychosocial support. However, participants noted barriers to the implementation of psychiatric genetic counselling services including, but not limited to, the complexities of uncertainty in psychiatric diagnoses, patient engagement and ethical concerns regarding limited capacity.     

Community as Outsider Witness: Utilising Community Members in the Reconstitution of Problem-Saturated Identities

This study explored community members' ability to enlist discourses affirming of psychiatric patients' quest for generative identities. The participants were members of the public who attended an exhibition of psychiatric patients' artwork (n = 7, age range 18–55). A Foucauldian discourse analysis was used to analyse the research interviews. Results revealed that the majority of community members used dominant cultural discourses to speak about psychiatric patient-artists. These discourses conferred a problem-saturated identity on to psychiatric patients. We conclude that community members can be recruited as outsider witnesses to support psychiatric patients' search for generative identities, provided community members resist discourses that produce problem-saturated identity conclusions.     

Tötungsdelinquenten im Normalvollzug unter besonderer Berücksichtigung psychiatrisch unauffälliger Mörder

We collected data on 121 cases of homicide and manslaughter in the normal penitentiary system and counted the cases of perpetrators with, and without, psychiatric diagnosis. About 30% of the sample consisted in perpetrators without any psychiatric diagnosis; in contrast, about 40% were diagnosed as personality disorder; some few cases (7%) were classified as alcoholism or polytoxicomania, respectively; and the rest (23%) were cases of both personality disorder and alcoholism/polytoxicomania. Perpetrators without psychiatric diagnosis differed in systematic ways from perpetrators with psychiatric diagnosis. The former committed their offenses more on victims in partnership and family, while perpetrators with psychiatric diagnosis frequently offended strangers. Perpetrators lacking a diagnosis used poison, and striking to dead, relatively more frequently while homicide and manslaughter by stabbing, shooting, or some combination thereof were committed mainly by perpetrators with psychiatric diagnosis. Diagnosed perpetrators had more frequently been previously convicted (nearly 70%). In sum we found a considerable percentage of perpetrators who lacked a psychiatric diagnosis. We argue that this group can properly be distinguished from perpetrators who have some psychiatric diagnosis.     

Introducing Spirituality into Psychiatric Care

Spirituality is important to many psychiatric patients, and these patients may be moved toward recovery more effectively if their spiritual needs are addressed in treatment. This, however, is rarely given expression in the psychiatric services of teaching hospitals. In order to develop this potential area of improved care, we (1) evaluated the differential attitudes of patients and psychiatric trainees toward the value of spirituality in the recovery process, (2) established a program of group meetings conducted by psychiatric residents and staff where patients can discuss how to draw on their spirituality in coping with their problems, and (3) established related training experiences for psychiatric residents. The results and implications of these three initiatives are presented.     

Factors of Early Suicide after Discharge: A National Linkage Study for Suicide Victims in Taiwan

Patients recently discharged from psychiatric inpatient care have a higher suicide rate. The study aimed to identify the characteristics associated with early suicide of those patients discharged from psychiatric wards in Taiwan. The results indicated that among 672 suicide victims who died within one year post‐discharge from psychiatric wards in Taiwan between 2000 and 2004, diagnosis of schizophrenia, shorter disease duration, and co‐morbidity with cancer were all significantly associated with suicide occurring within one month of discharge. Clinical diagnosis of psychiatric disorders, recent psychiatric diagnosis, and co‐morbidity with severe physical illnesses should receive special monitoring for potential suicide after discharge.     

Family Functioning and Mental Illness: A Comparison of Psychiatric and Nonclinical Families

The primary objective of the present investigation was to examine adaptive functioning in the families of patients with a wide range of psychiatric disorders. Seven dimensions of family functioning, as measured by the Family Assessment Device (FAD), were compared across families of patients with a schizophrenia spectrum disorder (n = 61 ), bipolar disorder (n = 60 ), major depression (n = 111 ), anxiety disorder (n = 15 ), eating disorder (n = 26 ), substance abuse disorder (n = 48 ), and adjustment disorder (n = 46 ). Families in each psychiatric group were also compared to a control group of nonclinical families (N = 353 ). Results indicated that regardless of specific diagnosis, having a family member in an acute phase of a psychiatric illness was a risk factor for poor family functioning compared to the functioning of control families. However, with few exceptions, the type of the patient's psychiatric illness did not predict significant differences in family functioning. Thus, having a family member with a psychiatric illness is a general stressor for families, and family interventions should be considered for most patients who require a psychiatric hospitalization for either the onset of, or an acute exacerbation of, any psychiatric disorder.     

Prevention of admission and continuity of care

An in-depth analysis of the recent reform in Italian psychiatry reveals that the relevance of these changes transcends national borders. However, these changes are, from the scientific point of view, worth much more than mere biased pragmatic interest. The reshaping of theory made possible by the transformation of Italian psychiatry in fact opens up new prospects for a scientifically founded form of psychiatric care. Thanks to the new Mental Health Act (No. 180 of 1978),² it has been possible to set up a type of administrative and institutional organization in which the psychiatric hospital no longer constitutes a functional part of the structures of psychiatric care. This reform thus provides the launching path for a real alternative where current psychiatric ideas and working methods can no longer be accepted as the gospel truth. This paper discusses how a correct problem-definition of psychiatric admission can provide a basis for a correct approach to psychopathological behaviour in a setting where the psychiatric hospital has no role to play and for the consolidation of this new practice.     

Women accused of sex offenses: a gender-based comparison

Sexual offenses committed by women are likely underestimated and under-reported. This exploratory study compares and contrasts women accused of sexual offenses and their male counterparts. Data were retrospectively compiled on all alleged female and age-matched male sex offenders who were referred for psychiatric evaluation to a large Midwestern city's court psychiatric clinic over a six-year period. Data were abstracted regarding their crimes, charges, demographics, social history, medical history, legal history, violence history, substance use, sexual history, psychiatric history and their victims. Like the men, women were most frequently referred for sexual predator classification evaluations. Ages ranged from 19 to 62 years, and the majority had children. Most had prior arrests. One-third had a past history of psychiatric hospitalization, and most were given a non-paraphilic psychiatric diagnosis. The majority of the women reported past histories of sexual or physical victimization. While there were many similarities between female and male sex offenders in this psychiatric sample, women more frequently had victims of both genders.     

Beliefs About God and Mental Health Among American Adults

This study examines the association between beliefs about God and psychiatric symptoms in the context of Evolutionary Threat Assessment System Theory, using data from the 2010 Baylor Religion Survey of US Adults (N = 1,426). Three beliefs about God were tested separately in ordinary least squares regression models to predict five classes of psychiatric symptoms: general anxiety, social anxiety, paranoia, obsession, and compulsion. Belief in a punitive God was positively associated with four psychiatric symptoms, while belief in a benevolent God was negatively associated with four psychiatric symptoms, controlling for demographic characteristics, religiousness, and strength of belief in God. Belief in a deistic God and one’s overall belief in God were not significantly related to any psychiatric symptoms.     

Suicide mortality of suicide attempt patients discharged from emergency room, nonsuicidal psychiatric patients discharged from emergency room, admitted suicide attempt patients, and admitted nonsuicidal psychiatric patients

The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients admitted for suicide attempt, and psychiatric inpatients admitted for other reasons were examined. The records of 3,897 patients who were treated at a general hospital in Seoul, Korea, from July 2003 to December 2006 were reviewed. Forty-three of the 3,897 subjects died by suicide during the 2.5-year observation period. Compared to the general Korean population, the suicide mortality rate was 82-fold higher for suicide attempt patients, admitted; 54-fold higher for suicide attempt patients, discharged; 21-fold higher for nonsuicidal patients, admitted; and 11-fold higher for nonsuicidal patients, discharged. In all four groups, diagnosis of a depressive disorder and suicide attempt at presentation were each significant independent risk factors for suicide completion. These results highlight the need for suicide prevention strategies for depressed patients who present to the ER or are admitted to a psychiatric ward after a suicide attempt.     

COUNSELING THE EMOTIONALLY TROUBLED CLIENT FOR PSYCHIATRIC REFERRAL

From time to time the employment counselor encounters applicants who need referral for psychiatric assistance in order to increase their employability and potential work adjustment. In many instances the client may feel that he has neither an emotional problem nor a need for psychiatric evaluation. The counselor can help the applicant to recognize his problem and to accept a psychiatric referral by using communication alternatives such as reflection of feeling, reflection of experience, sharing of the process experience, interpretation, and confrontation with maintenance of tension. The client can be assisted in evaluating community mental health resources and in arranging for the initial psychiatric evaluation appointment.     

The description and classification of presidential threateners

Presidential threateners who received court-ordered psychiatric evaluations at the Medical Center for Federal Prisoners in 1981 and 1982 were studied. Using data from psychiatric reports and other background documents, the cases were analyzed according to demographic, legal, and psychiatric variables. Cases were also classified according to a system based on the characteristics of the threatener and the context in which the threat was made.     

Minimal brain dysfunction in adolescent and young adult psychiatric inpatients

This paper presents data on a study of 100 consecutive young adult psychiatric admissions to Horsham Hospital, to determine the incidence of minimal brain dysfunction in this population, to define the subcategories of common psychiatric presentation, and to compare these data with those from the companion study conducted by our research group of fifty consecutive adolescent psychiatric admissions, reported by Horowitz, 1981.