Finding genes for bipolar disorder in the functional genomics era: from convergent functional genomics to phenomics and back

Psychiatric genetics, while promising to unravel the mechanisms of psychiatric disorders, has proven to be a challenging field. Psychiatric disorders, like other common genetic traits, are complex and heterogeneous. Psychiatric genetics has also suffered from a lack of quantifiable, biology-based phenotypes. However, the field is currently at an opportune moment. The work of various investigators is on the verge of paying rich dividends. Efforts at positional cloning are being greatly accelerated by the fruits of the Human Genome Project. New tools of functional genomics, such as expression profiling and proteomics, are being applied to animal models. These two methods can complement each other in an approach we have termed convergent functional genomics. Lastly, improvements in the measurement of biologically distinct endophenotypes--or phenomic--will lead to a better understanding of the mapping of genes to phenotypes in both animal and human systems.     

Personal computer software for teaching differential psychodiagnostics

The third edition of theDiagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980), outlines for the student what symptoms to consider when attempting to arrive at an accurate differential diagnosis of eight broad psychiatric categories. This paper describes a program developed to instruct a medical or graduate student in the science of such decision making.     

Problems Caused for Mental Health Professionals Worldwide by Increasing Multicultural Populations and Proposed Solutions

Psychiatric disorders on a global scale, combined with rapid national population diversification, demand that mental health professionals worldwide become more informed about the realities of diagnosing and treating a multicultural patient population. Recommendations are offered to enable such professionals to most efficaciously diagnose and treat patients from diverse sociocultural backgrounds.     

Suicide among psychologists and a proposal for the American Psychological Association

The response of the American Medical Association and of the American Psychiatric Association to suicide among their members is contrasted with the response of the American Psychological Association. It is suggested that an association should be concerned with suicide among its members and two proposals are suggested.     

An administrative model for close monitoring and managing high risk individuals.

The public expects central government to have immediate knowledge of the condition and circumstances of certain vulnerable or dangerous individuals such as insanity acquittees, and to take action in individual cases to protect the individual and the public. Therefore, such persons conditionally released to community settings require an unusual degree of close monitoring and management. Being immediately aware of the condition and circumstances of its assignees, together with other duties of a board or commission responsible for that monitoring and management, is largely an information management function. The Psychiatric Security Review Board in Oregon is used to illustrate this unique mission, operations, and information management. In this paper, the Psychiatric Security Review Board is described in terms of its core and secondary businesses, together with a model information system that is based on information and information management processes actually employed by the Board.     

Approximate interval estimation for a certain intraclass correlation coefficient

When the raters participating in a reliability study are a random sample from a larger population of raters, inferences about the intraclass correlation coefficient must be based on the three mean squares from the analysis of variance table summarizing the results: between subjects, between raters, and error. An approximate confidence interval for the parameter is presented as a function of these three mean squares.Dr. Fleiss is also with the Biometrics Research Unit of the New York State Psychiatric Institute. This work was supported in part by grant DE 04068 from the National Institute of Dental Research.     

Helping at the edges of life: Perspectives of a psychedelic therapist

A case history is presented of a 70 year old man treated with psychedelic psychotherapy for depression, anxiety, and pain associated with terminal cancer. Interpersonal and intrapersonal aspects of treatment following a single 90 mg dose of dipropyltryptamine (DPT) are described. Comparisons are made between transpersonal, mystical, and religious elements in psychedelic drug experiences and near-death experiences.This paper is based on a study in which the author participated as a research psychotherapist at the Maryland Psychiatric Research Center. The author gives special thanks to the late Dr. T. Glyne Williams for his supervision, and to Dr. Albert A. Kurland for his administrative support of this work, and also thanks Friends of Medical Science Research, the Maryland Psychiatric Research Center, the Maryland Department of Health and Mental Hygiene, and the Mary Reynolds Babcock Foundation for the opportunity to carry out this work.     

Forced migration, adolescence, and identity formation

Adolescence is a complex biopsychosocial phenomenon. All the inner-subjective changes in adolescents take place within the context of a specific social environment, which offers the necessary ideological setting that adolescents must confront in the course of their identity formation. Forced migration creates conditions under which the adolescent Ego may be traumatized more easily, resulting in the development of defensive mechanisms, which may interfere with the natural process of identity formation. The aim of this paper is to investigate how a traumatic situation such as forced migration may affect the mechanisms of identity formation in adolescence. For this purpose, clinical material, consisting of two cases of psychoanalytical psychotherapy of adolescents who were forced to immigrate to Greece, is presented and discussed in a psychoanalytical theoretical framework, along with the historical-sociological background.Dimitris C. Anagnostopoulos, M.D., is a child psychiatrist and psychoanalyst, Child and Adolescent Psychiatric Unit, Community Mental Health Center, Psychiatric Department, Medical School, University of Athens, Athens, Greece.Maria Vlassopoulos, Ph.D., is at the Child and Adolescent Psychiatric Unit, Community Mental Health Center, Psychiatric Department, Medical School, University of Athens, Athens, Greece.Helen Lazaratou, M.D., is at the Child and Adolescent Psychiatric Unit, Community Mental Health Center, Psychiatric Department, Medical School, University of Athens, Athens, Greece.     

Application of The APA Practice Guidelines on Suicide to Clinical Practice

This article presents charts from The American Psychiatric Association Practice Guideline for the Assessment and Treatment of Patients with Suicidal Behaviors, part of the Practice Guidelines for the Treatment of Psychiatric Disorders Compendium, and a summary of the assessment information in a format that can be used in routine clinical practice. Four steps in the assessment process are presented: the use of a thorough psychiatric examination to obtain information about the patient's current presentation, history, diagnosis, and to recognize suicide risk factors therein; the necessity of asking very specific questions about suicidal ideation, intent, plans, and attempts; the process of making an estimation of the patient's level of suicide risk is explained; and the use of modifiable risk and protective factors as the basis for treatment planning is demonstrated. Case reports are used to clarify use of each step in this process.     

DSM-IV: WhatY's New

The significant differences between the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987) and the DSM-IV (American Psychiatric Association, 1994) are described, focusing on the types of mental disorders counselors frequently diagnose and treat. These include several disorders included in the children's section as well as Adjustment Disorders, Substance-Related Disorders, Mood Disorders, Anxiety Disorders, and Personality Disorders.     

Development and first results of the Borderline Personality Inventory: a self-report instrument for assessing borderline personality organization.

This article reports the development of a short 53-item true-false self-report instrument, the Borderline Personality Inventory (BPI). The BPI is based on Kernberg's (1984) concept of borderline personality organization. However, the diagnostic criteria are compatible with both the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) and Gunderson's (Gunderson & Kolb, 1978) concept of borderline personality disorder (BPD). The BPI contains scales for assessing identity diffusion, primitive defense mechanisms, and reality testing. Another scale refers to the fear of closeness. The construction of the scales is based on the results of a factor analysis. As a result of several studies, a cutoff score is proposed to make the diagnosis of a BPD. Thus, the BPI combines dimensional and categorical models of BPD. The BPI was tested in several studies. According to the results, internal consistency and retest reliability are satisfactory (Cronbach's alpha = .68-.91, rtt = .73-.89). Results for sensitivity are .85 to .89, and results for specificity .78 to .89. The BPI identifies borderline patients in high agreement with Kernberg's criteria of borderline personality organization, Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) criteria of BPD and Gunderson's criteria of BPD. The BPI is recommended as a screening instrument for borderline personality organization and BPD and for dimensional research of borderline features in Axis I and Axis II disorders.     

Ethical Dimensions of Diagnosing: Considerations for Clinical Mental Health Counselors

There are numerous ethical considerations inherent within the process of assigning a Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM‐IV‐TR; American Psychiatric Association, 2000) diagnosis. In this article, general ethics considerations such as informed consent and confidentiality, accuracy of diagnosis, and multiple relationships are examined as they relate to clinical mental health counselors' use of the DSM‐IV‐TR. The article concludes with the authors' suggestions for ethically sensitive diagnostic practices.     

Risks of Mortality of Suicide Attempters Compared with Psychiatric and General Populations

ABSTRACT: This study compares mortality risk among suicide attempters, psychiatric patients, and members of the general population using demographic data from the Monroe County (New York) Psychiatric Case Register for 1960 to 1970. During this 11-year period there were 172 deaths reported for the suicide attempt group, 6,108 for the Psychiatric Register population, and 58,542 for the general population. The relative risk of death from all causes of the suicide attempt group was nearly twice that of the general population and slightly higher than that of the psychiatric group. High risks of mortality were differentially associated with several demographic and treatment variables. Implications for predictive criteria and interventive strategies are discussed.     

Trends and Implications of Proposed Changes to the DSM‐5 for Vulnerable Populations

The revision process for the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) has increased consciousness for the role of diagnosis in counseling. In this article, the authors discuss 3 trends of the proposed changes: the influence of the medical model, the attention to nosology, and lowered thresholds and their potential impact on nondominant populations. Potential implications for reflection and advocacy among counseling professionals are discussed.     

Resource Document on Access to Firearms by People with Mental Disorders

The American Psychiatric Association, (“APA”), with more than 36,000 members at present, is the Nation's leading organization of physicians who specialize in psychiatry. APA provides for education and advocacy and develops policy through Position Statements. It promotes enhanced knowledge of particular topics relevant to psychiatric practice and patient care through Resource Documents. Since 1993, the APA has developed various positions and resource materials related to firearms and mental illness, incorporating evolving themes as new issues emerge. This paper reflects the APA's 2014 Resource Document on “Access to Firearms by People with Mental Disorders.” This article is derived from work done on behalf of American Psychiatric Association and remains the property of APA. It has been altered only in response to the requirements of peer review. Copyright © 2015 American Psychiatric Association. Published with permission (original adopted by the American Psychiatric Association 2014).     

Investigating the Psychometric Properties of the Severity Measure for Specific Phobia

Journal of Psychopathology and Behavioral Assessment - With the publication of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, the American Psychiatric Association...     

Psychopathology of parenthood: Implications for mental health of children

Psychiatric illness among mothers of infants and young children is believed to have serious implications for the child's cognitive and socio-emotional development, and presents a continuing crisis in the provision of reliable parental care: frequent rehospitalizations are disruptive both for the parent-child tie, and for the stability of the family unit. This chapter reviews findings regarding the impact of maternal psychiatric disorders upon the child's development, and intervention programs designed to reduce the impact of these disorders upon both child and family. In addition to considering families in which there is major psychopathology, problems are noted among families in which “an ordinary devoted mother” shows markedly lowered morale, but does not become a part of the mental health system. Findings from a number of innovative intervention programs are summarized in terms of possible next steps in working with these troubled parents and their children.     

Integrating normal and abnormal personality structure: a proposal for DSM-V

The personality disorders section of the American Psychiatric Association's fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is currently being developed. The purpose of the current paper is to encourage the authors of DSM-V to integrate normal and abnormal personality structure within a common, integrative model, and to suggest that the optimal choice for such an integration would be the five-factor model (FFM) of general personality structure. A proposal for the classification of personality disorder from the perspective of the FFM is provided. Discussed as well are implications and issues associated with an FFM of personality disorder, including validity, coverage, feasibility, clinical utility, and treatment implications.     

The Escalating Incidence of Suicide Among African Americans: Implications for Counselors

Suicide rates have soared among African Americans within the past 2 decades. Curiously, this fact remains poorly understood within and outside the African American community. This article includes a review of M. Compton, N. Thompson, and N. Kaslow's (2005) study, recently published in Social Psychiatry and Psychiatric Epidemiology, and identifies important implications for counseling professionals.     

Personality disorder research agenda for the DSM-V

The American Psychiatric Association is sponsoring a series of international conferences to set a research agenda for the development of the next edition of the diagnostic manual. The first conference in this series, "Dimensional Models of Personality Disorder: Etiology, Pathology, Phenomenology, and Treatment," was devoted to reviewing the existing research and setting a future research agenda that would be most effective in leading the field toward a dimensional classification of personality disorder. The purpose of this article, authored by the Steering Committee of this conference, was to provide a summary of the conference papers and their recommendations for research. Covered herein are the reviews and recommendations concerning alternative dimensional models of personality disorder, behavioral genetics and gene mapping, neurobiological mechanisms, childhood antecedents, cross-cultural issues, Axes I and II continuity, coverage and cutoff points for diagnosis, and clinical utility.