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Defining Mental Illness and Psychiatric Disability
Published in Joel Michael Reynolds, Christine Wieseler, The Disability Bioethics Reader, 2022
Defining illness and disability is a value-laden enterprise. Value judgments go into deciding what facets of a lived condition are pathological or within the range of healthy human diversity. Not all problems presented by living are pathological, so a line or threshold has to be drawn somewhere. This definitional work is complex, messy, and evolving in all of medicine, but the challenge in psychiatry can be especially immense. The history of psychiatric diagnostic systems is riddled with unfortunate social biases (including racist, sexist, heterosexist, cissexist, classist, and others). With any of these attempts, emotional states, desires, ways of thinking and processing, and patterns of behavior are identified that presumably would benefit from some sort of medical intervention. The stakes for psychiatric diagnosis are significant: patient complaints can be taken seriously by healthcare professionals and insurance providers only if they have a diagnostic label attached to their concerns, but the label of mental illness also frequently heaps on stigma, discrimination, and distrust.
Chronic Health Conditions and Mental Well-Being in Children and Young People
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
The most common psychiatric diagnosis made is that of an adjustment disorder, after a physical health diagnosis is made (Mitchell et al., 2011). An adjustment disorder is defined as emotional symptoms and/or behaviour that are temporarily linked to a life event and that subsequently resolve, within six months of the life event. This is without the presence of other diagnosable mental health conditions, such as major depressive disorder.
Neurology
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
Tumours can grow from the brain (from non-neuronal supporting cells called glia) and can vary from the indolent and non-aggressive to those that are highly malignant and rapidly fatal. Of more concern in medico-legal circles are the tumours of the dura—meningiomas, slow-growing benign tumours developing from the dura mater—which cause damage by slowly squeezing brain tissue. These can present with subtle intellectual and behavioural decline that may be easily attributed to ‘ageing’, and which is potentially reversible with the early removal of the tumour. The larger the tumour the more difficult they are to remove. Clinical failures to recognize the presence of such tumours are well recorded, and the poor clinical results of late surgery have resulted in successful litigation. The failures of diagnosis frequently involve a failure to listen to the patient and to take a detailed history. In such cases a psychiatric diagnosis has been proffered by the GP, general physician, or even neurologist, before the physical aspects of the patient’s condition become obvious.
Childhood adversity, symptoms, and cortisol in first episode psychosis: a cross-sectional, secondary, observational analysis of a subsample of FEP patients
Published in Nordic Journal of Psychiatry, 2023
Giovanni Mansueto, Sarah Tosato, Natascia Brondino, Chiara Bonetto, Simona Tomassi, Pierluigi Politi, Antonio Lasalvia, Giulia Fioravanti, Silvia Casale, Katia De Santi, Mariaelena Bertani, Marcella Bellani, Paolo Brambilla, Mirella Ruggeri, Carlo Faravelli
This research was run within the framework of the GET UP research project [27,28] (Supplementary Material S1). Participation in this trial included 126 Italian community mental health centres (CMHCs), among which, 117 (92.8%, covering 9,304,093 inhabitants) participated. Detailed information on the study design was reported elsewhere [27,28]. The inclusion criteria were: (a) age 18–54 years; (b) residence within the catchment areas of CMHCs; (c) occurrence of at least one of these symptoms: hallucinations, delusions, qualitative speech disorder, qualitative psychomotor disorder or bizarre or grossly inappropriate behaviour; or two of the following symptoms: loss of excitement, initiative and drive; social withdrawal; episodic severe excitement; purposeless destructiveness; overwhelming fear or marked self-neglect; (d) first lifetime contact with CMHCs, due to these symptoms. Given that FEP is a phase characterized by great diagnostic instability, the specific ICD-10 codes for psychosis (F1x.4; F1x.5; F1x.7; F20–29; F30.2; F31.2; F31.5; F31.6; F32.3; F33.3) were allocated at the 9-month follow-up. ICD-10 diagnosis was defined by consensus of a panel of clinicians [27,28] (Supplementary Material S1). Exclusion criteria were: (a) antipsychotic medication (used for more than three months); (b) psychiatry disorder associated to a general medical condition; (c) moderate and/ore severe mental retardation; (d) psychiatric diagnosis other than ICD-10 for psychosis; (e) medical conditions that alter HPA functioning; and (f) medications that alter HPA functioning. All eligible patients provide written informed consent.
Non-Suicidal Self-Injury in Russian Patients with Suicidal Ideation
Published in Archives of Suicide Research, 2022
Mikhail Zinchuk, Massimiliano Beghi, Ettore Beghi, Elisa Bianchi, Alla Avedisova, Alexander Yakovlev, Alla Guekht
A patient was included in the study if he/she gave an affirmative answer to the question: “Have you ever had thoughts of killing yourself?” We excluded all the patients who were later diagnosed with a psychotic disorder (included in the DSM-5 spectrum of schizophrenia and related disorders or in the category F2x, except F21.8 [Schizotypal personality disorder] in the Russian variant of ICD-10, chapter V). After releasing a written informed consent, eligible patients underwent a structured interview for the collection of demographic and clinical data. A detailed ad-hoc questionnaire (see the Appendix) was used. It included family history of psychiatric disorders, previous traumatic events (physical and sexual abuse, domestic violence witnessing, bullying), behavioral features (sexual orientation and experiences, body modifications, substance (ab)use, self-injurious behaviors (suicide plans, suicide gestures, history of suicidal attempts, age at onset of SI, history of NSSI), history of psychiatric disorders, and hospital admissions. Family history was investigated in the antecedents and siblings, but not in the descendants. A detailed psychiatric diagnosis was made by using the ICD-10 codes. NSSI was diagnosed according to the criteria listed in Section III of DSM-5. All the interviews were made by the two authors (MZ and AA).
Analysis of global prevalence of mental and substance use disorders within countries: focus on sociodemographic characteristics and income levels
Published in International Review of Psychiatry, 2022
João Mauricio Castaldelli-Maia, Dinesh Bhugra
The higher prevalence of mental disorders in the Americas (and Europe) may be explained as following: first, the international diagnostic manuals available in 2019 (DSM-5 and ICD-10) originated from these two continents, largely influenced by local schools of psychiatry (Scull, 2021) – psychiatrists from other cultures (e.g., China) pointed out that these manuals may have a good cross-cultural applicability but do not apply to all disorders (Zou et al., 2008); second, local culture and treatment-seeking behaviours may play an important role in such discrepancies (Faiad et al., 2018); third, the psychometric validity of instruments for diagnostic assessment of these manuals (SCID- The Structured Clinical Interview- and CIDI- Composite International Diagnostic Interview) is also weak in some areas (Quintana et al., 2007), which may generate systematic differences in the prevalence of diagnoses generated in the surveys that supply the global databases - anthropological equivalence, conceptual equivalence, and language are traditional issues in translating diagnostic manuals for mental disorders (Krause, 1990) and, although they may have been overcome in many studies, it is likely that some local concepts may have led to exaggeration or lower diagnosis of certain disorders. An excellent example of culturally-informed diagnosis using ICD-10 is the Revised Version of the Latin American Guide of Psychiatric Diagnosis (GLADP-VR), which has emerged as a new diagnostic tool (Mezzich et al., 2014). This tool employs culturally informed ICD-10 categories and disease description codes with a focus on total well-being.