The Nosology of Schizophrenia: Toward DSM-5 and ICD-11

Although dementia praecox or schizophrenia has been considered a unique disease entity for more than a century, definitions and boundaries have changed and its precise cause and pathophysiology remain elusive. Despite uncertain validity, the construct of schizophrenia conveys useful clinical and etiopathophysiologic information. Revisions of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases seek to incorporate new information about schizophrenia and include elimination of subtypes, addition of psychopathological dimensions, elimination of special treatment of Schneiderian "first-rank" symptoms, better delineation of schizoaffective disorder, and addition of a new category of "attenuated psychosis syndrome".     

Defining Psychosis: The Evolution of DSM-5 Schizophrenia Spectrum Disorders

Bereavement is a common experience in adults aged 60 and older. Loss of a loved one usually leads to acute grief characterized by yearning and longing, decreased interest in ongoing activities, and frequent thoughts of the deceased. For most, acute grief naturally evolves into a state of integrated grief, where the bereaved is able to reengage with everyday activities and find interest or pleasure. About 7 % of bereaved older adults, however, will develop the mental health condition of Complicated Grief (CG). In CG, the movement from acute to integrated grief is derailed, and grief symptoms remain severe and impairing. This article reviews recent publications on the diagnosis of CG, risk factors for the condition and evidenced-based treatments for CG. Greater attention to CG detection and treatment in older adults is needed.     

What the DSM-5 Portends for Research, Diagnosis, and Treatment of Autism Spectrum Disorders

In May 2013 the APA will release DSM-5, which will restructure the diagnostic classification for autism spectrum disorders (ASDs) into a single category. The proposed changes in DSM-5 aim to better reflect the current state of research by consistently identifying the core features in social/communication and restrictive and repetitive behaviors that are specific to ASDs. This review describes the empirical and theoretical bases of research in the nosology of ASDs, given the impending shift in DSM-5 diagnostic criteria. General issues in diagnosis and prevalence are described, with differences between DSM-IV and DSM-5 highlighted. To address concerns about the application of the proposed DSM-5 criteria, the current literature assessing the sensitivity and specificity of the proposed DSM-5 criteria is reviewed. Last, we discuss the implications of the changes in DSM-5 for the treatment of ASDs and recommend areas for future research.     

Impact of DSM-5 on epidemiology of Autism Spectrum Disorder

This paper extensively and comprehensively reviews the literature on epidemiology of autism focusing on the prevalence rates of Autistic Disorder (AD) and Autism Spectrum Disorder (ASD), and the potential negative impact of DSM-5 ASD on future ASD prevalence studies. Between 1966 and 2013, there are 72 published prevalence studies of AD and 61 published studies of ASD. The AD has a broad range of prevalence rates and has shown a trend of increasing rates over time. But there are also some evidences showing that the increase seems to have leveled off. The current prevalence of AD is estimated in the range of 10–30 per 10,000 people (i.e., 1 in 1000 to 1 in 333). The ASD also has a wide range of prevalence rates with a median rate of 69.5 per 10,000 people (1 in 144). When the prevalence rates are subdivided into several sub-ranges (e.g., 10–20, 20–40, etc. per 10,000), it is difficult to pick a particular sub-range to represent the prevalence of ASD. The present review notes that several recent studies comparing the utility of DSM-IV/DSM-IV-TR ASD and the DSM-5 ASD have reported that about 9–54% of DSM-IV ASD cases do not qualify for the DSM-5 ASD. Suggestions of research designs for future ASD prevalence studies are offered.     

Perceived Impact of the Disclosure of a Schizophrenia Diagnosis

Stigma against those with schizophrenia has demonstrated deleterious effects. However, less is known about the experience of individuals who disclose this diagnosis and how such disclosures differ by social situations. This study examines diagnosis disclosure in different contexts. A convenience sample of 258 adults with schizophrenia recruited via the internet and e-mail lists completed an online survey. Subjects were more open about their diagnosis with doctors, parents and friends than with employers or police. Those who report very good current mental health or who had fewer types of relationships were more open overall. Although reactions to disclosure varied, many report worse treatment by police and better treatment by parents after disclosure. Many also experienced worse treatment for medical problems after disclosing their schizophrenia diagnosis. These results support targeted anti-stigma interventions. It also suggests that stigma must be understood through individual experience in specific contexts rather than as a unitary experience.     

Anxiety and DSM-5

The DSM-5 process, and the publication of DSM-5 in 2013, have had a considerable impact on the classification of anxiety disorders. Major changes included the reorganization of the chapter structure, individual groupings of disorders within each chapter from a life span viewpoint, and the use of specifiers. The DSM-5 chapter on anxiety disorders does not include obsessive-compulsive disorder or post-traumatic stress disorder. The chapter itself now reflects a developmental approach. The text of each disorder has been enhanced with short sections on development and course, risk and prognostic factors, etc. It is expected that the reformulation of anxiety disorders in DSM-5 will lead to greater precision in a variety of ways, as illustrated in the papers in this issue of Dialogues in Clinical Neuroscience. In summary, these changes in the way we classify anxiety disorders reflect our best view on the clinical empirical data and should prove useful in the assessment of specific anxiety disorders.     

急性精神分裂症中枢5-HT功能状态的研究

目的：探讨急性精神分裂症中枢5-HT的功能状态，并了解与临床症状间的关系。方法：通过帕罗西汀激发实验，以催乳素（PRL）作为应答指标；精神症状采用阳性和阴性综合征量表（PANSS）进行评定。结果：（1）急性组PRL基础水平符合正态分布，且明显低于慢性对照组，与健康对照组比较无显差异。（2）急性组激发后的PRL含量虽有增高趋势，但缺乏显意义；与慢性和健康两个对照组比较，均有显差异。（3）急性组PRL水平、AUC（曲线下面积）以及激发反应值与PANSS多介无明显相关关系。结论：与慢性精神分裂症相比，急性精神分裂症中枢5-HT的功能可能更加亢进；但与精神症状之间尚缺乏明显的相关关系。     

The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond

In this paper we review the impact of DSM-III and its successors on the field of autism—both in terms of clinical work and research. We summarize the events leading up to the inclusion of autism as a “new” official diagnostic category in DSM-III, the subsequent revisions of the DSM, and the impact of the official recognition of autism on research. We discuss the uses of categorical vs. dimensional approaches and the continuing tensions around broad vs. narrow views of autism. We also note some areas of current controversy and directions for the future.

     

Impact of Antipsychotic Treatment on Attention and Motor Learning Systems in First-Episode Schizophrenia

Background: Antipsychotic medications have established clinical benefit, but there are few neuroimaging studies before and after initiating antipsychotic medication to assess drug influence on brain circuitry. Attention and motor learning tasks are promising approaches for examining treatment-related changes in frontostriatal systems. Methods: Twenty-one unmedicated first-episode schizophrenia patients (14 antipsychotic-naïve) participated in functional imaging studies while performing visual attention (prosaccades) and motor learning tasks (predictive saccades). Posttreatment testing was completed in 14 patients after 4–6 weeks of antipsychotic treatment. Matched healthy controls were studied in parallel. Results: Pretreatment, patients had reduced activation in the dorsal neocortical visual attention network. Activation deficits were significantly reduced posttreatment. Higher medication dose was associated with greater caudate activation at follow-up. For the motor learning task, patients’ dorsolateral prefrontal cortex (DLPFC) was unimpaired prior to treatment but showed significantly reduced activation after treatment. Conclusion: Impairments in dorsal cortical attention networks are present in untreated first-episode schizophrenia patients. These impairments are reduced after antipsychotic treatment, suggesting a beneficial effect on neural systems for attention. Treatment-emergent decreases in DLPFC activation observed for the motor learning task are consistent with other clinical and preclinical evidence suggesting that antipsychotics can have adverse effects on prefrontal function.Key words: fMRI, cognition, dorsolateral prefrontal cortex, saccades, caudate, risperidone     

A Comparison of DSM-IV-TR and DSM-5 Diagnostic Classifications in the Clinical Diagnosis of Autistic Spectrum Disorder

Aim of this study was to compare children diagnosed with Pervasive Developmental Disorder (PDD) according to DSM-IV-TR and DSM-5 diagnostic systems. One hundred fifty children aged between 3 and 15 years diagnosed with PDD by DSM-IV-TR were included. PDD symptoms were reviewed through psychiatric assessment based on DSM-IV-TR and DSM-5 criteria. Clinical severity was determined using Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC). A statistically significant decrease (19.3?%) was detected in the diagnostic ratio with DSM-5. Age and symptom severity differed significantly between those who were and were not diagnosed with PDD using DSM-5. B4 criteria in DSM-5 was most common criterion. Results indicate that individuals diagnosed with PDD by DSM-IV-TR criteria may not be diagnosed using DSM-5 criteria.     

DSM-5 Trichotillomania: Perception of Adults With Trichotillomania After Psychosocial Treatment

Objective: Trichotillomania (TTM) is associated with significant embarrassment and is viewed negatively by others. A potentially important outcome variable that is often overlooked in treatment for TTM is appearance and social perception. Method: The present study tested whether participants in a randomized controlled trial (RCT) of psychotherapy for TTM are viewed more positively by others. All participants in the trial were photographed at baseline and posttreatment. Three treatment responders and three treatment nonresponders were selected randomly for the present study. Several healthy controls were also photographed in a similar manner. Undergraduate college students (N = 245) assessed whether they would reject the person socially, whether the individual has a psychological or medical problem, and attractiveness. Results: Individuals with TTM were viewed more negatively than healthy controls at baseline, but treatment responders showed positive improvements on all perceptions relative to nonresponders. While treatment responders were still perceived more poorly than controls on social rejection and perceptions of problems at posttreatment, responders where rated no differently than controls on attractiveness at posttreatment. Conclusions: The results suggest that persons with TTM who respond to treatment are rated by others as significantly improved in appearance, but they might be still stigmatized or socially rejected.     

急性共济失调的诊断和治疗

共济失调是一类病死率和致残率较高的疾病。众所周知,急性共济失调在几小时至几天发病,正确的诊断和紧急治疗可挽救患者生命。文中综述了急性共济失调的病因、临床表现、诊断以及治疗。