Hysterical psychosis: an empirical approach

Criteria for hysterical psychosis set forth by Hollender and Hirsch were systematically applied to a representative sample of 217 patients hospitalized for the first time in their lives for functional psychiatric illness. Surprisingly, no patients who met all of these criteria were found.     

Thinking the unthinkable: an approach to psychosis

The author approaches to the psychotic disorders in different stages. Firstly the previous difficulties are outlined. Secondly, a mental model is proposed. Thirdly the mental pathology is described as well as a framework for the understanding of the psychotic functioning. Finally some conclusions are presented.     

Posttraumatic stress disorder: an evidence-based approach

The interventions used in the clinical management of posttraumatic stress disorder (PTSD) focus on: 1. Prevention of the development of the disorder, after a traumatic event 2. Treatment of the disorder, once it is already established, 3. Maintenance of long term functioning and quality of life. A variety of psychotherapies and pharmacological treatments have been proposed as therapeutic options in the treatment of PTSD. However, many of these treatment modalities lack scientific background. In this article authors present the treatment modalities of PTSD which are supported by scientific evidence and discuss its applications and drawbacks.     

DSM categories and dimensions in clinical and research contexts

An enhancement to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) is currently under consideration, one that would enhance both the reliability and validity of the Diagnostic and Statistical Manual (DSM) diagnoses: the addition of a dimensional adjunct to each of the traditional categorical diagnoses of the DSM. We first review the history and context of this proposal and define the concepts on which this dimensional proposal is based. The advantages of dimensional measures over categorical measures have long been known, but we here illustrate what is known with a theoretical and a practical demonstration of the potential effects of this addition. Possible objections to the proposal are discussed, concluding with some general criteria for implementing this proposal.     

Medical and legal problems in psychiatric coding under the DSM and ICD systems

The various diagnostic systems in psychiatry have differed in their terminology and associated numerical codes. Lack of attention to coding variations in the DSM and ICD systems during the review of patient records can lead to misinterpretation and confusion; reliance on historical or statistical studies that use differing systems may be questionable. Two cases illustrate the problems caused by lack of awareness of these factors. Specification by the psychiatrist of both the diagnostic system used and the appropriate revision or edition can lessen communication error or misunderstanding.     

Combining medication and psychosocial treatments: an evidence-based medicine approach

In a perfectly evidence-based world, selecting an appropriate treatment regimen for the anxious child from among the many possible options would be reasonably straightforward. In the complex world of clinical practice, choices are rarely so clear-cut. Many experts recommend the combination of medication and psychosocial treatment as offering the best chance of normalization. Despite a lack of supporting evidence, valid reasons for combining treatment include the presence of comorbidity and the propensity of single treatments to yield partial response. Within the conceptual framework of evidence-based medicine (EBM), this article provides a conceptual framework for how to combine drug and psychosocial treatments at the level of the individual patient.     

Queer diagnoses revisited: The past and future of homosexuality and gender diagnoses in DSM and ICD

The American Psychiatric Association (APA) recently completed a several year process of revising the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). During that time, there were objections raised to retaining DSM's gender identity disorder diagnoses and calls to remove them, just as homosexuality had been removed from DSM-II in 1973. At the conclusion of the DSM-5 revision process, the gender diagnoses were retained, albeit in altered form and bearing the new name of ‘gender dysphoria’. The author of this paper was a member of the DSM-5 Workgroup on Sexual and Gender Identity Disorders and presently serves on the WHO Working Group on Sexual Disorders and Sexual Health. Both groups faced similar tasks: reconciling patients’ needs for access to care with the stigma of being given a psychiatric diagnosis. The differing nature of the two diagnostic manuals led to two different outcomes. As background, this paper updates the history of homosexuality and the gender diagnoses in the DSM and in the International Statistical Classification of Diseases and Related Health Problems (ICD) as well as what is expected to happen to the homosexuality and gender diagnoses following the current ICD-11 revision process.     

A tiered model of psychogeriatric service delivery: an evidence-based approach

BACKGROUND: Previous models of mental health care for older persons have not considered the full spectrum of mental disorders. AIM: To describe a tiered model for comprehensive evidence-based planning of service delivery for mental disorders in late life. METHOD: The model depicts tiers of mental disorders in ascending order of severity and consequent interventions required. RESULTS: Interventions aim both to avert individuals from moving up tiers (prevention) and to move individuals down tiers (treatment). Individuals in the lower tiers have no mental disorders and prevention strategies are targeted at known risk factors. In the middle tiers, individuals with mild-moderate mental disorders will mainly be treated in primary care, often in collaboration with specialist mental health services for older people. Individuals in the top tiers with severe mental disorders usually require institutional care. CONCLUSION: The tiered model provides a basis for planning comprehensive service delivery.     

DSM III-R and ICD 10 Classifications of Alcohol Use disorders and Associated Disabilities: a structural analysis

A structural framework is developed for the purposes of evaluating and comparing the DSM III-R and ICD 10 classifications of alcohol abuse, harmful use, and alcohol dependence (syndrome). The analysis describes the origin of the diagnostic categories and presents a content analysis of the disorders in terms of their conceptual status and diagnostic criteria. The structural architecture of the alcohol use disorder categories and their positions within the larger classification systems are analysed with a view towards explicating their clinical and research implications. Two agendas for future work on the classification of alcohol abuse and dependence within larger diagnostic systems are outlined. One is directly based on the results of the structural analysis. The other explores the prospects for an all-embracing integrated psychiatric nomenclature and statistical classification.     

Classification for clinical practice: how to make ICD and DSM better able to serve clinicians

With DSM-V and ICD-11 on the horizon, now is an excellent time to consider options for improving their utility in clinical practice. A prerequisite for determining what can be done to improve their clinical utility is to establish a baseline from which to work. Surprisingly, there is virtually no information available that illuminates how clinicians actually use the DSM-IV and ICD-10 in clinical practice settings. Our first recommendation is for studies to be conducted that examine how the DSM-IV and ICD-10 is being used in the field and then to identify areas in need of improvement. We then propose two new diagnostic approaches to be considered that might significantly improve the system's clinical utility: (1) the addition of clinically useful dimensions (i.e., dimensions for indicating disorder severity, dimensions that cut across various disorders that would quantify symptoms of particular treatment-relevance such as psychosis, and dimensions to measure functioning) and (2) the augmentation of the DSM and ICD operationalized diagnostic criteria with the addition of a prototype-matching system that is likely to more closely conform to the way clinicians think about psychiatric diagnoses.     

Classification for clinical practice: How to make ICD and DSM better able to serve clinicians

With DSM-V and ICD-11 on the horizon, now is an excellent time to consider options for improving their utility in clinical practice. A prerequisite for determining what can be done to improve their clinical utility is to establish a baseline from which to work. Surprisingly, there is virtually no information available that illuminates how clinicians actually use the DSM-IV and ICD-10 in clinical practice settings. Our first recommendation is for studies to be conducted that examine how the DSM-IV and ICD-10 is being used in the field and then to identify areas in need of improvement. We then propose two new diagnostic approaches to be considered that might significantly improve the system's clinical utility: (1) the addition of clinically useful dimensions (i.e., dimensions for indicating disorder severity, dimensions that cut across various disorders that would quantify symptoms of particular treatment-relevance such as psychosis, and dimensions to measure functioning) and (2) the augmentation of the DSM and ICD operationalized diagnostic criteria with the addition of a prototype-matching system that is likely to more closely conform to the way clinicians think about psychiatric diagnoses.     

Cross-cultural and comparative epidemiology of insomnia: the Diagnostic and Statistical Manual (DSM), International Classification of Diseases (ICD) and International Classification of Sleep Disorders (ICSD)

ObjectiveTo compare the prevalence of insomnia according to symptoms, quantitative criteria, and Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th Edition (DSM-IV and DSM-5), International Classification of Diseases, 10th Revision (ICD-10), and International Classification of Sleep Disorders, 2nd Edition (ICSD-2), and to compare the prevalence of insomnia disorder between Hong Kong and the United States by adopting a similar methodology used by the America Insomnia Survey (AIS).MethodsPopulation-based epidemiological survey respondents (n = 2011) completed the Brief Insomnia Questionnaire (BIQ), a validated scale generating DSM-IV, DSM-5, ICD-10, and ICSD-2 insomnia disorder.ResultsThe weighted prevalence of difficulty falling asleep, difficulty staying asleep, waking up too early, and non-restorative sleep that occurred ≥3 days per week was 14.0%, 28.3%, 32.1%, and 39.9%, respectively. When quantitative criteria were included, the prevalence dropped the most from 39.9% to 8.4% for non-restorative sleep, and the least from 14.0% to 12.9% for difficulty falling asleep. The weighted prevalence of DSM-IV, ICD-10, ICSD-2, and any of the three insomnia disorders was 22.1%, 4.7%, 15.1%, and 22.1%, respectively; for DSM-5 insomnia disorder, it was 10.8%.ConclusionCompared with 22.1%, 3.9%, and 14.7% for DSM-IV, ICD-10, and ICSD-2 in the AIS, cross-cultural difference in the prevalence of insomnia disorder is less than what is expected. The prevalence is reduced by half from DSM-IV to DSM-5. ICD-10 insomnia disorder has the lowest prevalence, perhaps because excessive concern and preoccupation, one of its diagnostic criteria, is not always present in people with insomnia.